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Bale R, Richter M, Dünser M, Levy E, Buchberger W, Schullian P. Stereotactic Radiofrequency Ablation for Breast Cancer Liver Metastases. J Vasc Interv Radiol 2017; 29:262-267. [PMID: 29273283 DOI: 10.1016/j.jvir.2017.09.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 09/29/2017] [Accepted: 09/30/2017] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To evaluate outcomes in patients with liver metastases from breast cancer treated with stereotactic radiofrequency (RF) ablation. MATERIALS AND METHODS A retrospective analysis of 29 stereotactic RF ablation treatment sessions in 26 consecutive patients with 64 biopsy-proven breast cancer liver metastases (BCLMs) was conducted. Patients were included only if systemic treatment failed and all visible BCLMs were treatable. RESULTS Primary and secondary technical success rates were 96.9% (62 of 64) and 100%, respectively. There were no perioperative mortalities. Local recurrence was identified in 5 tumors (7.8%), with no significant differences among tumor sizes (P = .662): < 3 cm (9.3%), 3-5 cm (0%), and > 5 cm (8.3%). Median estimated overall survival (OS) from first stereotactic ablation treatment was 29.3 months ± 8.9 (95% confidence interval [CI], 11.9-46.8 mo; mean, 28.7 mo) after a median follow-up of 23.1 months (mean, 31.3 mo; range, 0.1-100.8 mo). No significant differences in OS (P = .223) were observed among tumor volumes < 50 cm3 (median, 84.9 mo ± 53.1; mean, 58.4 mo), 50-100 cm3 (median, 37.8 mo ± 5.7; mean, 36.3 mo), and > 100 cm3 (median, 17.1 mo ± 3.5; mean, 21.8 mo). Numbers of metastases did not affect estimated OS, with a median OS of 32.7 months ± 10.4 (mean, 35.8 mo) for single lesions vs 17.7 months ± 3.2 (mean, 25.9 mo) for 2/3 lesions and a mean of 68.4 months ± 17.23 for > 3 lesions (P = .113). CONCLUSIONS Multiple-electrode stereotactic RF ablation proved to be a safe minimally invasive alternative to surgical liver resection in selected patients with BCLMs.
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Affiliation(s)
- Reto Bale
- Department of Radiology, Section of Microinvasive Therapy, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - Michael Richter
- Department of Radiology, Section of Microinvasive Therapy, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Martina Dünser
- Department of Surgery, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Elliot Levy
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland
| | - Wolfgang Buchberger
- Department of Radiology, Section of Microinvasive Therapy, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Peter Schullian
- Department of Radiology, Section of Microinvasive Therapy, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
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Yoshino O, Perini MV, Christophi C, Weinberg L. Perioperative fluid management in major hepatic resection: an integrative review. Hepatobiliary Pancreat Dis Int 2017; 16:458-469. [PMID: 28992877 DOI: 10.1016/s1499-3872(17)60055-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 04/10/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Fluid intervention and vasoactive pharmacological support during hepatic resection depend on the preference of the attending clinician, institutional resources, and practice culture. Evidence-based recommendations to guide perioperative fluid management are currently limited. Therefore, we provide a contemporary clinical integrative overview of the fundamental principles underpinning fluid intervention and hemodynamic optimization for adult patients undergoing major hepatic resection. DATA SOURCES A literature review was performed of MEDLINE, EMBASE and the Cochrane Central Registry of Controlled Trials using the terms "surgery", "anesthesia", "starch", "hydroxyethyl starch derivatives", "albumin", "gelatin", "liver resection", "hepatic resection", "fluids", "fluid therapy", "crystalloid", "colloid", "saline", "plasma-Lyte", "plasmalyte", "hartmann's", "acetate", and "lactate". Search results for MEDLINE and EMBASE were additionally limited to studies on human populations that included adult age groups and publications in English. RESULTS A total of 113 articles were included after appropriate inclusion criteria screening. Perioperative fluid management as it relates to various anesthetic and surgical techniques is discussed. CONCLUSIONS Clinicians should have a fundamental understanding of the surgical phases of the resection, hemodynamic goals, and anesthesia challenges in attempts to individualize therapy to the patient's underlying pathophysiological condition. Therefore, an ideal approach for perioperative fluid therapy is always individualized. Planning and designing large-scale clinical trials are imperative to define the optimal type and amount of fluid for patients undergoing major hepatic resection. Further clinical trials evaluating different intraoperative goal-directed strategies are also eagerly awaited.
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Affiliation(s)
- Osamu Yoshino
- Department of Surgery, Austin Hospital and University of Melbourne, Melbourne, Victoria, Australia.
| | - Marcos Vinicius Perini
- Department of Surgery, Austin Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher Christophi
- Department of Surgery, Austin Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Laurence Weinberg
- Department of Surgery, Austin Hospital and University of Melbourne, Melbourne, Victoria, Australia; Anaesthesia Perioperative Pain Medicine Unit, University of Melbourne, Melbourne, Victoria, Australia
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103
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MAPK, NFκB, and VEGF signaling pathways regulate breast cancer liver metastasis. Oncotarget 2017; 8:101452-101460. [PMID: 29254177 PMCID: PMC5731887 DOI: 10.18632/oncotarget.20843] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 08/07/2017] [Indexed: 12/31/2022] Open
Abstract
In this study, we investigated the molecular pathways regulating breast cancer liver metastasis. We identified 48 differentially expressed genes (4 upregulated and 44 downregulated) by analyzing microarray dataset GSE62598 from Gene Expression Omnibus (GEO). We constructed a genetic interaction network with 84 nodes and 237 edges using the String consortium database. The network was reliably robust with a clustering coefficient (cc) of 0.598 and protein-protein interaction (PPI) enrichment p value of zero. Using the Gene Ontology and Kyoto Encyclopedia of Genes and Genomes databases, we identified MAPK, NFκB and VEGF signaling pathways as the most critical pathways regulating breast cancer liver metastasis. These results indicate that the distinct breast cancer metastatic stages, including dissemination from the primary breast tumor, transit through the vasculature, and survival and proliferation in the liver, are regulated by the MAPK, NFκB, and VEGF signaling pathways.
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104
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Outcome after resection of Adrenocortical Carcinoma liver metastases: a retrospective study. BMC Cancer 2017; 17:522. [PMID: 28778197 PMCID: PMC5545028 DOI: 10.1186/s12885-017-3506-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 07/27/2017] [Indexed: 12/12/2022] Open
Abstract
Background Metastatic Adrenocortical Carcinoma (ACC) is a rare malignancy with a poor 5-year-survival rate (<15%). A surgical approach is recommended in selected patients if complete resection of distant metastasis can be achieved. To date there are only limited data on the outcome after surgical resection of hepatic metastases of ACC. Methods A retrospective analysis of the German Adrenocortical Carcinoma Registry was conducted. Patients with liver metastases of ACC but without extrahepatic metastases or incomplete tumour resection were included. Results Seventy-seven patients fulfilled these criteria. Forty-three patients underwent resection of liver metastases of ACC. Complete tumour resection (R0) could be achieved in 30 (69.8%). Median overall survival after liver resection was 76.1 months in comparison to 10.1 months in the 34 remaining patients with unresected liver metastases (p < 0.001). However, disease free survival after liver resection was only 9.1 months. Neither resection status (R0/R1) nor extent of liver resection were significant predictive factors for overall survival. Patients with a time interval to the first metastasis/recurrence (TTFR) of greater than 12 months or solitary liver metastases showed significantly prolonged survival. Conclusions Liver resection in the case of ACC liver metastases can achieve long term survival with a median overall survival of more than 5 years, but disease free survival is short despite metastasectomy. Time to recurrence and single versus multiple metastases are predictive factors for the outcome.
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105
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Fatty liver decreases the risk of liver metastasis in patients with breast cancer: a two-center cohort study. Breast Cancer Res Treat 2017; 166:289-297. [PMID: 28741275 DOI: 10.1007/s10549-017-4411-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/20/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND The influence of hepatic steatosis (HS) on liver metastasis in patients with non-metastatic breast cancer (BC) remains unclear. The aim of this study was to clarify the relationship between HS and liver metastasis in non-metastatic BC patients. METHODS Patients who underwent treatment for BC at two affiliated hospitals of Southern Medical University, between January 1, 2005 and December 31, 2015, were retrospectively reviewed. BC patients were divided into the study and control groups based on the presence of HS. The association between HS and liver metastasis was analyzed, adjusting for the confounding factors using Cox regression and propensity score case-match analysis. RESULTS In total, 1230 female BC patients were included, and 372 (30.2%) patients were diagnosed with HS (at the time of diagnosis BC or before). The cumulative liver metastasis-free survival (MFS) rate was significantly higher in the study group than in the control group (hazard ratio 0.61; 95% confidence interval 0.40-0.94; P = 0.024). On multivariate analysis, HS was an independent protective factor for local liver metastasis (HR 0.55; 0.35-0.86; P = 0.008). After one-to-one matching of the study group (344) with the control group (344), liver MFS remained significantly better in the study group (HR 0.42; 0.26-0.69; P = 0.001). CONCLUSION This study indicated that HS may serve as an independent factor to decrease liver metastasis in patients with BC. Additional prospective studies are necessary to validate this finding.
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106
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Motoyama H, Kobayashi A, Yokoyama T, Shimizu A, Kitagawa N, Notake T, Fukushima K, Masuo H, Yoshizawa T, Miyagawa SI. Survival Benefits of Surgical Resection in Patients with Recurrent Biliary Tract Carcinoma. World J Surg 2017; 41:2817-2829. [DOI: 10.1007/s00268-017-4107-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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107
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Kenny LM, Orsi F, Adam A. Interventional radiology in breast cancer. Breast 2017; 35:98-103. [PMID: 28704698 DOI: 10.1016/j.breast.2017.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/13/2017] [Accepted: 06/15/2017] [Indexed: 01/01/2023] Open
Abstract
Molecular profiling of metastatic disease may greatly influence the systemic therapy recommended by oncologists and chosen by patients, allowing treatment to be more targeted. Comprehensive care of patients with advanced breast cancer now includes percutaneous image-guided biopsy if this has the potential to influence systemic treatment [1]. Interventional radiologists can contribute significantly to the care of patients affected by breast cancer, in diagnostic and supportive procedures and importantly also in treatment. Interventional radiologists carry out image guided percutaneous biopsies not only of the primary tumour but also of metastases. They insert percutaneous ports and tunnelled central venous catheters. They ablate painful bone metastases, and can treat or prevent pathological fractures. Most importantly they can ablate liver metastases in patients with limited or oligometastatic disease. The inhomogeneity and variety of cell populations in metastatic tumours from breast cancer, which is an important consideration in systemic therapy, is not an important consideration in the treatment of metastatic tumours using percutaneous ablative techniques, which are the major focus of this article. The treatment of primary tumours in the breast is also being explored, but is considered in its infancy at this stage.
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Affiliation(s)
- Lizbeth Moira Kenny
- School of Medicine, University of Queensland, Australia; Royal Brisbane and Women's Hospital, Australia
| | - Franco Orsi
- University Statale, Milan, Italy; Chair of the Division of Interventional Radiology at the European Institute of Oncology, Milan, Italy
| | - Andreas Adam
- Interventional Radiology, King's College London, London, UK; Guy's and St Thomas's Hospital, London, UK.
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108
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Golse N, Adam R. Liver Metastases From Breast Cancer: What Role for Surgery? Indications and Results. Clin Breast Cancer 2017; 17:256-265. [DOI: 10.1016/j.clbc.2016.12.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/26/2016] [Indexed: 12/30/2022]
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109
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Abstract
OBJECTIVE To estimate the cost-effectiveness of liver resection followed by adjuvant systemic therapy relative to systemic therapy alone for patients with breast cancer liver metastasis. BACKGROUND Data on cost-effectiveness of liver resection for advanced breast cancer with liver metastasis are lacking. METHODS A decision-analytic Markov model was constructed to evaluate the cost-effectiveness of liver resection followed by postoperative conventional systemic therapy (strategy A) versus conventional therapy alone (strategy B) versus newer targeted therapy alone (strategy C). The implications of using different chemotherapeutic regimens based on estrogen receptor and human epidermal growth factor receptor 2 status was also assessed. Outcomes included quality-adjusted life months (QALMs), incremental cost-effectiveness ratio, and net health benefit (NHB). RESULTS NHB of strategy A was 10.9 QALMs compared with strategy B when letrozole was used as systemic therapy, whereas it was only 0.3 QALMs when docetaxel + trastuzumab was used as a systemic therapy. The addition of newer biological agents (strategy C) significantly decreased the cost-effectiveness of strategy B (conventional systemic therapy alone). The NHB of strategy A was 31.6 QALMs versus strategy C when palbociclib was included in strategy C; similarly, strategy A had a NHB of 13.8 QALMs versus strategy C when pertuzumab was included in strategy C. Monte-Carlo simulation demonstrated that the main factor influencing NHB of strategy A over strategy C was the cost of systemic therapy. CONCLUSIONS Liver resection in patients with breast cancer liver metastasis proved to be cost-effective when compared with systemic therapy alone, particularly in estrogen receptor-positive tumors or when newer agents were used.
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110
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Hamner JB, Raoof M, Dumitra S, Schoellhammer HF, Crowder C, Ituarte PH, Kim J, Singh G. Evolving Role of Hepatic Resection for Metastatic Urologic Malignancies. Am Surg 2017. [DOI: 10.1177/000313481708300629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Liver resection for noncolorectal, nonneuroendocrine metastases remains controversial. Here, we evaluate a single institutional experience with hepatic resection for metastatic urologic malignancies. A single-institution review of patients who underwent hepatic resection for metastatic urologic tumors between the years of 2000 and 2013 was performed. Patient charts were analyzed for pathologic data and perioperative outcomes including short- and long-term morbidity, mortality, and overall and disease-free survival. Eleven patients were identified who underwent hepatic resection for metastatic urologic malignancy. The mean age was 63.5 years. All patients had an R0 resection. There were three major complications. Mean length of stay was 6.5 days and there was no 90-day mortality. Three patients have died of recurrent disease at an average of 11.2 months from resection to death. The remaining patients are still alive during a mean follow-up of 31.5 months. Five-year overall and disease-free survival was 50 and 21 months, respectively. Hepatic resection for metastatic urologic tumors is safe with low morbidity and mortality and durable long-term survival can be achieved. Liver resection for isolated hepatic disease should be considered for this rare metastatic disease to the liver.
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Affiliation(s)
- John B. Hamner
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Mustafa Raoof
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Sinziana Dumitra
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Hans F. Schoellhammer
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Carly Crowder
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Philip H.G. Ituarte
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Joseph Kim
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Gagandeep Singh
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California
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111
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Fukumitsu N, Okumura T, Numajiri H, Takizawa D, Ohnishi K, Mizumoto M, Aihara T, Ishikawa H, Tsuboi K, Sakurai H. Follow-up study of liver metastasis from breast cancer treated by proton beam therapy. Mol Clin Oncol 2017; 7:56-60. [PMID: 28685076 DOI: 10.3892/mco.2017.1283] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 03/17/2017] [Indexed: 02/07/2023] Open
Abstract
Liver metastasis from breast cancer (LMBC) is an incurable, fatal disease with a very poor prognosis. Although various local treatments have been applied, their clinical utility has not been established. The purpose of this study was to investigate the safety and effectiveness of proton beam therapy (PBT) for the treatment of patients with LMGC. A total of 8 female patients (aged 38-63 years) with LMBC who received PBT between 2002 and 2012 were retrospectively reviewed. Patients who had tumors confined to the liver were investigated, whereas patients with extrahepatic tumors were excluded. A total of 5 patients had solitary tumors and 3 had multiple tumors. The total irradiation dose was 66-72.6 Gray equivalent [Gy relative biological effectiveness (RBE)] and 2 patients received concurrent chemotherapy or hormone therapy. The overall and progression-free survival (OS and PFS) rates, local control (LC) rate and adverse effects were investigated. All the patients completed treatment without interruption and late adverse effects of grade >3 were not observed. The OS rate was 88/73/58%, the PFS rate was 50/25/0% and the LC rate was 86/86/86% at 1/3/5 years, respectively. Thus, PBT is a safe treatment and the OS and PFS rates are comparable to those with other local treatments. PBT may be considered as an effective local treatment option for the treatment of LMBC patients.
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Affiliation(s)
- Nobuyoshi Fukumitsu
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Toshiyuki Okumura
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Haruko Numajiri
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Daichi Takizawa
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Kayoko Ohnishi
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Masashi Mizumoto
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Teruhito Aihara
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Hitoshi Ishikawa
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Koji Tsuboi
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Hideyuki Sakurai
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
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112
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Nguyen A, King TA. New Insights on the Role of Surgery for the Breast Primary Tumor in Patients Presenting With Stage IV Disease. CURRENT BREAST CANCER REPORTS 2017. [DOI: 10.1007/s12609-017-0241-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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113
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Shamimi-Noori S, Gonsalves CF, Shaw CM. Metastatic Liver Disease: Indications for Locoregional Therapy and Supporting Data. Semin Intervent Radiol 2017; 34:145-166. [PMID: 28579683 DOI: 10.1055/s-0037-1602712] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Metastatic liver disease is a major cause of cancer-related morbidity and mortality. Surgical resection is considered the only curative treatment, yet only a minority is eligible. Patients who present with unresectable disease are treated with systemic agents and/or locoregional therapies. The latter include thermal ablation and catheter-based transarterial interventions. Thermal ablation is reserved for those with limited tumor burden. It is used to downstage the disease to enable curative surgical resection, as an adjunct to surgery, or in select patients it is potentially curative. Transarterial therapies are indicated in those with more diffuse disease. The goals of care are to palliate symptoms and prolong survival. The indications and supporting data for thermal ablation and transarterial interventions are reviewed, technical and tumor factors that need to be considered prior to intervention are outlined, and finally several cases are presented.
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Affiliation(s)
- Susan Shamimi-Noori
- Division of Interventional Radiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Carin F Gonsalves
- Division of Interventional Radiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Colette M Shaw
- Division of Interventional Radiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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114
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Frigerio I, Regi P, Giardino A, Scopelliti F, Girelli R, Bassi C, Gobbo S, Martini PT, Capelli P, D'Onofrio M, Malleo G, Maggino L, Viviani E, Butturini G. Downstaging in Stage IV Pancreatic Cancer: A New Population Eligible for Surgery? Ann Surg Oncol 2017; 24:2397-2403. [PMID: 28516291 DOI: 10.1245/s10434-017-5885-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Recent papers consider surgery as an option for synchronous liver oligometastatic patients [metastatic pancreatic ductal adenocarcinoma (mPDAC)]. In this study, we present our series of resected mPDACs after neoadjuvant chemotherapy (nCT). PATIENTS AND METHODS All patients resected after downstaging of mPDAC were included in this study. Downstaging criteria were disappearance of liver metastasis and a decrease in cancer antigen (CA) 19-9. The type and duration of nCT, last nCT surgery interval, histology, morbidity, and mortality were recorded, and overall survival (OS) and disease-free survival (DFS) were analyzed. RESULTS Overall, 24 of 535 patients (4.5%) observed with mPDAC were included. These patients received gemcitabine alone (5/24), gemcitabine + nanoparticle albumin-bound (nab)-paclitaxel (3/24), and FOLFIRINOX (16/24). Primary tumor size decreased from 31 to 19 mm (p < 0.001), and serum CA19-9 decreased from 596 to 18 U/mL (p < 0.001). In 14/24 patients, the tumor was located in the head. Median interval nCT surgery was 2 months, there were no mortalities, and the postoperative course was uneventful in 34% of cases. Grade B/C pancreatic fistula, postoperative bleeding, and sepsis occurred in 17/4, 4, and 12% of cases, respectively, and reoperation rate was 4%. R0 resection was achieved in 88% of cases, with 17% complete pathological response. Positive nodes were found in 9/24 patients with a median node ratio of 0.37, and OS and DFS was 56 and 27 months, respectively. CONCLUSIONS Patients with mPDAC who were fully responsive to nCT may be cautiously considered for surgery, with potential benefit in survival compared with palliative chemotherapy alone. This is supported by results of our retrospective study, which is the largest ever reported.
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Affiliation(s)
| | - Paolo Regi
- HPB Surgical Unit, Pederzoli Hospital, Verona, Italy
| | | | | | | | - Claudio Bassi
- General Surgery B, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Stefano Gobbo
- Department of Pathology, Pederzoli Hospital, Verona, Italy
| | | | - Paola Capelli
- Department of Pathology, Pederzoli Hospital, Verona, Italy
| | - Mirko D'Onofrio
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Giuseppe Malleo
- General Surgery B, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Laura Maggino
- General Surgery B, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Elena Viviani
- General Surgery B, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
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白 秀, 杨 薇, 严 昆. 乳腺癌肝转移治疗现状及射频消融的应用及前景. Shijie Huaren Xiaohua Zazhi 2017; 25:1143-1149. [DOI: 10.11569/wcjd.v25.i13.1143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
乳腺癌是女性发病率和死亡率最高的恶性肿瘤. 乳腺癌晚期常发生转移, 好发转移部位依次为骨、肺、肝等. 近年来, 虽然乳腺癌肝转移(breast cancer liver metastases, BCLM)治疗成功率逐渐提高, 但是BCLM的预后仍然较差. 目前, BCLM的治疗方式尚未成熟, 主要以手术切除、化疗、射频消融(radiofrequency ablation, RFA)治疗、肝动脉栓塞灌注化疗等为主. 本文回顾分析了国内外有关治疗BCLM治疗的文献, 其中重点关注BCLM局部治疗中的RFA治疗, 分析RFA治疗BCLM的应用及前景.
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116
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Systematic review of early and long-term outcome of liver resection for metastatic breast cancer: Is there a survival benefit? Breast 2017; 32:162-172. [DOI: 10.1016/j.breast.2017.02.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/29/2016] [Accepted: 02/04/2017] [Indexed: 12/21/2022] Open
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117
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Takemura N, Saiura A. Role of surgical resection for non-colorectal non-neuroendocrine liver metastases. World J Hepatol 2017; 9:242-251. [PMID: 28261381 PMCID: PMC5316844 DOI: 10.4254/wjh.v9.i5.242] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/12/2016] [Accepted: 12/09/2016] [Indexed: 02/06/2023] Open
Abstract
It is widely accepted that the indications for hepatectomy in colorectal cancer liver metastases and liver metastases of neuro-endocrine tumors result in relatively better prognoses, whereas, the indications and prognoses of hepatectomy for non-colorectal non-neuroendocrine liver metastases (NCNNLM) remain controversial owing to the limited number of cases and the heterogeneity of the primary diseases. There have been many publications on NCNNLM; however, its background heterogeneity makes it difficult to reach a specific conclusion. This heterogeneous disease group should be discussed in the order from its general to specific aspect. The present review paper describes the general prognosis and risk factors associated with NCNNLM while specifically focusing on the liver metastases of each primary disease. A multidisciplinary approach that takes into consideration appropriate timing for hepatectomy combined with chemotherapy may prolong survival and/or contribute to the improvement of the quality of life while giving respite from systemic chemotherapy.
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118
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Kawai H, Shiba H, Kanehira M, Sakamoto T, Furukawa K, Yanaga K. Successful resection of a solitary metastatic liver tumor from prostate cancer 15 years after radical prostatectomy: a case report. Surg Case Rep 2017; 3:17. [PMID: 28124309 PMCID: PMC5267580 DOI: 10.1186/s40792-017-0292-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 01/18/2017] [Indexed: 12/21/2022] Open
Abstract
Background A solitary metastatic liver tumor of prostate cancer is extremely rare because liver metastasis occurs as a part of systemic dissemination of prostate cancer. We herein report a successfully resected case of a solitary metastatic liver tumor from prostate cancer almost 15 years after radical prostatectomy. Case presentation A 70-year-old male who had undergone radical prostatectomy for prostate cancer 15 years previously presented to our hospital for treatment of a liver tumor. Serum prostate-specific antigen was elevated at 13.77 ng/ml. Abdominal computed tomography revealed a solitary tumor with a diameter of 54 mm in segment 4 of the liver. No metastatic lesions were found in other organs. The patient was given a diagnosis of a metastatic liver tumor from prostate cancer, and he underwent medial segmentectomy. Microscopically, the resected specimen was composed of eosinophilic tumor cells with oval nuclei and prominent nucleoli, which exhibited a cribriform pattern and a fused glands pattern with positive prostate-specific antigen and prostatic acid phosphatase staining; these findings were compatible with metastatic prostate cancer. Other than portal thrombosis that required anticoagulation, the patient made a satisfactory recovery and was discharged on postoperative day 15. Conclusion To the best of our knowledge, this is the first report describing successful resection of a solitary metastatic liver tumor from prostate cancer in the medical literature. In such a rare circumstance, hepatic resection for liver metastasis of prostate cancer seems justified.
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Affiliation(s)
- Hironari Kawai
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Hiroaki Shiba
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Masaru Kanehira
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Taro Sakamoto
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kenei Furukawa
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Katsuhiko Yanaga
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
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Gronchi A, Guadagnolo BA, Erinjeri JP. Local Ablative Therapies to Metastatic Soft Tissue Sarcoma. Am Soc Clin Oncol Educ Book 2017; 35:e566-75. [PMID: 27249769 DOI: 10.1200/edbk_157450] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The approach to metastatic soft tissue sarcoma is complex and depends upon several factors, such as the extent of the disease, the histologic subtype of the primary tumor, the disease-free interval, patient status and comorbidities, and previous treatments. The effect of systemic chemotherapy is suboptimal, therefore local ablative therapies are often considered when the disease is limited, especially if confined to a single site/organ. Historically, surgery has been considered the treatment of choice for isolated lung metastases. This approach also has been extended to metastases in the liver, although a formal demonstration of its benefit has never been provided. Radiation therapy instead has been mainly used to obtain pain control and to reduce the risk of bone fracture and cord compression. Advances in techniques, such as the development of more precise conformational modalities and the employment of particles, may change the role of this modality in the strategic approach to metastatic soft tissue sarcoma. Recently, the use of interventional radiology in this scenario has expanded. Ablative approaches, such as radiofrequency ablation and cryoablation, have shown durable eradication of tumors. Catheter-directed therapies, such as hepatic artery embolization, are potential techniques for treating the patient who has multiple unresectable liver metastases. Understanding the timing and role of these three different modalities in the multidisciplinary approach to metastatic soft tissue sarcoma is critical to provide better care and to personalize the approach to the single patient.
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Affiliation(s)
- Alessandro Gronchi
- From the Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - B Ashleigh Guadagnolo
- From the Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph Patrick Erinjeri
- From the Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
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Tapia Rico G, Townsend AR, Klevansky M, Price TJ. Liver metastases resection for gastric and esophageal tumors: is there enough evidence to go down this path? Expert Rev Anticancer Ther 2016; 16:1219-1225. [PMID: 27744727 DOI: 10.1080/14737140.2016.1249858] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Surgical resection of liver metastases from colorectal and neuroendocrine tumours has become a standard of care for resectable patients with isolated hepatic disease and good performance status, leading to extended survival in a carefully selected subgroup of these patients. However, the role of hepatic surgery in gastric and oesophageal liver metastases is controversial and not clearly defined. Areas covered:a systematic electronic literature search was performed to select the most representative evidence regarding hepatectomies in liver metastases from these two tumours. PubMed, Medline, Embase Ovid and Google Scholar databases were scanned for articles written in English and published in peer-reviewed journals between 1994 and May 2016. Expert commentary: Given the shortage of randomised studies and the limited number of patients in many of the studies discussed here, the evidence base for the use of hepatectomies in these settings is not strong. Thus, while the data for resections of gastric liver metastases may in particular seem encouraging, the results should be interpreted with caution.
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Affiliation(s)
- Gonzalo Tapia Rico
- a Department of Medical Oncology , The Queen Elizabeth Hospital , Adelaide , SA , Australia
| | - Amanda R Townsend
- a Department of Medical Oncology , The Queen Elizabeth Hospital , Adelaide , SA , Australia.,b University of Adelaide , Adelaide , SA , Australia
| | - Myron Klevansky
- a Department of Medical Oncology , The Queen Elizabeth Hospital , Adelaide , SA , Australia
| | - Timothy J Price
- a Department of Medical Oncology , The Queen Elizabeth Hospital , Adelaide , SA , Australia.,b University of Adelaide , Adelaide , SA , Australia
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Fairhurst K, Leopardi L, Satyadas T, Maddern G. The safety and effectiveness of liver resection for breast cancer liver metastases: A systematic review. Breast 2016; 30:175-184. [PMID: 27764727 DOI: 10.1016/j.breast.2016.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 08/11/2016] [Accepted: 09/15/2016] [Indexed: 02/08/2023] Open
Abstract
Breast cancer liver metastases have traditionally been considered incurable and any treatment given therefore palliative. Liver resections for breast cancer metastases are being performed, despite there being no robust evidence for which patients benefit. This review aims to determine the safety and effectiveness of liver resection for breast cancer metastases. A systematic literature review was performed and resulted in 33 papers being assembled for analysis. All papers were case series and data extracted was heterogeneous so a meta-analysis was not possible. Safety outcomes were mortality and morbidity (in hospital and 30-day). Effectiveness outcomes were local recurrence, re-hepatectomy, survival (months), 1-, 2-, 3-, 5- year overall survival rate (%), disease free survival (months) and 1-, 2-, 3-, 5- year disease free survival rate (%). Overall median figures were calculated using unweighted median data given in each paper. Results demonstrated that mortality was low across all studies with a median of 0% and a maximum of 5.9%. The median morbidity rate was 15%. Overall survival was a median of 35.1 months and a median 1-, 2-, 3- and 5-year survival of 84.55%, 71.4%, 52.85% and 33% respectively. Median disease free survival was 21.5 months with a 3- and 5-year median disease free survival of 36% and 18%. Whilst the results demonstrate seemingly satisfactory levels of overall survival and disease free survival, the data are of poor quality with multiple confounding variables and small study populations. Recommendations are for extensive pilot and feasibility work with the ultimate aim of conducting a large pragmatic randomised control trial to accurately determine which patients benefit from liver resection for breast cancer liver metastases.
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Affiliation(s)
- Katherine Fairhurst
- University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Woodville, Adelaide, South Australia, 5011, Australia.
| | - Lisa Leopardi
- University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Woodville, Adelaide, South Australia, 5011, Australia.
| | - Thomas Satyadas
- University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Woodville, Adelaide, South Australia, 5011, Australia.
| | - Guy Maddern
- University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Woodville, Adelaide, South Australia, 5011, Australia.
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Ruiz A, Wicherts DA, Sebagh M, Giacchetti S, Castro-Benitez C, van Hillegersberg R, Paule B, Castaing D, Morère JF, Adam R. Predictive Profile-Nomogram for Liver Resection for Breast Cancer Metastases: An Aggressive Approach with Promising Results. Ann Surg Oncol 2016; 24:535-545. [PMID: 27573523 DOI: 10.1245/s10434-016-5522-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Breast cancer liver metastases (BCLM) are considered the most lethal compared with other sites of metastases in patients with breast cancer. This study aimed to evaluate the outcome after hepatectomy for BCLM within current multidisciplinary treatment and to develop a clinically useful nomogram to predict survival. METHODS Between January 1985 and December 2012, 139 consecutive female patients underwent liver resection for BCLM at the authors' institution. Clinicopathologic data were collected and analyzed for survival outcome with determination of prognostic factors. A nomogram to predict survival was developed based on a multivariate Cox model. The predictive performance of the model was assessed according to the C-statistic and calibration plots. RESULTS After a median follow-up period of 55 months, the overall 3- and 5-year survival rates after hepatectomy were respectively 58 and 47 %. The median overall survival period was 56 months, and the median disease-free survival period after surgical resection was 33 months. A single hepatic metastasis, no triple negative tumors, no microscopic vascular invasion, and perioperative hormonal or targeted therapy were related to improved overall survival. The model achieved good discrimination and calibration, with a C-statistic of 0.80. CONCLUSIONS Liver resection for selected patients with breast cancer metastases can provide significant survival benefit. It should be part of a multidisciplinary treatment program in experienced liver surgery centers. The authors' nomogram facilitates personalized assessment of prognosis for these patients.
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Affiliation(s)
- Aldrick Ruiz
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.,Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dennis A Wicherts
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Mylène Sebagh
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France
| | - Sylvie Giacchetti
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.,Département de Cancérologie, APHP, Hopital Saint Louis, Paris, France
| | - Carlos Castro-Benitez
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.,Department of Surgery, Hospital Mexico, San José, Costa Rica
| | | | - Bernard Paule
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.,Département de Cancérologie, AP-HP Hôpital Paul Brousse, Villejuif, France
| | - Denis Castaing
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.,Inserm, Université Paris-Sud, UMR-S 785, Villejuif, France
| | - Jean-François Morère
- Département de Cancérologie, AP-HP Hôpital Paul Brousse, Villejuif, France.,Université Paris-Sud, UMR-S 785, 94804, Villejuif, France
| | - René Adam
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France. .,Université Paris-Sud, UMR-S 785, 94804, Villejuif, France.
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123
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D'Angelica M. Hepatic resection for metastatic breast cancer: an exercise in selection bias. HPB (Oxford) 2016; 18:631-2. [PMID: 27485056 PMCID: PMC4972372 DOI: 10.1016/j.hpb.2016.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 06/28/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Michael D'Angelica
- Correspondence Michael D'Angelica, Enid A Haupt Chair in Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. Tel: +1 212 639 3226. Fax: +1 212 717 3218.Memorial Sloan Kettering Cancer Center1275 York AvenueNew YorkNY10065USA
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The role of liver-directed surgery in patients with hepatic metastasis from primary breast cancer: a multi-institutional analysis. HPB (Oxford) 2016; 18:700-5. [PMID: 27485066 PMCID: PMC4972375 DOI: 10.1016/j.hpb.2016.05.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 05/12/2016] [Accepted: 05/30/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Data on surgical management of breast liver metastasis are limited. We sought to determine the safety and long-term outcome of patients undergoing hepatic resection of breast cancer liver metastases (BCLM). METHODS Using a multi-institutional, international database, 131 patients who underwent surgery for BCLM between 1980 and 2014 were identified. Clinicopathologic and outcome data were collected and analyzed. RESULTS Median tumor size of the primary breast cancer was 2.5 cm (IQR: 2.0-3.2); 58 (59.8%) patients had primary tumor nodal metastasis. The median time from diagnosis of breast cancer to metastasectomy was 34 months (IQR: 16.8-61.3). The mean size of the largest liver lesion was 3.0 cm (2.0-5.0); half of patients (52.0%) had a solitary metastasis. An R0 resection was achieved in most cases (90.8%). Postoperative morbidity and mortality were 22.8% and 0%, respectively. Median and 3-year overall-survival was 53.4 months and 75.2%, respectively. On multivariable analysis, positive surgical margin (HR 3.57, 95% CI 1.40-9.16; p = 0.008) and diameter of the BCLM (HR 1.03, 95% CI 1.01-1.06; p = 0.002) remained associated with worse OS. DISCUSSION In selected patients, resection of breast cancer liver metastases can be done safely and a subset of patients may derive a relatively long survival, especially from a margin negative resection.
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125
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Pikoulis E, Margonis GA, Antoniou E. Surgical Management of Renal Cell Cancer Liver Metastases. Scand J Surg 2016; 105:263-268. [PMID: 26929295 DOI: 10.1177/1457496916630644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIMS There is an increasing trend toward performing liver resections in the setting of metastatic disease. Renal cell cancer liver metastases are associated with poor survival. The indications for and the short- and long-term outcomes of liver resection for renal cell cancer liver metastases remain not well defined. MATERIAL AND METHODS A focused, structured literature review on PubMed, EMBASE, and Google Scholar was performed to identify primary research articles, on short- and long-term outcomes and prognostic factors of patients undergoing liver resection for renal cell cancer liver metastases. Only studies with a sample size equal or larger than 10 patients were included. RESULTS AND CONCLUSION A total of 10 studies met inclusion criteria. Median overall survival ranged between 16 and 142 months. Major morbidity was rare while 30-day postoperative mortality was less than 5%. A disease-free interval of more than 2 years from nephrectomy to evidence of liver metastases and a radical, microscopically negative surgical resection (R0) were the most consistent prognostic factors that, in turn, could be used as potential selection criteria to identify patients who can benefit the most from liver-directed surgery. Liver surgery for renal cell cancer liver metastases can be performed with low mortality, acceptable morbidity, and promising survival benefit in carefully selected patients. Studies that can assess the impact of modern, targeted regimens in the preoperative setting and liver-directed surgery and in turn shape new selection criteria are warranted.
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Affiliation(s)
- E Pikoulis
- 1 First Department of Surgery, Laiko Hospital, University of Athens, Athens, Greece
| | - G A Margonis
- 2 Department of Surgery, Johns Hopkins University, Baltimore, USA
| | - E Antoniou
- 3 Second Department of Propaedeutic Surgery, Laiko Hospital, University of Athens, Athens, Greece
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126
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Surgical management of lung, liver and brain metastases from gynecological cancers: a literature review. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2016; 3:7. [PMID: 27330821 PMCID: PMC4912748 DOI: 10.1186/s40661-016-0028-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/03/2016] [Indexed: 12/28/2022]
Abstract
Background The management of patients with recurrent gynecological malignancy is complex, and often contentious. While historically, patients with metastases in the lungs, liver or brain have been treated with palliative intent, surgery is proving to have an increasing role in the management of such patients. Methods In this review article, the surgical management of lung, liver and brain metastases from gynecological cancers is examined. A search of the English language literature over the last 25 years was conducted using the Medline and PubMed databases. Results The results for management of metastases from the endometrium, ovary and cervix to the lung, brain and liver show that surprisingly good long-term survival results can be achieved for resection of metastases from all three organs. Patient selection is critical, and surgery is often used in conjunction with other treatment modalities. Conclusions From this review, it is apparent that surgery should play an increasing role in the management of patients with parenchymal metastases from gynecological cancers. The surgery should ideally be performed in high volume, tertiary centers where there is a committed multi-disciplinary team with the necessary infrastructure to achieve the best possible outcomes in terms of both survival and morbidity.
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127
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Wu AW, Yuan P, Li ZY, Tang L, Bu ZD, Ren H, Ji JF. Capecitabine plus paclitaxel induction treatment in gastric cancer patients with liver metastasis: a prospective, uncontrolled, open-label Phase II clinical study. Future Oncol 2016; 12:2107-16. [PMID: 27256000 DOI: 10.2217/fon-2016-0145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIM To determine the overall survival rate, radical resection rate, objective response rate and safety of capecitabine plus paclitaxel induction chemotherapy in gastric cancer patients with liver metastases. PATIENTS & METHODS A total of 30 patients (median age: 59.5 years) diagnosed as gastric adenocarcinoma with liver metastasis received ≥3 cycles of capecitabine and paclitaxel therapy followed by radical resection 4-6 weeks after termination of chemotherapy. RESULTS The median survival time was 11.4 months, and the objective response rate was 53.3%. The radical resection rate was 23.3% (95% CI: 9.9-42.3). Major toxicities included grade 3 neutropenia (10.0%) and grade 3 diarrhea (3.3%). CONCLUSION Capecitabine plus paclitaxel chemotherapy may be effective and safe to improve overall survival and the resection rate of gastric cancer patients with liver metastases. ClinicalTrials.gov identifier: NCT0116704.
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Affiliation(s)
- Ai-Wen Wu
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Peking University Cancer Hospital, Beijing Cancer Hospital & Institute, Beijing 100142, China
| | - Peng Yuan
- Department of Endoscopy, Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Peking University Cancer Hospital, Beijing Cancer Hospital & Institute, Beijing 100142, China
| | - Zi-Yu Li
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Peking University Cancer Hospital, Beijing Cancer Hospital & Institute, Beijing 100142, China
| | - Lei Tang
- Department of Radiology, Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Peking University Cancer Hospital, Beijing Cancer Hospital & Institute, Beijing 100142, China
| | - Zhao-De Bu
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Peking University Cancer Hospital, Beijing Cancer Hospital & Institute, Beijing 100142, China
| | - Hui Ren
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Peking University Cancer Hospital, Beijing Cancer Hospital & Institute, Beijing 100142, China
| | - Jia-Fu Ji
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Peking University Cancer Hospital, Beijing Cancer Hospital & Institute, Beijing 100142, China
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Schiergens TS, Lüning J, Renz BW, Thomas M, Pratschke S, Feng H, Lee SML, Engel J, Rentsch M, Guba M, Werner J, Thasler WE. Liver Resection for Non-colorectal Non-neuroendocrine Metastases: Where Do We Stand Today Compared to Colorectal Cancer? J Gastrointest Surg 2016; 20:1163-72. [PMID: 26921025 DOI: 10.1007/s11605-016-3115-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/16/2016] [Indexed: 01/31/2023]
Abstract
The continuing controversy about surgery for non-colorectal non-neuroendocrine liver metastases (NCRNNE) necessitates identifying risk factors of worsened outcomes to improve patient selection and survival. Prospectively collected data of 167 patients undergoing hepatectomy for NCRNNE were analyzed, and a comparison to a matched population of colorectal liver metastases (CLM) was performed. Overall survival (OS) (35 vs. 54 months; P = 0.008) and recurrence-free survival (RFS) (15 vs. 29 months; P = 0.004) of NCRNNE patients were significantly shorter compared to those with CLM. The best survival was found in the genitourinary (GU; OS, 45 months; RFS, 21 months) NCRNNE subgroup, whereas survival for gastrointestinal (GI) metastases was low (OS, 8 months; RFS, 7 months). Patients with renal cell carcinoma (RCC) showed excellent outcomes when compared to CLM (OS, 50 vs. 51 months; P = 0.901). Extrahepatic disease (EHD) was identified as independent prognostic factor for reducing both RFS (P = 0.040) and OS (P = 0.046). The number of liver lesions (P = 0.024), residual tumor (P = 0.025), and major complications (P = 0.048) independently diminished OS. The degree of survival advantage by surgery is determined by the primary tumor site, EHD, the number of metastases, and residual tumor. Thus-even more than in CLM-these oncological selection criteria must prevail. GU metastases, especially RCC, represent a favorable subgroup.
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Affiliation(s)
- Tobias S Schiergens
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Juliane Lüning
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Bernhard W Renz
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Michael Thomas
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Sebastian Pratschke
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Hao Feng
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Serene M L Lee
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Jutta Engel
- Munich Cancer Registry (MCR) of the Munich Tumor Center (TZM), Institute for Medical Information Sciences, Biometry, and Epidemiology (IBE), University Hospital of Munich, Munich, Germany
| | - Markus Rentsch
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Markus Guba
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Jens Werner
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Wolfgang E Thasler
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Marchioninistr. 15, 81377, Munich, Germany
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Charalampoudis P, Mantas D, Sotiropoulos GC, Dimitroulis D, Kouraklis G, Markopoulos C. Surgery for liver metastases from breast cancer. Future Oncol 2016; 11:1519-30. [PMID: 25963429 DOI: 10.2217/fon.15.43] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Liver metastases from breast cancer (BCLM) confer poor survival. Liver resection in BCLM patients has been increasingly employed. AIM We undertook a systematic review to evaluate the role of hepatic resection in patients with breast cancer metastatic to the liver. MATERIALS & METHODS In total, 36 studies were overviewed. Patient populations, characteristics, morbidity, mortality and survival were documented. RESULTS Median overall survival was 41 months. Major morbidity was rare while 30-day postoperative mortality was near nil. CONCLUSION Liver surgery for BCLM can be performed with low mortality, acceptable morbidity and promising survival benefit in carefully selected patients.
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Affiliation(s)
- Petros Charalampoudis
- Breast Unit, Second Propedeutic Department of Surgery, Laiko General Hospital, Athens University School of Medicine, Athens, Greece
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Matkowskyj KA, Rao MS, Yang GY. Pathologic Features of Primary and Metastatic Hepatic Malignancies. Cancer Treat Res 2016; 168:257-293. [PMID: 29206377 DOI: 10.1007/978-3-319-34244-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In the mammalian liver, 60 % of the cellular components are hepatocytes while the remainder (35 %) includes biliary epithelium, Kupffer cells, endothelial cells, fat storing cells and connective tissue cells. Although neoplasms of hepatocytes are the most common, a significant number of both benign and malignant primary liver neoplasms arising from other cell types can develop, such as tumors of bile duct epithelium (Table 1). In addition, the liver is one of the most susceptible sites for metastatic tumors arising from other organs of the body. Not too long ago, liver tumors were left untreated because the liver was considered a complex and mysterious organ inaccessible to surgery. Advances in imaging procedures and surgical techniques over the past 40 years have revolutionized the approaches to the treatment of benign and malignant liver tumors. Subsegmentectomy, segmentectomy, lobectomy, and transplantation are routinely performed for the treatment of primary and metastatic liver tumors with minimal morbidity and mortality. Since accurate diagnosis remains the key to clinical and surgical management, the emphasis of this chapter is on classification, morphological features and differential diagnosis of malignant neoplasms of the liver.
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Hepatic resection during cytoreductive surgery for primary or recurrent epithelial ovarian cancer. J Cancer Res Clin Oncol 2015; 142:1509-20. [PMID: 26660323 DOI: 10.1007/s00432-015-2090-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 11/30/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE Surgical cytoreduction remains a cornerstone in the management of patients with advanced and recurrent epithelial ovarian cancer. Parenchymal liver metastases determine stage VI disease and are commonly considered a major limit in the achievement of an optimal cytoreduction. The purpose of this manuscript was to discuss the rationale of liver resection and the morbidity related to this procedure in advanced and recurrent ovarian cancer. METHODS A search of the National Library of Medicine's MEDLINE/PubMed database until March 2015 was performed using the keywords: "ovarian cancer," "hepatic," "liver," and "metastases." RESULTS In patients with liver metastases, hepatic resection is associated with a similar prognosis as stage IIIC patients. The length of the disease-free interval between primary diagnosis and occurrence of liver metastases, as well as residual disease after resection, is the most important prognostic factors. In addition, the number of liver lesions, resection margins, and the gynecologic oncology group performance status seem to play also an important role in determining outcome. CONCLUSIONS In properly selected patients, liver resections at the time of cytoreduction increase rates of optimal cytoreduction and improve survival in advanced-stage and recurrent ovarian cancer patients.
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Ruiz A, Castro-Benitez C, Sebagh M, Giacchetti S, Castro-Santa E, Wicherts DA, van Hillegersberg R, Paule B, Castaing D, Morère JF, Adam R. Repeat Hepatectomy for Breast Cancer Liver Metastases. Ann Surg Oncol 2015; 22 Suppl 3:S1057-66. [PMID: 26259753 DOI: 10.1245/s10434-015-4785-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Resection of breast cancer liver metastases (BCLM) combined with systemic treatment is increasingly accepted as a therapeutic option; however, the potential benefit of repeat hepatectomy for recurrent BCLM is unknown. METHODS All consecutive female patients who underwent liver resection for BCLM at our center between January 1985 and December 2012 were included. Patients who had a single hepatectomy (N = 120) were compared with those who also underwent repeat hepatectomy (N = 19). Patients were selected for repeat hepatectomy based on operability and disease control. Prognostic factors of survival after repeat hepatectomy were determined. RESULTS Median overall survival since first hepatectomy was 35 months, with a 3- and 5-year survival rate of 50 and 38 %, respectively. Overall survival following repeat hepatectomy was 64 and 46 % at 3 and 5 years, respectively. From the time of first hepatectomy, patients who underwent repeat hepatectomy had a better survival than those who had only one hepatectomy (95 and 84 vs. 50 and 38 % at 3 and 5 years, respectively) (p = 0.002). Median survival was 35 and 100 months, respectively, and median survival since the diagnosis of BCLM was 51 and 112 months in the single and repeat hepatectomy groups, respectively. Since the time of diagnosis, overall 3-, 5-, and 7-year survival rates were 75, 57, and 44 %, respectively, for all 139 patients. Improved overall survival after repeat hepatectomy was related to a time interval between breast cancer diagnosis and first hepatectomy of >2 years, a limited hepatectomy, solitary liver metastasis, positive progesterone receptor status, and chemotherapy following repeat hepatectomy. Patients with single BCLM at first hepatectomy had a 3- and 5-year overall survival rate of 76 and 76 % compared with 51 and 17 % in patients with multiple metastases (p = 0.023). CONCLUSION In selected patients with BCLM, repeat hepatectomy for liver recurrence combined with systemic treatment provided survival rates comparable to those after first hepatectomy.
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Affiliation(s)
- Aldrick Ruiz
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.,Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carlos Castro-Benitez
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.,Department of Surgery, Hospital Mexico, San Jose, Costa Rica
| | - Mylène Sebagh
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France
| | - Sylvie Giacchetti
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.,Département de Cancérologie, APHP, Hopital Saint Louis, Paris, France
| | - Edward Castro-Santa
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.,National Center for Transplantation and Hepato-Panacreato-Biliary Surgery of Costa Rica, San Jose, Costa Rica
| | - Dennis A Wicherts
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Bernard Paule
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France
| | - Denis Castaing
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.,Inserm, Université Paris-Sud, UMR-S 785, Villejuif, France
| | | | - René Adam
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France. .,Inserm, Université Paris-Sud, UMR-S 776, Villejuif, France.
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133
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Liver metastases from non-gastrointestinal non-neuroendocrine tumours: review of the literature. Updates Surg 2015; 67:223-33. [PMID: 26341625 DOI: 10.1007/s13304-015-0315-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 06/21/2015] [Indexed: 12/23/2022]
Abstract
Liver resection is integrated in the oncological surgical management of metastatic gastrointestinal and neuroendocrine tumours. However, the good prognosis reached in these cases has not been obtained for metastatic tumours of other histological types. In this review, we analysed the published case reports and series of hepatectomies in patients with metastatic breast cancer, melanoma, sarcoma, genitourinary tumours, pulmonary and adrenocortical tumours. From the reported data the surgical resection of oligometastases yields good results in terms of improved survival, in particular when the disease-free time period is longer than 1 year. Hepatic resection can be a valid surgical strategy to obtain a survival benefit in patients with liver metastases from non-gastrointestinal, non-neuroendocrine tumours. However, a careful patient selection is needed in order to obtain a real survival benefit; patients with a good performance status, with a disease-free period longer than 1 year and with oligometastases may obtain the best advantage from this approach.
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134
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Primary small-bowel malignancy: update in tumor biology, markers, and management strategies. J Gastrointest Cancer 2015; 45:421-30. [PMID: 25339426 DOI: 10.1007/s12029-014-9658-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Primary small-bowel malignancies (SBM) are rare tumors but their incidence is rising. An estimated 9160 new cases and 1210 deaths due to SBM may occur in the USA in 2014. We review advances made in tumor biology, immunohistochemistry, and discuss treatment strategies for these malignancies. METHODS Relevant articles from PubMed/Medline and Embase searches were collected using the phrases "small-bowel adenocarcinoma, gastrointestinal carcinoids, gastrointestinal stromal tumors, small-bowel leiomyosarcoma, and small-bowel lymphoma". RESULTS Advances in imaging techniques such as wireless capsule endoscopy, CT and MRI enterography, and endoscopy (balloon enteroscopy) along with discovery of molecular markers such as c-kit and PDGFRA for GIST tumors have improved our ability to diagnose, localize, and treat these patients. Early detection and surgical resection offers the best chance for long-term survival in all tumors except bowel lymphoma where chemotherapy plays the main role. Adjuvant therapy with imatinib has improved overall survival for GIST tumors, somatostatin analogs have improved symptoms and also inhibited tumor growth and stabilized metastatic disease in carcinoid disease, but chemotherapy has not improved survival for adenocarcinoma. CONCLUSIONS Recent advances in molecular characterization holds promise in novel targeted therapies. Currently ongoing trials are exploring efficacy of targeted therapies and role of adjuvant therapy for adenocarcinoma and results are awaited. Early detection and aggressive surgical therapy for all localized tumors and lymph node sampling particularly for adenocarcinoma remains the main treatment modality.
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135
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Hoffmann K, Bulut S, Tekbas A, Hinz U, Büchler MW, Schemmer P. Is Hepatic Resection for Non-colorectal, Non-neuroendocrine Liver Metastases Justified? Ann Surg Oncol 2015; 22 Suppl 3:S1083-92. [PMID: 26242369 DOI: 10.1245/s10434-015-4775-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Discussions about the benefit of liver resection (LRx) for non-colorectal, non-neuroendocrine metastases are controversial. This study aimed to analyze the outcome of LRx for these patients and validate a previously published prognostic risk model. METHODS The study analyzed 150 patients who underwent LRx for non-colorectal non-neuroendocrine (NCNN) metastases. Patients' demographics, tumor characteristics, treatment options, and postoperative outcome were investigated. The Kaplan-Meier method and Cox regression models were used to assess survival and prognostic variables. RESULTS After a median follow-up period of 61 months, 39 % of the patients were alive. The 30-day mortality rate was 0.7 %. The overall, disease-free, and intrahepatic recurrence-free survival rates were respectively 42, 29, and 51 % at 5 years and 28, 23, and 47 % at 10 years. The negative prognostic factors identified in the multivariate analysis were melanoma (p = 0.04), squamous tumors (p = 0.01), and a primary tumor liver metastasis, with an interval shorter than 2 years (p = 0.02), whereas the predictive prognostic factors identified were breast cancer (p = 0.04), stromal tumors (p = 0.03), and major LRx (p = 0.04). The prognostic risk score stratified patients into low risk (0-3 points: n = 50; 5-year overall survival [OS] 58 %), medium risk (4-6 points: n = 91; 5-year OS 35 %), and high risk (≥7 points: n = 9; 5-year OS, 33 %) groups (p = 0.01). CONCLUSION Liver resection for patients with NCNN metastases is a safe treatment option. More than 25 % of patients can achieve a long-term survival of 10 years when the histology of the primary tumor and the surrogates for the individual biologic tumor behavior are taken into account. Exclusion of patients with NCNN liver metastases from surgical therapy is no longer justified.
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Affiliation(s)
- Katrin Hoffmann
- Department of General, Visceral, and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany.
| | - Sümeyra Bulut
- Department of General, Visceral, and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Aysun Tekbas
- Department of General, Visceral, and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ulf Hinz
- Department of General, Visceral, and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral, and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Schemmer
- Department of General, Visceral, and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany.
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136
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Seidensticker M, Garlipp B, Scholz S, Mohnike K, Popp F, Steffen I, Seidensticker R, Stübs P, Pech M, PowerskI M, Hass P, Costa SD, Amthauer H, Bruns C, Ricke J. Locally ablative treatment of breast cancer liver metastases: identification of factors influencing survival (the Mammary Cancer Microtherapy and Interventional Approaches (MAMMA MIA) study). BMC Cancer 2015; 15:517. [PMID: 26169362 PMCID: PMC4501116 DOI: 10.1186/s12885-015-1499-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 06/18/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Liver metastases from breast cancer (LMBC) are typically considered to indicate systemic disease spread and patients are most often offered systemic palliative treatment only. However, retrospective studies suggest that some patients may have improved survival with local treatment of their liver metastases compared to systemic therapy alone. In the absence of randomized trials, it is important to identify patient characteristics indicating that benefit from local treatment can be expected. METHODS 59 patients undergoing radiofrequency ablation (RFA), interstitial brachytherapy (BT), or radioembolization (RE) of LMBC as a salvage treatment were studied. Potential factors influencing survival were analyzed in a multivariate Cox model. For factors identified to have an independent survival impact, Kaplan-Meier analysis and comparison of overall survival (OS) using the log-rank test was performed. RESULTS Median OS following local interventional treatment was 21.9 months. Considering only factors evaluable at treatment initiation, maximum diameter of liver metastases (≥3.9 cm; HR: 3.1), liver volume (≥ 1376 mL; HR: 2.3), and history of prior chemotherapy (≥ 3 lines of treatment; HR: 2.5-2.6) showed an independent survival impact. When follow-up data were included in the analysis, significant factors were maximum diameter of liver metastases (≥ 3.9 cm; HR: 3.1), control of LMBC during follow-up (HR: 0.29), and objective response as best overall response (HR: 0.21). Neither the presence of any extrahepatic metastases nor presence of bone metastases only had a significant survival impact. Median OS was 38.7 vs. 16.1 months in patients with metastases < vs. ≥ 3.9 cm, 36.6 vs. 10.2 months for patients having objective response vs. stable/progressive disease, and 38.5 vs. 14.2 months for patients having controlled vs. non-controlled disease at follow-up. CONCLUSION Local control of LMBC confers a survival benefit and local interventional treatment for LMBC should be studied in a randomized trial. Patients with small metastases and limited history of systemic LMBC treatment are most likely to benefit from local approaches. Limited extrahepatic disease should not lead to exclusion from a randomized study and should not be a contraindication for local LMBC treatment as long as no randomized data are available.
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Affiliation(s)
- Max Seidensticker
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. .,International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany.
| | - Benjamin Garlipp
- Universitätsklinik Magdeburg, Klinik für Allgemein, Viszeral- und Gefäßchirurgie, Magdeburg, Germany.
| | - Sophia Scholz
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany.
| | - Konrad Mohnike
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. .,International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany.
| | - Felix Popp
- Universitätsklinik Magdeburg, Klinik für Allgemein, Viszeral- und Gefäßchirurgie, Magdeburg, Germany.
| | - Ingo Steffen
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany.
| | - Ricarda Seidensticker
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. .,International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany.
| | - Patrick Stübs
- Universitätsklinik Magdeburg, Klinik für Allgemein, Viszeral- und Gefäßchirurgie, Magdeburg, Germany.
| | - Maciej Pech
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. .,International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany. .,Second Department of Radiology, Medical University of Gdansk, Gdansk, Poland.
| | - Maciej PowerskI
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany.
| | - Peter Hass
- Institut für Strahlentherapie, Universitätsklinik Magdeburg, Magdeburg, Germany.
| | - Serban-Dan Costa
- Universitätsklinik Magdeburg, Universitätsfrauenklinik, Magdeburg, Germany.
| | - Holger Amthauer
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. .,International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany.
| | - Christiane Bruns
- International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany. .,Universitätsklinik Magdeburg, Klinik für Allgemein, Viszeral- und Gefäßchirurgie, Magdeburg, Germany.
| | - Jens Ricke
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. .,International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany.
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137
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Uggeri F, Ronchi PA, Goffredo P, Garancini M, Degrate L, Nespoli L, Gianotti L, Romano F. Metastatic liver disease from non-colorectal, non-neuroendocrine, non-sarcoma cancers: a systematic review. World J Surg Oncol 2015; 13:191. [PMID: 26022107 PMCID: PMC4455532 DOI: 10.1186/s12957-015-0606-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 05/20/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Hepatic resection of liver metastases of non-colorectal, non-neuroendocrine, and non-sarcoma (NCNNNS) primary malignancies seems to improve survival in selected patients. The aims of the current review were to describe long-term results of surgery and to evaluate prognostic factors for survival in patients who underwent resection of NCNNNS liver metastases. METHODS We identified 30 full texts (25 single-center and 5 multicenter studies) published after year 1995 and published in English with a total of 3849 patients. For NCNNNS liver metastases, 83.4 % of these subjects were resected. RESULTS No prior systematic reviews or meta-analyses on this topic were identified. All studies were case series without matching control groups. The most common primary sites were breast (23.8 %), genito-urinary (21.8 %), and gastrointestinal tract (19.8 %). The median 5- and 10-year overall survival were 32.3 % (range 19-42 %) and 24 % (indicated only in two studies, range 23-25 %), respectively, with 71 % of R0 resections. CONCLUSIONS There is evidence suggesting that surgery of NCNNNS metastases is safe, feasible, and effective if treatment is part of a multidisciplinary approach and if indication is based on the prognostic factors underlined in literature analysis.
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Affiliation(s)
- Fabio Uggeri
- Department of Surgery and Translational Medicine, University of Milano-Bicocca, San Gerardo Hospital, via Pergolesi 33, Monza, 20900, Italy.
| | | | | | - Mattia Garancini
- Department of Surgery, San Gerardo Hospital, via Pergolesi 33, Monza, 20900, Italy.
| | - Luca Degrate
- Department of Surgery, San Gerardo Hospital, via Pergolesi 33, Monza, 20900, Italy.
| | - Luca Nespoli
- Department of Surgery and Translational Medicine, University of Milano-Bicocca, San Gerardo Hospital, via Pergolesi 33, Monza, 20900, Italy.
| | - Luca Gianotti
- Department of Surgery and Translational Medicine, University of Milano-Bicocca, San Gerardo Hospital, via Pergolesi 33, Monza, 20900, Italy.
| | - Fabrizio Romano
- Department of Surgery and Translational Medicine, University of Milano-Bicocca, San Gerardo Hospital, via Pergolesi 33, Monza, 20900, Italy.
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138
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Bacalbaşa N, Alexandrescu ST, Popescu I. A role for hepatic surgery in patients with liver metastatic breast cancer: review of literature. Hepat Oncol 2015; 2:159-170. [PMID: 30190995 PMCID: PMC6095411 DOI: 10.2217/hep.14.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Traditionally, patients with metastatic breast cancer were seen as carrying a grim prognosis and therapy was based mainly on palliative chemotherapy and hormonal therapy, with surgery being considered as ineffective. However, in the last 20 years different centers worldwide published series of metastatic breast cancer patients who underwent resection for different metastatic sites (liver, brain, lung), reporting favorable results. Most of these papers addressed to the role of liver surgery in patients with breast cancer liver metastases, mainly due to the favorable results achieved by liver resection in patients with metastatic colorectal cancer. In this review are presented the results achieved by liver surgery in patients with breast cancer liver metastases.
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Affiliation(s)
- Nicolae Bacalbaşa
- ‘Carol Davila’ University of Medicine & Pharmacy, Bucharest, Romania
| | - Sorin Tiberiu Alexandrescu
- ‘Carol Davila’ University of Medicine & Pharmacy, Bucharest, Romania
- Dan Setlacec Center of General Surgery & Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Irinel Popescu
- ‘Carol Davila’ University of Medicine & Pharmacy, Bucharest, Romania
- Dan Setlacec Center of General Surgery & Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
- Center of Digestive Diseases & Liver Transplantation, Center of General Surgery & Liver, Transplantation ‘Dan Setlacec’, of Fundeni Clinical Institute, Bucharest, Romania, Sos. Fundeni 258, Bucharest 022328, Romania
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139
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Kast K, Link T, Friedrich K, Petzold A, Niedostatek A, Schoffer O, Werner C, Klug SJ, Werner A, Gatzweiler A, Richter B, Baretton G, Wimberger P. Impact of breast cancer subtypes and patterns of metastasis on outcome. Breast Cancer Res Treat 2015; 150:621-9. [PMID: 25783184 DOI: 10.1007/s10549-015-3341-3] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 03/10/2015] [Indexed: 01/07/2023]
Abstract
Clinical outcome of patients with stage IV breast cancer is dependent on tumor biology, extent, and localization of metastases. Routine imaging diagnostics for distant metastasis is not recommended by the national guidelines for breast cancer follow-up. In this study, we evaluated different patterns of metastases of cancer subtypes in order to generate hypotheses on individualization of follow-up after breast cancer in the adjuvant setting. Patients of the Regional Breast Cancer Center Dresden diagnosed within the years 2006-2011 were classified into the five intrinsic subtypes luminal A (ER+, Her2-, G1/2), luminal B/Her2 negative (ER+, Her2-, G3), triple positive (ER+, PR+, Her2+), Her2-enriched (ER-, Her2+), and triple negative (ER-, PR-, Her2-) and with a median follow-up of 45 months. Tumor stage at time of first diagnosis of breast cancer as well as time and site of metastasis at first diagnosis of distant metastatic disease was analyzed. Tumor specimen of 2284 female patients with primary breast cancer was classified into five subtypes. Distant recurrence-free survival at 3 years was most unfavorable in Her2-enriched (66.8 %), triple negative (75.9 %), and triple-positive breast cancer (81.7 %). The same subtypes most frequently presented with visceral metastases only at first presentation: Her2-enriched 46.9 %, triple negative 45.5 %, and triple-positive breast cancer 37.5 %. Longest median survival of 2.3 years was seen in luminal A and in Her2-enriched metastatic disease, respectively. Median survival was significantly better in the luminal A, Her2-enriched, and triple-positive subtype compared to triple-negative breast cancer (p < 0.005). Differences in time to metastatic disease, first localization of metastases, and overall survival after diagnosis of metastatic disease were shown. Considering new targeted therapies and the option of surgery of oligometastases, screening for visceral metastases might be reasonable after diagnosis of Her2-positive subtypes.
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Affiliation(s)
- Karin Kast
- Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany,
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140
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Zanini N, Lombardi R, Masetti M, Giordano M, Landolfo G, Jovine E. Surgery for isolated liver metastases from pancreatic cancer. Updates Surg 2015; 67:19-25. [PMID: 25702263 DOI: 10.1007/s13304-015-0283-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 02/05/2015] [Indexed: 12/16/2022]
Abstract
The resection of liver metastases from pancreatic ductal adenocarcinoma has been discouraged because it is commonly thought that it does not improve survival. However, the role of potential prognostic factors is unclear, and universally accepted strategies have not been proposed. Between 2003 and 2014, 15 patients with isolated synchronous or metachronous metastases from pancreatic cancer underwent liver resection in our department. The role of potential prognostic factors was analyzed to predict survival. One right hepatectomy, 1 bisegmentectomy and 13 wedge resections were performed. Eleven patients underwent simultaneous pancreatic and liver resection for synchronous disease. The median overall survival (OS) was 9.1 months (95% CI 8.6-9.7). The only potential prognostic factor that significatively affected survival was the timing of metastases (metachronous vs. synchronous). Median OS in patients with metachronous disease was 11.4 months (95% CI 0-25.1) vs. 8.3 months (95% CI 6.9-9.7), p = 0.038. Surgery for liver metastases from pancreatic cancer is not suggested for most patients. If resection is considered, timing of metastatic disease could be a prognostic factor for survival after surgery.
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Affiliation(s)
- Nicola Zanini
- Department of Surgery, Maggiore Hospital, Bologna, Italy,
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141
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Ma R, Feng Y, Lin S, Chen J, Lin H, Liang X, Zheng H, Cai X. Mechanisms involved in breast cancer liver metastasis. J Transl Med 2015; 13:64. [PMID: 25885919 PMCID: PMC4440291 DOI: 10.1186/s12967-015-0425-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 01/30/2015] [Indexed: 12/25/2022] Open
Abstract
Liver metastasis is a frequent occurrence in patients with breast cancer; however, the available treatments are limited and ineffective. While liver-specific homing of breast cancer cells is an important feature of metastasis, the formation of liver metastases is not random. Indeed, breast cancer cell factors contribute to the liver microenvironment. Major breakthroughs have been achieved recently in understanding breast cancer liver metastasis (BCLM). The process of liver metastasis consists of multiple steps and involves various factors from breast cancer cells and the liver microenvironment. A further understanding of the roles of breast cancer cells and the liver microenvironment is crucial to guide future work in clinical treatments. In this review we discuss the contribution of breast cancer cells and the liver microenvironment to liver metastasis, with the aim to improve therapeutic efficacy for patients with BCLM.
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Affiliation(s)
- Rui Ma
- Department of Surgery, Zhejiang University Hospital, Zhejiang University, Hangzhou, Zhejiang, 310027, China.
| | - Yili Feng
- Department of General Surgery, Institute of Minimally Invasive Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China.
| | - Shuang Lin
- Department of General Surgery, Institute of Minimally Invasive Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China.
| | - Jiang Chen
- Department of General Surgery, Institute of Minimally Invasive Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China.
| | - Hui Lin
- Department of General Surgery, Institute of Minimally Invasive Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China.
| | - Xiao Liang
- Department of General Surgery, Institute of Minimally Invasive Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China.
| | - Heming Zheng
- Department of General Surgery, Institute of Minimally Invasive Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China.
| | - Xiujun Cai
- Department of General Surgery, Institute of Minimally Invasive Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China.
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142
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Vertriest C, Berardi G, Tomassini F, Vanden Broucke R, Depypere H, Cocquyt V, Denys H, Van Belle S, Troisi RI. Resection of single metachronous liver metastases from breast cancer stage I-II yield excellent overall and disease-free survival. Single center experience and review of the literature. Dig Surg 2015; 32:52-9. [PMID: 25675843 DOI: 10.1159/000375132] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/07/2015] [Indexed: 12/10/2022]
Abstract
PURPOSE Improved survival after liver resection for breast cancer liver metastases (BCLM) has been proven; however, there is still controversy on predictive factors influencing outcomes. The analysis of factors related to primary and metastatic cancer eventually influencing long-term outcomes and a review of the literature are presented in this report. METHODS Twenty-seven patients diagnosed with metachronous BCLM between 1996 and 2013 were retrospectively reviewed. Patients who had a minimum disease-free interval between primary tumor and liver metastasis of 12 months, no more than 3 liver lesions, no macroscopic extra-hepatic disease and in which systemic therapy showed a good response were included. RESULTS Twenty-two patients (82%) were initially diagnosed with a stage I-II disease. Twelve patients presented with multiple liver metastases. The 5 years overall survival (OS) rate was 78%, while the 5 years disease-free survival (DFS) rate was 36%. Initial tumor stage III-IV at first diagnosis and number of metastases >1 was significantly associated with a shorter DFS at multivariate analysis (p = 0.03 and p = 0.04 respectively). Patients with multiple lesions had a median DFS of 15 months compared to 47 months in patients with a single lesion (p = 0.03). CONCLUSIONS Resection of single BCLM from primary stage I-II cancer offers very good long-term survival rates and a low morbidity.
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Affiliation(s)
- Céline Vertriest
- Department of Obstetrics and Gynecology, Ghent University Hospital and Medical School, Ghent, Belgium
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143
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Lee SY, Sadot E. Does liver resection provide long-term survival benefits for breast cancer patients with liver metastasis? A question yet to be answered. Yonsei Med J 2015; 56:309-10. [PMID: 25510782 PMCID: PMC4276774 DOI: 10.3349/ymj.2015.56.1.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Ser Yee Lee
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.; Department of Surgical Oncology, National Cancer Centre, Singapore.; Duke-National University of Singapore (NUS) Graduate Medical School, Singapore.
| | - Eran Sadot
- Department of Surgery, Division of Surgical Oncology, Rabin Medical Center, Petach Tikva, Israel.; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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144
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Ciacio O, Voron T, Pittau G, Lewin M, Vibert E, Adam R, Sa Cunha A, Cherqui D, Schielke A, Soubrane O, Scatton O, Salloum C, Azoulay D, Benoist S, Goyer P, Vaillant JC, Hannoun L, Boleslawski E, Agostini H, Samuel D, Castaing D. Interest of preoperative immunonutrition in liver resection for cancer: study protocol of the PROPILS trial, a multicenter randomized controlled phase IV trial. BMC Cancer 2014; 14:980. [PMID: 25523036 PMCID: PMC4302113 DOI: 10.1186/1471-2407-14-980] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 11/26/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Malnutrition is an independent risk factor of postoperative morbidity and mortality and it's observed in 20 to 50% of surgical patients. Preoperative interventions to optimize the nutritional status, reduce postoperative complications and enteral nutrition has proven to be superior to the parenteral one. Moreover, regardless of the nutritional status of the patient, surgery impairs the immunological response, thus increasing the risk of postoperative sepsis. Immunonutrition has been developed to improve the immunometabolic host response in perioperative period and it has been proven to reduce significantly postoperative infectious complications and length of hospital stay in patients undergoing elective gastrointestinal surgery for tumors. We hypothesize that a preoperative oral immunonutrition (ORAL IMPACT®) can reduce postoperative morbidity in liver resection for cancer. METHODS/DESIGN Prospective multicenter randomized placebo-controlled double-blind phase IV trial with two parallel treatment groups receiving either study product (ORAL IMPACT®) or control supplement (isocaloric isonitrogenous supplement--IMPACT CONTROL®) for 7 days before liver resection for cancer. A total of 400 patients will be enrolled. Patients will be stratified according to the type of hepatectomy, the presence of chronic liver disease and the investigator center. The main end-point is to evaluate in intention-to-treat analysis the overall 30-day morbidity. Secondary end-points are to assess the 30-day infectious and non-infectious morbidity, length of antibiotic treatment and hospital stay, modifications on total food intake, compliance to treatment, side-effects of immunonutrition, impact on liver regeneration and sarcopenia, and to perform a medico-economic analysis. DISCUSSION The overall morbidity rate after liver resection is 22% to 42%. Infectious post-operative complications (12% to 23%) increase the length of hospital stay and costs and are responsible for a quarter of 30-day mortality. Various methods have been advocated to decrease the rate of postoperative complications but there is no evidence to support or refute the use of any treatment and further trials are required. The effects of preoperative oral immunonutrition in non-cirrhotic patients undergoing liver resection for cancer are unknown. The present trial is designed to evaluate whether the administration of a short-term preoperative oral immunonutrition can reduce postoperative morbidity in non-cirrhotic patients undergoing liver resection for cancer. TRIAL REGISTRATION Clinicaltrial.gov: NCT02041871.
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Affiliation(s)
- Oriana Ciacio
- Centre Hépato-biliaire, Paul Brousse Hospital - APHP, 12-14 Avenue Paul Vaillant Couturier, 94800 Villejuif, France.
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145
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Suh CH, Tirumani SH, Shinagare AB, Kim KW, Rosenthal MH, Ramaiya NH, Baheti AD. Diagnosis and management of duodenal adenocarcinomas: a comprehensive review for the radiologist. ACTA ACUST UNITED AC 2014; 40:1110-20. [DOI: 10.1007/s00261-014-0309-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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146
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Huang F, Wu G, Yang K. Oligometastasis and oligo-recurrence: more than a mirage. Radiat Oncol 2014; 9:230. [PMID: 25359216 PMCID: PMC4222373 DOI: 10.1186/s13014-014-0230-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 10/04/2014] [Indexed: 12/22/2022] Open
Abstract
The standard treatment choice for cancer metastasis has been systemic management, including cytotoxic chemotherapy, hormonal manipulation, and targeted therapy. Emerging evidence has shown an oligometastatic state, an intermediate state between limited primary cancer and polymetastatic cancer, in which local therapy for metastatic lesions results in satisfactory survival comparable to non-metastatic disease. We provide a comprehensive introduction of evidence from experimental and clinical studies in favor of the oligometastatic phenotype, we review the efficacy and safety of surgery and stereotactic body radiotherapy in the treatment of oligometastases, and finally, we discuss the way to differentiate the oligometastatic state from polymetastasis.
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Affiliation(s)
- Fang Huang
- Wuhan Union Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
| | - Gang Wu
- Wuhan Union Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
| | - Kunyu Yang
- Wuhan Union Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
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147
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Mátrai Z, Rényi Vámos F. [Surgical possibilities in the treatment of advanced and locally recurrent breast cancers]. Orv Hetil 2014; 155:1461-8. [PMID: 25194868 DOI: 10.1556/oh.2014.29891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Stage IV breast cancer is an incurable but treatable condition. Therapy of distant metastatic disease consists primarily of systemic and symptomatic treatments, while the role of surgery is subordinate. Conventional medical treatments result in 18-24 months average overall survival, and about 5-20% 5-year overall survival. However, it seems that in selected cases with solitary or oligometastases, mainly in those which respond well to drug therapy, the aggressive surgical removal of both the primary tumour and visceral metastases results in a survival advantage. After accurate evaluation of the patients, the indication for surgical treatment should be established through a biological and multidisciplinary approach. Other possible indications for surgical treatment are ulceration, bleeding, hygienic conditions undignified of human life, central nervous system metastases, acute neurological disorders, hydro- and pneumothorax greatly reducing respiratory surface and impending fractures. Surgical procedures include simple pleural drainage, minimal invasive techniques, large body cavity surgeries, extensive resection of soft tissue and chest wall due to the primary tumor, and plastic surgical reconstruction as well. Scientific assessment of the oncological value of surgical oncological interventions in stage IV. breast cancer require further multicentric prospective comparative studies. The present paper provides a broad review of the literature on surgical interventions and results in patients with breast cancer and remote metastases, and the surgical options of locally recurrent tumours.
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Affiliation(s)
- Zoltán Mátrai
- Országos Onkológiai Intézet, Daganatsebészeti Központ Emlő- és Lágyrészsebészeti Osztály Budapest Ráth Gy. u. 7-9. 1125
| | - Ferenc Rényi Vámos
- Országos Onkológiai Intézet, Daganatsebészeti Központ Mellkassebészeti Osztály Budapest
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148
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Tiberio GAM, Baiocchi GL, Morgagni P, Marrelli D, Marchet A, Cipollari C, Graziosi L, Ministrini S, Vittimberga G, Donini A, Nitti D, Roviello F, Coniglio A, de Manzoni G. Gastric cancer and synchronous hepatic metastases: is it possible to recognize candidates to R0 resection? Ann Surg Oncol 2014; 22:589-96. [PMID: 25190117 DOI: 10.1245/s10434-014-4018-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE Management of patients with synchronous hepatic metastases as the sole metastatic site at diagnosis of gastric cancer is debated. We studied a cohort of patients admitted to surgical units, investigating prognostic factors of clinical relevance and the results of various therapeutic strategies. METHODS Retrospective multicentre chart review. We evaluated how survival from surgery was influenced by patient-related, gastric cancer-related, metastasis-related and treatment-related candidate prognostic factors. RESULTS Forty-four patients received palliative surgery without resection, 98 palliative gastrectomy (in 16 cases associated with R+ hepatectomy), whereas 53 patients received both curative gastrectomy and hepatic resection(s) (R0). Adjuvant chemotherapy was administered to 44 patients. Therapeutic approach was selected on the basis of extension of disease, patient's general conditions and surgeon's attitude. Surgical mortality was 4.6 % and morbidity was 17.4 %. Survival was independently influenced by the factor T of the gastric primary (p = 0.036) and by the degree of hepatic involvement (p = 0.010). T > 2 and H3 liver involvement were associated with worse prognosis with cumulative effect (p = 0.002). Therapeutic approach to the metastases (p = 0.009) and adjuvant chemotherapy (p < 0.001) displayed independent impact upon survival, with benefit for those receiving aggressive multimodal treatment. The 1-, 3-, and 5-year survival rates were 50.4, 14.0, and 9.3 %, respectively, for patients submitted to curative surgery, 16, 8.5, and 4.3 % after palliative gastrectomy, and 6.8, 2.3, and 0 % after palliative surgery without resection. CONCLUSIONS Our data suggest some clinical criteria that may facilitate selection of candidates to curative surgery, which offers the best survival chances, especially when associated with adjuvant chemotherapy.
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149
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Fitzgerald TL, Brinkley J, Banks S, Vohra N, Englert ZP, Zervos EE. The benefits of liver resection for non-colorectal, non-neuroendocrine liver metastases: a systematic review. Langenbecks Arch Surg 2014; 399:989-1000. [PMID: 25148767 DOI: 10.1007/s00423-014-1241-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 08/11/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE Defining the benefits of resection of isolated non-colorectal, non-neuroendocrine (NCRNNE) liver metastases is difficult. To better understand the survival benefit in this group of patients, we conducted a systematic review of the previous literature. METHODS Medline, Web of Knowledge, and manual searches were performed using search terms, such as "liver resection" and "primary tumor." Inclusion criteria were year>1990, >five patients, and median survival reported or derived. An expected median survival was calculated from weighted averages of median survivals, and differences were assessed using a permutation test. RESULTS A total of 7,857 references were identified. Overall 4,735 abstracts were reviewed; 120 manuscripts evaluated and of these, 73 met the study inclusion criteria. The final population consisted of 3,596 patients with renal (n=234), ovarian (n=119), testicular (n=153), adrenal (n=90), small bowel (n=28), gallbladder (n=21), duodenum (n=38), gastric (n=481), pancreatic (n=55), esophageal (n=23), head and neck (n=15), and lung (n=36) cancers, gastrointestinal stromal tumors (GISTs) (n=106), cholangiocarcinoma (n=13), sarcoma (n=189), and melanoma (n=643). The greatest expected median was 63 months for genitourinary (GU) primaries (n=549; range 5.4-142 months) followed by 44.4 months for breast cancer (n=1,013; range 8-74 months), 22.3 months for gastrointestinal cancer (n=549; range 5-58 months), and 23.7 months for other tumor types (n=1,082; range 10-72 months). Using a permutation test, we observed that survival was best for patients with GU primaries followed by that for breast cancer patients. Additionally, we also observed that survival was similar for those with cancer of the GI tract and other primary sites. CONCLUSIONS There appears to be a benefit to resection for patients with NCRNNE liver metastases. The degree of survival advantage is predicated by primary site.
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Affiliation(s)
- Timothy L Fitzgerald
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine, East Carolina University, 4S24 600 Moye Boulevard, Greenville, NC, 27834, USA,
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150
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Stereotactic body radiotherapy for liver tumors. Strahlenther Onkol 2014; 190:872-81. [DOI: 10.1007/s00066-014-0714-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 06/28/2014] [Indexed: 12/14/2022]
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