Risk stratification and goal of systemic therapy for successful surgical management of colorectal liver metastases: Oncological optimization

Shindoh, Junichi

doi:10.1002/jhbp.964

Cited by 4 publications

(5 citation statements)

References 31 publications

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“…Liver metastasis is no longer a contraindication of surgery for colorectal cancer [3]. Resection of a limited number of liver metastases is reported as beneficial for improving the prognosis of patients with CRC [28]. In our study, although liver metastasis was generally observed to occur in the CRC lesions without mucus or SRCC, which always had intense 18 F-FDG uptake, some small liver metastases were missed by 18 F-FDG PET/CT, similar to the report by Maffione AM [29].…”

Section: Discussionmentioning

confidence: 99%

PET/CT imaging fibroblast activation protein in initial colorectal cancer: compared to 18F-FDG PET/CT

Dong,

Sun,

et al. 2023

Nuclear Medicine Communications

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Objective In this study, the potential advantage of FAPI over 18F-labelled deoxyglucose (18F-FDG) in evaluation of the initial staging colorectal cancer (CRC) was investigated. Materials and methods Thirty-two patients with histopathologically confirmed primary CRC were included in our study. They all underwent both 18F-FDG and FAPI PET/CT. Lesion detectability and tracer uptakes, mainly quantified by maximum standardized uptake value (SUVmax) and target-to-background ratio (TBR), were compared for paired lesions between both modalities using the Wilcoxon signed-rank test and paired t-test. Results Thirty-five CRC lesions in 32 patients were diagnosed. The sensitivity of FAPI PET/CT in diagnosis of the CRC lesions was 100% while 93.8% of 18F-FDG PET/CT. FAPI and 18F-FDG had a similar uptake in CRC lesion (mean SUVmax: 14.3 ± 8.6 vs. 15.4 ± 9.8, P = 0.604), but lesions contained mucus and/or signet-ring cell carcinoma seemed to have a trend of higher FAPI uptake although there was no statistical difference (mean SUVmax: 12.7 ± 5.6 vs. 8.5 ± 4.1, P = 0.152) and higher TBR (13.4 ± 6.2 vs. 4.9 ± 2.2, P = 0.004) than those of 18F-FDG. For regional lymph node metastases, both FAPI and FDG PET/CTs showed high sensitivity (7/8 vs. 7/8), specificity (7/8 vs. 6/8) and accuracy (14/16 vs. 13/16) (all P > 0.05). For distant metastasis, FAPI PET/CT depicted more positive lesions in distant lymph node (46 vs. 26), liver (13 vs. 7) and peritoneum (107 vs. 45) than 18F-FDG PET/CT. FAPI PET/CT also had a higher peritoneal cancer index score (median 11 vs 4; P < 0.001) than 18F-FDG PET/CT in evaluation of peritoneal metastases. Conclusion FAPI PET/CT showed high sensitivity in detection of primary CRC and superiority to 18F-FDG PET/CT in detection of metastases to distant lymph node, liver and peritoneum.

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Section: Discussionmentioning

confidence: 99%

PET/CT imaging fibroblast activation protein in initial colorectal cancer: compared to 18F-FDG PET/CT

Dong,

Sun,

et al. 2023

Nuclear Medicine Communications

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“…The prognostic relevance of LDT for LM from certain malignancies, such as colorectal cancer, has already been established [ 7 - 9 ]. In such tumors, LDT can achieve good local disease control, and even a cure in some cases.…”

Section: Discussionmentioning

confidence: 99%

“…Systemic chemotherapy is generally considered to be the standard treatment for hepatic recurrence following EC resection, but its prognostic relevance is limited, with a reported median post-recurrence survival of only 7 months [ 6 ]. For other malignancies (e.g., colorectal carcinoma), liver-directed therapy (LDT), which includes surgical resection, irradiation and radiofrequency ablation (RFA), is regarded as being effective, and possibly even a curative strategy for liver recurrence [ 7 - 9 ]. However, the role of liver-focused management for hepatic recurrence of EC remains poorly understood [ 9 ], and thus merits further exploration.…”

Section: Introductionmentioning

confidence: 99%

Implications of Liver-Directed Therapy for Postoperative Hepatic Metastasis from Esophageal Cancer

et al. 2022

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Background: Distant recurrence of esophageal cancer (EC), even after radical resection, is common, and the most frequent site of EC metastasis is the liver. However, a multidisciplinary treatment strategy for postoperative liver metastasis (LM) from EC has yet to be established; in particular, the role of liver-directed therapy (LDT) remains uncertain. We investigated the clinicopathological features and outcomes of patients undergoing post-esophagectomy LM with versus without LDT to explore its therapeutic implications. Methods: Among 624 consecutive patients undergoing R0/R1 esophagectomy for EC, 30 were identified in whom LM had developed as the initial recurrence. Their characteristics were retrospectively reviewed. Results: Six of the 30 subjects underwent LDT for metachronous LM. Five of those 6 also received systemic chemotherapy. A comparison between the 6 LDT and 24 non-LDT cases revealed no significant differences in major clinicopathological and operative factors, except for concurrent metastasis to extrahepatic organs (1/6 vs. 15/24, p=0.044). Twenty-nine of the 30 patients died during the study period, whereas 1 who had received multimodal treatment with LDT remained alive more than 200 months after multiple LM had been detected. Kaplan-Meier analysis for survival after LM demonstrated significantly prolonged survival in LDT cases compared to non-LDT cases treated with systemic chemotherapy alone (p=0.014). Even when the analysis was limited to patients without extrahepatic metastasis, this significant prognostic advantage of LDT was maintained (p=0.047). Conclusion: Multimodal treatment combined with LDT might be beneficial for patients with metachronous LM from EC and should therefore be considered a potential treatment option.

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“…(17,18) Even though various clinical trials serve as evidence to guide our clinical practice, the clinical decision making is actually complex and heavily dependent on the conditional probability based on the reported data and our experiences. (16) As such, a multidisciplinary team approach is important to take the appropriate path, avoiding unnecessary/inefficient ways, for maximizing the survival outcomes of patients with advanced hepatic malignancies.…”

Section: Clinical Decision and Fate Of A Patient With Hepatic Malignancymentioning

confidence: 99%

Multidisciplinary Approach to the Treatment of Advanced Hepatocellular Carcinoma in the Era of New Biologic Agents

Shindoh

2022

J Nippon Med Sch

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With the recent advances in the field of systemic therapy, an increasing number of patients with advanced hepatocellular carcinoma (HCC) are expected to benefit from surgery.However, given the complex background of the disease and frequent presence of underlying liver injury, treatment of advanced HCC is rather complex and the treatment principle applied to colorectal liver metastases, for which conversion surgery has been actively performed, is often not applicable to patients with HCC. To maximize the survival outcomes of patients with HCC, optimization of each step of treatment through a multidisciplinary approach is inevitable. As the initial treatment, systematic removal of the tumor-bearing portal territory is associated with improved survival in patients with solitary HCC, and radiofrequency ablation is also effective for small, oligo HCCs. Although the high incidence of recurrence even after curative-intent treatment is a major issue in HCC, aggressive treatment for recurrence is also important, because a prolonged cancer-free interval is reported to be associated with improved overall survival. For patients with advanced disease, recently introduced molecular-targeted agents may potentially be effective for successful conversion to surgery in initially unresectable cases, although the overall response rate of HCC to systemic therapies remains unsatisfactory as compared to that of colorectal liver metastases. In this report, the theoretical bases for the management of HCC are revisited and the currently used strategies to maximize the survival outcomes in patients with advanced HCC is discussed..

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Risk stratification and goal of systemic therapy for successful surgical management of colorectal liver metastases: Oncological optimization

Cited by 4 publications

References 31 publications

PET/CT imaging fibroblast activation protein in initial colorectal cancer: compared to 18F-FDG PET/CT

PET/CT imaging fibroblast activation protein in initial colorectal cancer: compared to 18F-FDG PET/CT

Implications of Liver-Directed Therapy for Postoperative Hepatic Metastasis from Esophageal Cancer

Multidisciplinary Approach to the Treatment of Advanced Hepatocellular Carcinoma in the Era of New Biologic Agents

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