Modern multimodality approach to hepatic colorectal metastases: Solutions and controversies

Khatri, Vijay P.; Chee, Karen; Petrelli, Nicholas J.

doi:10.1016/j.suronc.2007.05.001

Cited by 73 publications

(35 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…An effective imaging modality for restaging of patients with suspicion of recurrent disease is crucial, as several studies have shown that surgery with curative intention may be possible even in patients with distant colorectal metastases (14,15). This study has shown that cePET/CT as a single-step examination has equal diagnostic confidence and impact compared with a sequential approach with ceCT first and non-cePET/CT afterward.…”

Section: Discussionmentioning

confidence: 73%

Staging Pathways in Recurrent Colorectal Carcinoma: Is Contrast-Enhanced ¹⁸F-FDG PET/CT the Diagnostic Tool of Choice?

Soyka¹,

Veit-Haibach²,

Strobel³

et al. 2008

J Nucl Med

View full text Add to dashboard Cite

18 F-FDG PET/CT has gained wide acceptance for evaluation of recurrent colorectal carcinoma. However in clinical practice, contrast-enhanced CT (ceCT) is still the first-line restaging tool. The aim of this study was to investigate the value of contrastenhanced PET/CT (cePET/CT) as a first-line restaging tool with a special focus on the importance of the use of intravenous contrast. Methods: Fifty-four patients (17 women, 37 men; mean age, 60.3 y), referred for restaging of colorectal carcinoma, were examined with cePET/CT. Retrospective analysis was performed by 2 experienced readers by consensus: first, ceCT alone; second, non-cePET/CT; and third, cePET/CT. The number, localization, and diagnostic certainty of lesions were evaluated. Additionally, the therapeutic impact of the findings was determined. In 29 patients, histology, clinical imaging, and clinical follow-up served as the reference standard. In 25 patients, clinical follow-up and imaging served as the reference standard. Results: Overall, non-cePET/CT delivered correct additional information to the ceCT findings in 27 of 54 patients (50%). This occurred in (a) 20 of 30 patients, where ceCT was found to be inconclusive, and in (b) 7 of 24 patients with conclusive ceCT findings, where non-cePET/CT found additional lesions, leading to a therapy modification in 5 patients. Compared with non-cePET/ CT, cePET/CT revealed additional information in 39 of 54 patients (72%), with therapeutic relevance in 23 patients. This large number was primarily due to correct segmental localization of liver metastases, which is crucial for surgical therapy planning. Conclusion: On the basis of its higher accuracy and therapeutic impact compared with ceCT, our data suggest that cePET/CT might be considered as the first-line diagnostic tool for restaging in patients with colorectal cancer.

show abstract

Section: Discussionmentioning

confidence: 73%

Staging Pathways in Recurrent Colorectal Carcinoma: Is Contrast-Enhanced ¹⁸F-FDG PET/CT the Diagnostic Tool of Choice?

Soyka¹,

Veit-Haibach²,

Strobel³

et al. 2008

J Nucl Med

View full text Add to dashboard Cite

show abstract

“…12 Radioembolization or selective internal radiation therapy with microspheres loaded with the radionuclide yttrium-90 ( 90 Y) enables multiple hepatic metastases to be targeted in a single procedure. 13 The 90 malignant microvasculature, where they deliver high, localized, therapeutic doses of ␤-radiation to tumor over approximately 14 days while maintaining radiation exposure of the normal liver within tolerable levels.…”

Section: Introductionmentioning

confidence: 99%

Phase III Trial Comparing Protracted Intravenous Fluorouracil Infusion Alone or With Yttrium-90 Resin Microspheres Radioembolization for Liver-Limited Metastatic Colorectal Cancer Refractory to Standard Chemotherapy

Hendlisz

Eynde

Peeters

et al. 2010

JCO

367

217

View full text Add to dashboard Cite

[FU] protracted intravenous infusion 300 mg/m(2) days 1 through 14 every 3 weeks) and arm B (radioembolization plus intravenous FU 225 mg/m(2) days 1 through 14 then 300 mg/m(2) days 1 through 14 every 3 weeks) until hepatic progression. The primary end point was time to liver progression (TTLP). Cross-over to radioembolization was permitted after progression in arm A. RESULTS: Forty-six patients were randomly assigned and 44 were eligible for analy... Document type : Article de périodique (Journal article)Référence bibliographique A B S T R A C T PurposeLiver dissemination is a major cause of mortality among patients with advanced colorectal cancer. Hepatic intra-arterial injection of the ␤-emitting isotope yttrium-90 ( 90 Y) bound to resin microspheres (radioembolization) delivers therapeutic radiation doses to liver metastases with minimal damage to adjacent tissues. Patients and MethodsWe conducted a prospective, multicenter, randomized phase III trial in patients with unresectable, chemotherapy-refractory liver-limited metastatic CRC (mCRC) comparing arm A (fluorouracil [FU] protracted intravenous infusion 300 mg/m 2 days 1 through 14 every 3 weeks) and arm B (radioembolization plus intravenous FU 225 mg/m 2 days 1 through 14 then 300 mg/m 2 days 1 through 14 every 3 weeks) until hepatic progression. The primary end point was time to liver progression (TTLP). Cross-over to radioembolization was permitted after progression in arm A. ResultsForty-six patients were randomly assigned and 44 were eligible for analysis (arm A, n ϭ 23; arm B, n ϭ 21). Median follow-up was 24.8 months. Median TTLP was 2.1 and 5.5 months in arms A and B, respectively (hazard ratio [HR] ϭ 0.38; 95% CI, 0.20 to 0.72; P ϭ .003). Median time to tumor progression (TTP) was 2.1 and 4.5 months, respectively (HR ϭ 0.51; 95% CI, 0.28 to 0.94; P ϭ .03). Grade 3 or 4 toxicities were recorded in six patients after FU monotherapy and in one patient after radioembolization plus FU treatment (P ϭ .10). Twenty-five of 44 patients received further treatment after progression, including 10 patients in arm A who received radioembolization. Median overall survival was 7.3 and 10.0 months in arms A and B, respectively (HR ϭ 0.92; 95% CI, 0.47 to 1.78; P ϭ .80). Conclusion Radioembolization with90 Y-resin microspheres plus FU is well tolerated and significantly improves TTLP and TTP compared with FU alone. This procedure is a valid therapeutic option for chemotherapy-refractory liver-limited mCRC.

show abstract

“…Hepatic resection is the treatment of choice for liver cancer if metastases are confined to the liver, and may achieve a 5 years survival of 25%-39% [1][2][3][4] . Resectability is usually determined by the absence of extrahepatic metastases, a maximum of four lesions in the liver and the ability to obtain cancerfree resection margins [5] .Therefore, only 10%-20% of patients with hepatic colorectal metastases are suitable www.wjgnet.com for resection [6] . For non-resectable liver metastases, chemotherapy or chemoembolization are often used, but the outcome is poor.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous cryosurgery for the treatment of hepatic colorectal metastases

Niu²,

He³

et al. 2008

WJG

View full text Add to dashboard Cite

AIM:To determine the safety and efficacy of efficacy of percutaneous cryosurgery for treatment of patients with hepatic colorectal metastases. METHODS:Three hundred and twenty-six patients with non-resectable hepatic colorectal metastases underwent percutaneous cryosurgery under the guidance of ultrasound or CT. Follow-up was 1 mo after cryosurgery and then every 4 mo thereafter by assessment of tumor markers, liver ultrasonography, and abdominal CT. For lesions suspicious of recurrence, a liver biopsy was performed and subsequent repeat cryosurgery was given if histology was positive for cancer. RESULTS:All patients underwent a total of 526 procedures of cryosurgery. There were 151 patients who underwent repeat procedures of cryosurgery for recurrent tumors in the liver and extrahepatic places. At 3 mo after cryosurgery, carcinoembryonic antigen (CEA) levels in 197 (77.5%) patients who had elevated markers before cryosurgery decreased to normal range. Among 280 patients who received CT following-up, cryotreated lesions showed complete response (CR) in 41 patients (14.6%), partial response (PR) in 115 patients (41.1%), stable disease (SD) in 68 patients (24.3%) and progressive disease (PD) in 56 patients (20%). The recurrence rate was 47.2% during a median follow-up of 32 mo (range, 7-61). Sixty one percent of the recurrences were seen in liver only and 13.9% in liver and extrahepatic areas. The recurrence rate at cryotreated site was only 6.4% for all cases. During a median follow-up of 36 mo (7-62 mo), the median survival of all patient was 29 mo (range 3-62 mo). Overall survival was 78%, 62%, 41%, 34% and 23% at 1, 2, 3, 4 and 5 years, respectively, after the treatment. Patients with tumor size less than 3 cm, tumor in right lobe of liver, lower CEA levels (< 100 ng/dL) and postcryosurgery TACE had higher survival rate. There was no significant difference in terms of survival based on the number of tumors, pre-cryosurgery chemotherapy and the timing of the development of metastases (synchronous vs metachronous). Patients who underwent 2-3 procedures of cryosurgery had increased survival compared to patients who received cryosurgery once only. There was no intra-cryosurgery mortality. Main adverse effects, such as hepatic bleeding, cryoshock, biliary fistula, liver failure, renal insufficiency and liver abscess were only observed in 0.3%-1.5% of patients.CONCLUSION:Percutaneous cryosurgery was a safe modality for hepatic colorectal metastases. Rather than an alternative to resection, this technique should be regarded as a complement to hepatectomy and as an additional means of achieving tumor eradication when total excision is not possible.

show abstract

Modern multimodality approach to hepatic colorectal metastases: Solutions and controversies

Cited by 73 publications

References 54 publications

Staging Pathways in Recurrent Colorectal Carcinoma: Is Contrast-Enhanced ¹⁸F-FDG PET/CT the Diagnostic Tool of Choice?

Staging Pathways in Recurrent Colorectal Carcinoma: Is Contrast-Enhanced ¹⁸F-FDG PET/CT the Diagnostic Tool of Choice?

Phase III Trial Comparing Protracted Intravenous Fluorouracil Infusion Alone or With Yttrium-90 Resin Microspheres Radioembolization for Liver-Limited Metastatic Colorectal Cancer Refractory to Standard Chemotherapy

Percutaneous cryosurgery for the treatment of hepatic colorectal metastases

Contact Info

Product

Resources

About

Modern multimodality approach to hepatic colorectal metastases: Solutions and controversies

Cited by 73 publications

References 54 publications

Staging Pathways in Recurrent Colorectal Carcinoma: Is Contrast-Enhanced 18F-FDG PET/CT the Diagnostic Tool of Choice?

Staging Pathways in Recurrent Colorectal Carcinoma: Is Contrast-Enhanced 18F-FDG PET/CT the Diagnostic Tool of Choice?

Phase III Trial Comparing Protracted Intravenous Fluorouracil Infusion Alone or With Yttrium-90 Resin Microspheres Radioembolization for Liver-Limited Metastatic Colorectal Cancer Refractory to Standard Chemotherapy

Percutaneous cryosurgery for the treatment of hepatic colorectal metastases

Contact Info

Product

Resources

About

Staging Pathways in Recurrent Colorectal Carcinoma: Is Contrast-Enhanced ¹⁸F-FDG PET/CT the Diagnostic Tool of Choice?

Staging Pathways in Recurrent Colorectal Carcinoma: Is Contrast-Enhanced ¹⁸F-FDG PET/CT the Diagnostic Tool of Choice?