Solitary Colorectal Liver Metastasis

Aloia, Thomas A.; Vauthey, Jean Nicolas; Loyer, Evelyne M.; Ribero, Dario; Pawlik, Timothy M.; Wei, S.; Curley, Steven A.; Zorzi, Daria; Abdalla, Eddie K.; Nagorney, David M.; Dayton, Merril T.; Schneider, Philip D.; Bilchik, Anton J.; McMasters, Kelly M.; Chapman, William C.

doi:10.1001/archsurg.141.5.460

Cited by 389 publications

(284 citation statements)

References 35 publications

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“…A randomized phase II trial of 119 patients with liver-limited disease demonstrated a significantly longer median PFS interval with than without RFA (p ϭ .025) [104]. However, the survival results with RFA or RFA combined with resection remain inferior to those with resection in patients with solitary or multiple liver metastases [105,106].…”

Section: Initially Unresectable Patientsmentioning

confidence: 99%

The Oncosurgery Approach to Managing Liver Metastases from Colorectal Cancer: A Multidisciplinary International Consensus

et al. 2012

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ABSTRACTpatients receive in different centers. Based on current evidence, the group agreed on a number of issues including the following: (a) the primary aim of treatment is achieving a long disease-free survival (DFS) interval following resection; (b) assessment of resectability should be performed with high-quality cross-sectional imaging, staging the liver with magnetic resonance imaging and/or abdominal computed tomography (CT), depending on local expertise, staging extrahepatic disease with thoracic and pelvic CT, and, in selected cases, fluorodeoxyglucose positron emission tomography with ultrasound (preferably contrastenhanced ultrasound) for intraoperative staging; (c) optimal first-line chemotherapy-doublet or triplet chemotherapy regimens combined with targeted therapy-is advisable in potentially resectable patients; (d) in this situation, at least four courses of first-line chemotherapy should be given, with assessment of tumor response every 2 months; (e) response assessed by the Response Evaluation Criteria in Solid Tumors (conventional chemotherapy) or nonsize-based morphological changes (antiangiogenic agents) is clearly correlated with outcome; no imaging technique is currently able to accurately diagnose complete pathological response but high-quality imaging is crucial for patient management; (f) the duration of chemotherapy should be as short as possible and resection achieved as soon as technically possible in the absence of tumor progression; (g) the number of metastases or patient age should not be an absolute contraindication to surgery combined with chemotherapy; (h) for synchronous metastases, it is not advisable to undertake major hepatic surgery during surgery for removal of the primary CRC; the reverse surgical approach (liver first) produces as good an outcome as the conventional approach in selected cases; (i) for patients with resectable liver metastases from CRC, perioperative chemotherapy may be associated with a modestly better DFS outcome; and (j) whether initially resectable or unresectable, cure or at least a long survival duration is possible after complete resection of the metastases, and MDT treatment is essential for improving clinical and survival outcomes. The group proposed a new system to classify initial unresectability based on technical and oncological contraindications.

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Section: Initially Unresectable Patientsmentioning

confidence: 99%

The Oncosurgery Approach to Managing Liver Metastases from Colorectal Cancer: A Multidisciplinary International Consensus

et al. 2012

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“…Studies have shown long-term survival in patients treated for resection of limited metastatic disease [1][2][3]. Similarly, aggressive treatment to a single site of metastatic disease in the brain has shown improved overall survival (OS) [4,5].…”

Section: Introductionmentioning

confidence: 99%

Differences Between Colon Cancer Primaries and Metastases Utilizing a Molecular Assay for Tumor Radiosensitivity Suggest Implications for Potential Oligometastatic SBRT Patient Selection

Ahmed

Berglund

Shridhar

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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Purpose/Objectives-We have previously developed a multigene expression model of tumor radiosensitivity (RSI) with clinical validation in multiple independent cohorts (breast, rectal, esophageal, and head and neck). The purpose of this study was to assess differences in RSI scores between primary colon cancer and metastases.Methods and Materials-Patients were identified from our institutional IRB approved prospective observational protocol. A total of 704 metastatic and 1,362 primary lesions were obtained from a de-identified meta-data pool. RSI was calculated using the previously published ranked based algorithm. An independent cohort of 29 lung or liver colon metastases treated with 60 Gy in 5 fractions stereotactic body radiotherapy (SBRT) was used for validation.Results-The most common sites of metastases included liver (n=374; 53%), lung (n=116; 17%), and lymph nodes (n=40; 6%). Sixty percent of metastatic tumors compared with 54% of primaries were in the RSI-radioresistant (RSI-RR) peak, suggesting that, metastatic tumors may be slightly more radioresistant than primaries (p=0.01). In contrast, when we analyzed metastases based on anatomical site, we uncovered large differences in RSI. The median RSIs for metastases Corresponding Author: Javier F. Torres-Roca MD, H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, 12902 Magnolia Dr., Tampa, FL 33612 USA, Telephone: 00-1-813-745-3568, Fax: 00-1-813-745-7231, javier.torresroca@moffitt.org. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conflicts of HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript in descending order of radioresistance were ovary (0.48), abdomen (0.47), liver (0.43), brain (0.42), lung (0.32), and lymph nodes (0.31), p<0.0001. These findings were confirmed when the analysis was restricted to lesions from the same patient (n=139). In our independent cohort of treated lung and liver metastases, lung metastases had an improved local control (LC) rate over patients with liver metastases (2 yr LC 100% vs. 73.0%, p=0.026).Conclusions-Assessment of radiosensitivity between primary and metastatic tissues of colon cancer histology, reveals significant differences based on anatomical location of metastases. These initial results warrant validation in a larger clinical cohort.

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“…Five-year survival [177][178][179][180][181][182][183][184][185][186][187][188][189] after hepatic resection in series published since 2000 reporting their experience from 1990 onwards is 23-58%, 10-year survival [185,187] is 17-28%, and the 30-day post-operative mortality ranged from 0% to 6.6% (median 2.8%). Aloia et al [190] recently reported a 5-year survival of 71% and 10-year survival of 60% in a prospective study of 150 patients resected for solitary CRLM. Advances in the use of neoadjuvant chemotherapy allow up to 38% of patients previously considered unresectable to be significantly downstaged and eligible for hepatic resection [191].…”

Section: Outcomes Of Ablation Therapies For Hepatic Metastases Colorementioning

confidence: 98%

“…Interstitial tissue ablation techniques for local tumor treatment have emerged as a viable therapeutic option for patients with limited hepatic malignant disease who are not surgical candidates. When applied to unresectable CRLM, these modalities achieve 5-year survival rates of 26% for cryoablation [184], 14-55% for RFA [190,[194][195][196][197][198][199][200], 31.9% for MWA [158], and 37% for LITT [201].…”

Section: Outcomes Of Ablation Therapies For Hepatic Metastases Colorementioning

confidence: 99%

Liver tumor ablation: Percutaneous and open approaches

Padma

Martinie

Iannitti

2009

Journal of Surgical Oncology

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The global incidence of liver cancer is greater than a million cases a year. Surgical resection where applicable is still the standard of care for these patients. Various liver-directed regional therapies have been developed in an effort to treat the vast majority of unresectable liver tumors. This article reviews the principles behind various ablation therapies currently available for malignant liver tumors and their outcomes.

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Solitary Colorectal Liver Metastasis

Cited by 389 publications

References 35 publications

The Oncosurgery Approach to Managing Liver Metastases from Colorectal Cancer: A Multidisciplinary International Consensus

The Oncosurgery Approach to Managing Liver Metastases from Colorectal Cancer: A Multidisciplinary International Consensus

Differences Between Colon Cancer Primaries and Metastases Utilizing a Molecular Assay for Tumor Radiosensitivity Suggest Implications for Potential Oligometastatic SBRT Patient Selection

Liver tumor ablation: Percutaneous and open approaches

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