Multimodality Treatment of Hepatic Metastases

Link, K. H.; Apell, Volker; Holtappels, Matthias; Zayed, Karim; Sagban, Tolga Atilla; Mörschel, M.; Weigel, Thomas Friedrich; Tischbirek, K.; Josten, K.; Thimm, Ralf; Staib, Ludger

doi:10.1007/3-540-26354-3_26

Cited by 3 publications

(7 citation statements)

References 135 publications

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“…At the time we started our multidisciplinary treatment concept, patients with liver metastases either were resectable according to standard indications[ 8 ] or they received palliative chemotherapy with 5-FU + FA either by systemic or by hepatic arterial infusion (HAI) chemotherapy. Systemic treatment with additional FA was even opposed by some medical oncologists at the Ulm Cancer Center at that time.…”

Section: Metastasesmentioning

confidence: 99%

“…HAI was performed due to the low effectivity of systemic 5-FU or 5-FU + FA, the therapeutic standard at our surgical department at that time in the late 1980s and early 1990s. Response and survival with HAI were twice as good as with systemic treatment[ 8 , 31 ].…”

Section: Metastasesmentioning

confidence: 99%

“…The lethal fate of patients with metastasis, e.g. , to the liver[ 8 , 9 ] or to the peritoneum[ 10 , 11 ] has been stepwise diminished, but not abolished. In the late 1980’s surgery was the only treatment of choice for patients with primary colon- and rectal tumors in Germany.…”

Section: Introductionmentioning

confidence: 99%

“…The local relapse rate for rectal cancer patients exceeded 30% at our hospital in a long-term review, despite them being originally operated on in curative attempt[ 16 ]. Only the minority of the patients with liver metastases were resected for cure[ 8 ], and patients with peritoneal carcinosis received palliative therapy only with 5-fluorouracil (5-FU) or 5-FU + folinic acid (FA) at median survival times below 15 mo[ 10 , 11 ]. Early detection of high-risk colon adenomas or early stage curable cancers by screening colonoscopy was not yet the standard to improve incidences and overall survival (OAS) rates of colon and rectal cancers.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Patient-centered developments in colon- and rectal cancer with a multidisciplinary international team: From translational research to national guidelines

Link¹,

Kornmann²,

Staib³

et al. 2021

WJGS

Self Cite

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Rarely, scientific developments centered around the patient as a whole are published. Our multidisciplinary group, headed by gastrointestinal surgeons, applied this research philosophy considering the most important aspects of the diseases “colon- and rectal cancer” in the long-term developments. Good expert cooperation/knowledge at the Comprehensive Cancer Center Ulm (CCCU) were applied in several phase III trials for multimodal treatments of primary tumors (MMT) and metastatic diseases (involving nearly 2000 patients and 64 centers), for treatment individualization of MMT and of metastatic disease, for psycho-oncology/quality of life involving the patients’ wishes, and for disease prevention. Most of the targets initially were heavily rejected/discussed in the scientific communities, but now have become standards in treatments and national guidelines or are topics in modern translational research protocols involving molecular biology for e.g. , “patient centered individualized treatment”. In this context we also describe the paths we had to tread in order to realize our new goals, which at the end were highly beneficial for the patients from many points of view. This description is also important for students and young researchers who, with an actual view on our recent developments, might want to know how medical progress was achieved.

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Section: Metastasesmentioning

confidence: 99%

Section: Metastasesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Patient-centered developments in colon- and rectal cancer with a multidisciplinary international team: From translational research to national guidelines

Link¹,

Kornmann²,

Staib³

et al. 2021

WJGS

Self Cite

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“…Studien zur adjuvanten regionalen oder sytemischen Chemotherapie nach Resektion von Lebermetastasen kolorektalen Ursprungs haben bisher widersprüchliche Resultate erbracht [6]. Bisher konnten auch neueste Phase-III-Studien zur adjuvanten Therapie nach Metastasenresektion keine signifikante Erhöhung der 5-Jahres-Überlebensraten nachweisen, so dass dieser Behandlungsansatz, obwohl oft praktiziert, nicht in den aktuellen S3-Leitlinien empfohlen wird.…”

Section: Adjuvante Therapie Nach Metastasenresektion?unclassified

Radikale Chirurgie bei primär metastasierten kolorektalen Karzinomen

Weber¹,

Link²

2007

Visc Med

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Bei primär metastasierten Kolon- bzw. Rektumkarzinomen im Stadium UICC IV muss zunächst entschieden werden, ob der Primärtumor und die vorliegenden Lebermetastasen potentiell kurativ reseziert werden können oder ob es sich beim Primärtumor bzw. den Metastasen oder auch beiden um eine zunächst lokal inkurable Situation handelt. Im Falle einer möglichen Kuration sollte immer die onkologisch radikale Operation von Primärtumor und Lebermetastase durchgeführt werden. Dies betrifft auch die En-bloc-Resektion von lokal fortgeschrittenen T4-Karzinomen. Die Entscheidung, ob der Primärtumor und die Lebermetastase(n) simultan oder in zeitlich getrennten Operationen reseziert werden, kann individuell erfolgen. Zeigt sich eine primär nichtresektable Lebermetastasierung, so kann versucht werden, eine Resektabilität mit Hilfe einer «neoadjuvanten» Chemotherapie zu erreichen, um dann sekundär die Leberresektion anzustreben. Ebenso kann bei primär nichtresektablen Primärtumoren des Kolons oder Rektums mit resektablen (simultanen) Lebermetastasen zunächst eine neoadjuvante Chemotherapie (Kolon) bzw. Radiochemotherapie plus Chemotherapie (Rektum) des Primärtumors durchgeführt werden. Ziel ist immer die kurative Resektion, da nur hiermit ein Langzeitüberleben für ein selektioniertes Patientengut erreicht wird. In einer rein palliativen Situation kann bei asymptomatischen Patienten auf eine radikale Resektion des Primärtumors verzichtet werden. Werden die Patienten symptomatisch, so kann sekundär bei Blutung eine palliative Tumorresektion, oder bei Ileus infolge eines stenosierenden Rektum- bzw. Sigmakarzinoms die Anlage eines Stomas oder auch die endoskopische Stent-Einlage vorgenommen werden.

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Peritonealkarzinose kolorektalen Ursprungs

Weber

Link

2012

Chirurg

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Until recently peritoneal carcinomatosis (PC) arising from colorectal cancer (CRC) was considered to be a terminal disease manifestation. Despite palliative systemic chemotherapy (CHT) the majority of patients died within a few months. Nowadays cytoreductive surgery (CRS) of the peritoneal cavity in combination with hyperthermic intraperitoneal CHT and perioperative systemic CHT may offer a chance for long-term survival in selected groups of patients. In this study we report the results obtained with this treatment strategy in 30 consecutive patients. Data were assessed prospectively. After a median follow-up of 16.9 months the median survival time in all 30 patients reached 24.3 months. Favorable prognostic factors are a low extent of intraperitoneal metastases as characterized by a low peritoneal cancer index (median survival PCI ≤ 10: 33.2 months vs. PCI 11-19: 12.1 months) and a complete or nearly complete CRS (median survival CCR 0/1: 33.1 months vs. CCR2/3: 12.1 months). The 2-year overall survival was 89% for patients with a PCI ≤ 10 and 65% for those with surgical CCR 0/1 cytoreduction. As not every patient with CRC and PC may profit from this relatively aggressive therapy an interdisciplinary patient selection (tumor board) and treatment in experienced surgical oncology centers is recommended.

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Multimodality Treatment of Hepatic Metastases

Cited by 3 publications

References 135 publications

Patient-centered developments in colon- and rectal cancer with a multidisciplinary international team: From translational research to national guidelines

Patient-centered developments in colon- and rectal cancer with a multidisciplinary international team: From translational research to national guidelines

Radikale Chirurgie bei primär metastasierten kolorektalen Karzinomen

Peritonealkarzinose kolorektalen Ursprungs

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