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Mendiratta-Lala M, Wiggermann P, Pech M, Serres-Créixams X, White SB, Davis C, Ahmed O, Parikh ND, Planert M, Thormann M, Xu Z, Collins Z, Narayanan G, Torzilli G, Cho C, Littler P, Wah TM, Solbiati L, Ziemlewicz TJ. The #HOPE4LIVER Single-Arm Pivotal Trial for Histotripsy of Primary and Metastatic Liver Tumors. Radiology 2024; 312:e233051. [PMID: 39225612 DOI: 10.1148/radiol.233051] [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: 09/04/2024]
Abstract
Background Histotripsy is a nonthermal, nonionizing, noninvasive, focused US technique that relies on cavitation for mechanical tissue breakdown at the focal point. Preclinical data have shown its safety and technical success in the ablation of liver tumors. Purpose To evaluate the safety and technical success of histotripsy in destroying primary or metastatic liver tumors. Materials and Methods The parallel United States and European Union and England #HOPE4LIVER trials were prospective, multicenter, single-arm studies. Eligible patients were recruited at 14 sites in Europe and the United States from January 2021 to July 2022. Up to three tumors smaller than 3 cm in size could be treated. CT or MRI and clinic visits were performed at 1 week or less preprocedure, at index-procedure, 36 hours or less postprocedure, and 30 days postprocedure. There were co-primary end points of technical success of tumor treatment and absence of procedure-related major complications within 30 days, with performance goals of greater than 70% and less than 25%, respectively. A two-sided 95% Wilson score CI was derived for each end point. Results Forty-four participants (21 from the United States, 23 from the European Union or England; 22 female participants, 22 male participants; mean age, 64 years ± 12 [SD]) with 49 tumors were enrolled and treated. Eighteen participants (41%) had hepatocellular carcinoma and 26 (59%) had non-hepatocellular carcinoma liver metastases. The maximum pretreatment tumor diameter was 1.5 cm ± 0.6 and the maximum post-histotripsy treatment zone diameter was 3.6 cm ± 1.4. Technical success was observed in 42 of 44 treated tumors (95%; 95% CI: 84, 100) and procedure-related major complications were reported in three of 44 participants (7%; 95% CI: 2, 18), both meeting the performance goal. Conclusion The #HOPE4LIVER trials met the co-primary end-point performance goals for technical success and the absence of procedure-related major complications, supporting early clinical adoption. Clinical trial registration nos. NCT04572633, NCT04573881 Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Nezami and Georgiades in this issue.
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Affiliation(s)
- Mishal Mendiratta-Lala
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Philipp Wiggermann
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Maciej Pech
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Xavier Serres-Créixams
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Sarah B White
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Clifford Davis
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Osman Ahmed
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Neehar D Parikh
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Mathis Planert
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Maximilian Thormann
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Zhen Xu
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Zachary Collins
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Govindarajan Narayanan
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Guido Torzilli
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Clifford Cho
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Peter Littler
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Tze Min Wah
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Luigi Solbiati
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Timothy J Ziemlewicz
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
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2
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Endo Y, Alaimo L, Moazzam Z, Woldesenbet S, Lima HA, Yang J, Munir MM, Shaikh CF, Azap L, Katayama E, Rueda BO, Guglielmi A, Ruzzenente A, Aldrighetti L, Alexandrescu S, Kitago M, Poultsides G, Sasaki K, Aucejo F, Pawlik TM. Optimal policy tree to assist in adjuvant therapy decision-making after resection of colorectal liver metastases. Surgery 2024; 175:645-653. [PMID: 37778970 DOI: 10.1016/j.surg.2023.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/03/2023] [Accepted: 06/18/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Although systemic postoperative therapy after surgery for colorectal liver metastases is generally recommended, the benefit of adjuvant chemotherapy has been debated. We used machine learning to develop a decision tree and define which patients may benefit from adjuvant chemotherapy after hepatectomy for colorectal liver metastases. METHODS Patients who underwent curative-intent resection for colorectal liver metastases between 2000 and 2020 were identified from an international multi-institutional database. An optimal policy tree analysis was used to determine the optimal assignment of the adjuvant chemotherapy to subgroups of patients for overall survival and recurrence-free survival. RESULTS Among 1,358 patients who underwent curative-intent resection of colorectal liver metastases, 1,032 (76.0%) received adjuvant chemotherapy. After a median follow-up of 28.7 months (interquartile range 13.7-52.0), 5-year overall survival was 67.5%, and 3-year recurrence-free survival was 52.6%, respectively. Adjuvant chemotherapy was associated with better recurrence-free survival (3-year recurrence-free survival: adjuvant chemotherapy, 54.4% vs no adjuvant chemotherapy, 46.8%; P < .001) but no overall survival significant improvement (5-year overall survival: adjuvant chemotherapy, 68.1% vs no adjuvant chemotherapy, 65.7%; P = .15). Patients were randomly allocated into 2 cohorts (training data set, n = 679, testing data set, n = 679). The random forest model demonstrated good performance in predicting counterfactual probabilities of death and recurrence relative to receipt of adjuvant chemotherapy. According to the optimal policy tree, patient demographics, secondary tumor characteristics, and primary tumor characteristics defined the subpopulation that would benefit from adjuvant chemotherapy. CONCLUSION A novel artificial intelligence methodology based on patient, primary tumor, and treatment characteristics may help clinicians tailor adjuvant chemotherapy recommendations after colorectal liver metastases resection.
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Affiliation(s)
- Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Laura Alaimo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH; Department of Surgery, University of Verona, Italy
| | - Zorays Moazzam
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Henrique A Lima
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Jason Yang
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Chanza F Shaikh
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Lovette Azap
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Erryk Katayama
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Belisario Ortiz Rueda
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | | | | | | | | | - Minoru Kitago
- Department of Surgery, Keio University, Tokyo, Japan
| | | | | | - Federico Aucejo
- Department of General Surgery, Cleveland Clinic Foundation, OH
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
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Knavel Koepsel EM, Smolock AR, Pinchot JW, Kim CY, Ahmed O, Chamarthy MRK, Hecht EM, Hwang GL, Kaplan DE, Luh JY, Marrero JA, Monroe EJ, Poultsides GA, Scheidt MJ, Hohenwalter EJ. ACR Appropriateness Criteria® Management of Liver Cancer: 2022 Update. J Am Coll Radiol 2022; 19:S390-S408. [PMID: 36436965 DOI: 10.1016/j.jacr.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
The treatment and management of hepatic malignancies can be complex because it encompasses a variety of primary and metastatic malignancies and an assortment of local and systemic treatment options. When to use each of these treatments is critical to ensure the most appropriate care for patients. Interventional radiologists have a key role to play in the delivery of a variety of liver directed treatments including percutaneous ablation, transarterial embolization with bland embolic particles alone, transarterial chemoembolization (TACE) with injection of a chemotherapeutic emulsion, and transarterial radioembolization (TARE). Based on 9 clinical variants, the appropriateness of each treatment is described in this document. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Amanda R Smolock
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Charles Y Kim
- Panel Vice-Chair, Duke University Medical Center, Durham, North Carolina
| | - Osmanuddin Ahmed
- Vice-Chair of Wellness, Director of Venous Interventions, University of Chicago, Chicago, Illinois
| | - Murthy R K Chamarthy
- Vascular Institute of North Texas, Dallas, Texas; Commission on Nuclear Medicine and Molecular Imaging
| | - Elizabeth M Hecht
- Vice-Chair of Academic Affairs, Professor of Radiology, Weill Cornell Medicine, New York, New York; RADS Committee; Member of Appropriateness Subcommittees on Hepatobiliary Topics; Member of LI-RADS
| | - Gloria L Hwang
- Associate Chair of Clinical Performance Improvement, Stanford Radiology, Stanford Medical Center, Stanford, California
| | - David E Kaplan
- Section Chief of Hepatology at the University of Pennsylvania Division of Gastroenterology and Hepatology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania; American Association for the Study of Liver Diseases
| | - Join Y Luh
- Providence Health Radiation Oncology Focus Group Chair, Providence St. Joseph Health, Eureka, California; Commission on Radiation Oncology; ACR CARROS President; ACR Council Steering Committee; California Radiological Society Councilor to ACR
| | - Jorge A Marrero
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; American Gastroenterological Association
| | | | - George A Poultsides
- Chief of Surgical Oncology and Professor of Surgery, Stanford University School of Medicine, Stanford, California; Society of Surgical Oncology
| | - Matthew J Scheidt
- Program Director of Independent IR Residency, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Eric J Hohenwalter
- Specialty Chair; Chief, MCW VIR, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
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Vidal-Jove J, Serres-Creixams X, Ziemlewicz TJ, Cannata JM. Liver Histotripsy Mediated Abscopal Effect-Case Report. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:3001-3005. [PMID: 34310299 DOI: 10.1109/tuffc.2021.3100267] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We present a case report that shows an abscopal effect in the context of a safety and efficacy clinical trial for histotripsy as ablation technique in liver tumors. The abscopal effect appears in the form of reduction in the volume of nontreated tumor lesions in the same organ, as well as sustained reduction of tumor marker [carcinoembryonic antigen (CEA)] that extends weeks away of the procedure. Histotripsy is a novel noninvasive, nonthermal, and nonionizing precise ablation technique for tissue destruction guided by ultrasonography. We discuss the feasibility of this technique compared with other focal therapies and its possibilities as immune system enhancer.
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5
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Majlesara A, Ghamarnejad O, Khajeh E, Golriz M, Gharabaghi N, Hoffmann K, Chang DH, Büchler MW, Mehrabi A. Portal vein arterialization as a salvage procedure in hepatopancreatobiliary surgery: a systematic review. Can J Surg 2021; 64:E173-E182. [PMID: 33739801 PMCID: PMC8064267 DOI: 10.1503/cjs.012419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Portal vein arterialization (PVA) is a possible option when hepatic artery reconstruction is impossible during liver resection. The aim of this study was to review the literature on the clinical application of PVA in hepatopancreatobiliary (HPB) surgery. Methods We performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched the PubMed, Embase and Web of Science databases until December 2019. Experimental (animal) studies, review articles and letters were excluded. Results Twenty studies involving 57 patients were included. Cholangiocarcinoma was the most common indication for surgery (40 patients [74%]). An end-to-side anastomosis between a celiac trunk branch and the portal vein was the main PVA technique (35 patients [59%]). Portal hypertension was the most common long-term complication (12 patients [21%] after a mean of 4.1 mo). The median follow-up period was 12 (range 1–87) months. The 1-, 3- and 5-year survival rates were 64%, 27% and 20%, respectively. Conclusion Portal vein arterialization can be considered as a rescue option to improve the outcome in patients with acute liver de-arterialization when arterial reconstruction is not possible. To prevent portal hypertension and liver injuries due to thrombosis or overarterialization, vessel calibre adjustment and timely closure of the anastomosis should be considered. Further prospective experimental and clinical studies are needed to investigate the potential of this procedure in patients whose liver is suddenly de-arterialized during HPB procedures.
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Affiliation(s)
- Ali Majlesara
- From the Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (Majlesara, Ghamarnejad, Khajeh, Golriz, Gharabaghi, Hoffman, Büchler, Mehrabi); and the Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (Chang)
| | - Omid Ghamarnejad
- From the Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (Majlesara, Ghamarnejad, Khajeh, Golriz, Gharabaghi, Hoffman, Büchler, Mehrabi); and the Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (Chang)
| | - Elias Khajeh
- From the Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (Majlesara, Ghamarnejad, Khajeh, Golriz, Gharabaghi, Hoffman, Büchler, Mehrabi); and the Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (Chang)
| | - Mohammad Golriz
- From the Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (Majlesara, Ghamarnejad, Khajeh, Golriz, Gharabaghi, Hoffman, Büchler, Mehrabi); and the Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (Chang)
| | - Negin Gharabaghi
- From the Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (Majlesara, Ghamarnejad, Khajeh, Golriz, Gharabaghi, Hoffman, Büchler, Mehrabi); and the Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (Chang)
| | - Katrin Hoffmann
- From the Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (Majlesara, Ghamarnejad, Khajeh, Golriz, Gharabaghi, Hoffman, Büchler, Mehrabi); and the Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (Chang)
| | - De-Hua Chang
- From the Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (Majlesara, Ghamarnejad, Khajeh, Golriz, Gharabaghi, Hoffman, Büchler, Mehrabi); and the Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (Chang)
| | - Markus W Büchler
- From the Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (Majlesara, Ghamarnejad, Khajeh, Golriz, Gharabaghi, Hoffman, Büchler, Mehrabi); and the Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (Chang)
| | - Arianeb Mehrabi
- From the Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (Majlesara, Ghamarnejad, Khajeh, Golriz, Gharabaghi, Hoffman, Büchler, Mehrabi); and the Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (Chang)
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Robles-Campos R, Brusadin R, López-Conesa A, López-López V, Navarro-Barrios Á, López-Espín JJ, Arévalo-Pérez J, Parrilla P. Long-Term Outcome After Conventional Two-Stage Hepatectomy Versus Tourniquet-ALPPS in Colorectal Liver Metastases: A Propensity Score Matching Analysis. World J Surg 2019; 43:2281-2289. [PMID: 31119359 DOI: 10.1007/s00268-019-05031-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND To compare the overall survival (OS) and disease-free survival (DFS) of Tourniquet-ALPPS (T-ALPPS) and conventional two-stage hepatectomy (TSH) in patients with colorectal liver metastases (CRLM). METHODS A retrospective study from a prospectively collected database was performed between October 2000 and July 2016. TSH was performed before September 2011, after which time T-ALPPS became the technique of choice. A propensity score matching (PSM) was performed based on a 1:1 ratio with consideration of the following variables: number and size of metastases, bilobar disease presence, and chemotherapy received. RESULTS Thirty-four patients received T-ALPPS; 41 patients received TSH. After PSM, 21 patients remained in each group, with 100% resectability in the T-ALPPS group and 90.5% resectability in the TSH group. The median OS for TSH was 41 months; for T-ALPPS, the median OS was 36 months (P = 0.925). The median DFS was 16 months in the TSH group; the median DFS was 9 months in the T-ALPPS group (P = 0.930). The 1-, 3-, and 5-year OS for TSH was 81%, 66.7%, and 23.8% vs. 76.2%, 57.1%, and 22.9% for T-ALPPS, respectively. The 1-, 3-, and 5-year DFS for TSH was 66.7%, 9.5%, and 5% vs. 44.6%, 11.1%, and 11.1% for T-ALPPS, respectively. The volume increase with T-ALPPS was superior to that with TSH (68% vs. 39%; P = 0.018). There were no differences in morbidity and mortality after stages 1 and 2. CONCLUSIONS T-ALPPS produces a similar outcome to TSH, indicating that it could be a safe and effective alternative for curative hepatectomy for all patients.
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Affiliation(s)
- Ricardo Robles-Campos
- Department of Liver Surgery and Transplantation, Virgen de La Arrixaca Clinic, University Hospital, IMIB-Arrixaca, Murcia, Spain. .,Department of Surgery, Virgen de La Arrixaca Clinic, University Hospital, El Palmar, Murcia, Spain.
| | - Roberto Brusadin
- Department of Liver Surgery and Transplantation, Virgen de La Arrixaca Clinic, University Hospital, IMIB-Arrixaca, Murcia, Spain
| | - Asunción López-Conesa
- Department of Liver Surgery and Transplantation, Virgen de La Arrixaca Clinic, University Hospital, IMIB-Arrixaca, Murcia, Spain
| | - Víctor López-López
- Department of Liver Surgery and Transplantation, Virgen de La Arrixaca Clinic, University Hospital, IMIB-Arrixaca, Murcia, Spain
| | - Álvaro Navarro-Barrios
- Department of Liver Surgery and Transplantation, Virgen de La Arrixaca Clinic, University Hospital, IMIB-Arrixaca, Murcia, Spain
| | | | | | - Pascual Parrilla
- Department of Liver Surgery and Transplantation, Virgen de La Arrixaca Clinic, University Hospital, IMIB-Arrixaca, Murcia, Spain
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Two-Stage Hepatectomy and ALPPS for Advanced Bilateral Liver Metastases: a Tailored Approach Balancing Risk and Outcome. J Gastrointest Surg 2019; 23:2391-2400. [PMID: 30820795 DOI: 10.1007/s11605-019-04145-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/29/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIM Two-stage hepatectomy (TSH) with or without portal vein ligation (PVL) or portal vein embolization (PVE) and associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) are surgical strategies in the treatment of advanced colorectal liver metastases (CRLM). The role of each strategy is yet ill defined. The aim of this analysis is to share our center experience with conventional TSH with or without PVL/PVE and ALPPS in patients with advanced bilateral CRLM. PATIENTS AND METHODS Data were extracted from a prospectively collected institutional database. Complication rates according to the Dindo-Clavien classification, overall and recurrence-free survival data were analyzed. RESULTS Between 2008 and 2017, 790 liver resections were performed in 611 patients with CRLM. Out of 320 patients with bilateral disease, TSH (as right or extended right hepatectomy) with or without PVL/PVE was performed in 50 patients and ALPPS in 8. Stage 2 was completed in 36 (72%) out of 50 TSH/PVL/PVE and in all ALPPS patients (100%). Median follow-up was 15.8 months (0.9 to 111.9 months). On an intention-to-treat basis, the median overall survival was 26.7 (21.8-35.1 range) months after TSH/PVL/PVE and 36.2 months (11.3-61.2 range) after ALPPS (p = 0.809). In the TSH/PVL/PVE cohort, the median overall survival was 29.9 (19.0-40.3) months in patients who completed stage 2 compared to 13.8 months in patients who did not (p < 0.001). Disease recurred in 60% in the TSH/PVL/PVE cohort and in 87.5% in the ALPPS cohort (p = 0.777). The median recurrence-free survival was 5.9 (1.7-18.6) months after TSH/PVL/PVE and 3 (1.6-14.8) months after ALPPS (p = 0.680). CONCLUSION The treatment of advanced bilateral CRLM remains a surgical and oncological challenge. A tailored approach to bilateral CRLM uses TSH/PVL/PVE as first and ALPPS as second rescue treatment in order to achieve resectability in patients with extensive tumor burden not amenable to one-stage resection. ALPPS should be reserved for patients with no other surgical options.
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Huiskens J, Bolhuis K, Engelbrecht MR, De Jong KP, Kazemier G, Liem MS, Verhoef C, de Wilt JH, Punt CJ, van Gulik TM. Outcomes of Resectability Assessment of the Dutch Colorectal Cancer Group Liver Metastases Expert Panel. J Am Coll Surg 2019; 229:523-532.e2. [PMID: 31520695 DOI: 10.1016/j.jamcollsurg.2019.08.1445] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Decision making on optimal treatment strategy in patients with initially unresectable colorectal cancer liver metastases (CRLM) remains complex because uniform criteria for (un)resectability are lacking. This study reports on the feasibility and short-term outcomes of The Dutch Colorectal Cancer Group Liver Expert Panel. STUDY DESIGN The Expert Panel consists of 13 hepatobiliary surgeons and 4 radiologists. Resectability assessment is performed independently by 3 randomly assigned surgeons, and CRLM are scored as resectable, potentially resectable, or permanently unresectable. In absence of consensus, 2 additional surgeons are invited for a majority consensus. Patients with potentially resectable or unresectable CRLM at baseline are evaluated every 2 months of systemic therapy. Once CRLM are considered resectable, a treatment strategy is proposed. RESULTS Overall, 398 panel evaluations in 183 patients were analyzed. The median time to panel conclusion was 7 days (interquartile range [IQR] 5-11 days). Intersurgeon disagreement was observed in 205 (52%) evaluations, with major disagreement (resectable vs permanently unresectable) in 42 (11%) evaluations. After systemic treatment, 106 patients were considered to have resectable CRLM, 84 of whom (79%) underwent a curative procedure. R0 resection (n = 41), R0 resection in combination with ablative treatment (n = 26), or ablative treatment only (n = 4) was achieved in 67 of 84 (80%) patients. CONCLUSIONS This study analyzed prospective resectability evaluation of patients with CRLM by a panel of radiologists and liver surgeons. The high rate of disagreement among experienced liver surgeons reflects the complexity in defining treatment strategies for CRLM and supports the use of a panel rather than a single-surgeon decision.
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Affiliation(s)
- Joost Huiskens
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Karen Bolhuis
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Marc Rw Engelbrecht
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Koert P De Jong
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Geert Kazemier
- Department of Surgery, Amsterdam UMC, VU University, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Mike Sl Liem
- Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | - Cornelis Verhoef
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Cornelis Ja Punt
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas M van Gulik
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Stelzner S, Radulova-Mauersberger O, Zschuppe E, Kittner T, Abolmaali N, Puffer E, Zimmer J, Witzigmann H. Prognosis in patients with synchronous colorectal cancer metastases after complete resection of the primary tumor and the metastases. J Surg Oncol 2019; 120:438-445. [PMID: 31168858 DOI: 10.1002/jso.25578] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 05/02/2019] [Accepted: 05/18/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Synchronous metastases are considered a negative prognostic factor in patients with metastatic colorectal cancer (CRC). We investigated the outcomes of stage IV CRC patients undergoing complete gross resection (R0/1) of both the primary tumor and the metastases under the guidance of a multidisciplinary team (MDT). METHODS All CRC patients with synchronous metastases were retrieved from a prospective database. Patients treated from 2006 to 2017 who underwent complete resection were analyzed. Various factors, including multiple metastatic sites and complex procedures, were investigated. Univariate and multivariate overall survival (OS) calculations were performed. RESULTS Of 330 consecutive patients with synchronous metastases, 101 (30.6%) achieved an R0/1 status including 12 (11.9%) patients with multiple metastatic sites. Complex procedures were necessary in 45 (44.6%) patients. Five-year OS was 53.0% for the R0/1 patient group. Multivariate analysis could not detect factors associated with prognosis. CONCLUSIONS With modern treatment, the prognosis of patients with synchronous CRC metastases can be improved. Decisions made by a MDT offered one-third of patients a potentially curative approach to their stage IV disease. Despite the treatment of a high rate of patients with complex metastases necessitating complex procedures, we achieved a favorable 5-year OS rate.
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Affiliation(s)
- Sigmar Stelzner
- Department of General and Visceral Surgery, Stadtisches Klinikum Dresden, Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - Olga Radulova-Mauersberger
- Department of General and Visceral Surgery, Stadtisches Klinikum Dresden, Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - Ernst Zschuppe
- Department of Medical Oncology, Stadtisches Klinikum Dresden, Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - Thomas Kittner
- Department of Radiology, Stadtisches Klinikum Dresden, Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - Nasreddin Abolmaali
- Department of Radiology, Stadtisches Klinikum Dresden, Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - Eric Puffer
- Department of Pathology, Stadtisches Klinikum Dresden, Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - Joerg Zimmer
- Department of Radiation Therapy, Stadtisches Klinikum Dresden, Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - Helmut Witzigmann
- Department of General and Visceral Surgery, Stadtisches Klinikum Dresden, Teaching Hospital of the Technical University of Dresden, Dresden, Germany
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Progressive Oncological Surgery Is Associated with Increased Curative Resection Rates and Improved Survival in Metastatic Colorectal Cancer. Cancers (Basel) 2019; 11:cancers11020218. [PMID: 30769860 PMCID: PMC6406820 DOI: 10.3390/cancers11020218] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/07/2019] [Accepted: 02/12/2019] [Indexed: 02/07/2023] Open
Abstract
Background: Secondary resection rates in first-line chemotherapy trials for metastatic colorectal cancer (mCRC) remain below 15%, representing a clear contrast to reports by specialised surgical centres, where progressive liver, peritoneal-surface, and pulmonary surgery increased access to curative-intent treatment. We present a long-term evaluation of oncosurgical management in a single-centre, analysing the aggregate effect of gradual implementation of surgical subspecialties and systemic treatments on mCRC patients’ resection rates and prognosis. Methods: Patients with newly diagnosed mCRC from 2003 to 2014 were retrospectively categorised into palliative treatment (PAT) and curative intent surgery (CIS) and three time periods were analysed for treatment changes and factors associated with survival. Results: Four hundred-twenty patients were treated (PAT:250/CIS:170). Over time periods, the number of presenting patients remained consistent, whereas curative resection rates increased from 29% to 55%, facilitated by an increment of patients undergoing hepatectomy (21 to 35%), pulmonary surgery (6 to 17%), and peritonectomy/intraoperative chemotherapy (0 to 8%). Also, recently, significantly more multi-line systemic treatments were applied. The median survival markedly improved from 21.9 months (2003–2006; 95% confidence interval (CI) 17.3–26.5) to 36.5 months (2011–2014; 95% CI 26.6–46.4; p = 0.018). PAT was a significant factor of poor survival and diagnosis of mCRC in the latest time period was independently associated with a distinctly lower risk for palliative treatment (odds ratio 0.15). Conclusions: In modern eras of medical oncology, achieving appropriate resection rates through utilization of state-of-the-art oncological surgery by dedicated experts represents a cornerstone for long-term survival in mCRC.
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11
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Zhang ZF, Luo YJ, Lu Q, Dai SX, Sha WH. Conversion therapy and suitable timing for subsequent salvage surgery for initially unresectable hepatocellular carcinoma: What is new? World J Clin Cases 2018; 6:259-273. [PMID: 30211206 PMCID: PMC6134280 DOI: 10.12998/wjcc.v6.i9.259] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/18/2018] [Accepted: 08/07/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To review the conversion therapy for initially unresectable hepatocellular carcinoma (HCC) patients and the suitable timing for subsequent salvage surgery.
METHODS A PubMed search was undertaken from 1987 to 2017 to identify articles using the keywords including “unresectable” “hepatocellular carcinoma”, ”hepatectomy”, ”conversion therapy”, “resection”, “salvage surgery” and “downstaging”. Additional studies were investigated through a manual search of the references from the articles. The exclusion criteria were duplicates, case reports, case series, videos, contents unrelated to the topic, comments, and editorial essays. The main and widely used conversion therapies and the suitable timing for subsequent salvage surgery were discussed in detail. Two members of our group independently performed the literature search and data extraction.
RESULTS Liver volume measurements [future liver remnant (FLR)/total liver volume or residual liver volume/bodyweight ratio] and function tests (scoring systems and liver stiffness) were often performed in order to justify whether patients were suitable candidates for surgery. Successful conversion therapy was usually defined as downstaging the tumor, increasing FLR and providing subsequent salvage surgery, without increasing complications, morbidity or mortality. The requirements for performing salvage surgery after transcatheter arterial chemoembolization were the achievement of a partial remission in radiology, the disappearance of the portal vein thrombosis, and the lack of extrahepatic metastasis. Patients with a standardized FLR (sFLR) > 20% were good candidates for surgery after portal vein embolization, while other predictive parameters like growth rate, kinetic growth rate were treated as an effective supplementary. There was probably not enough evidence to provide a standard operation time after associating liver partition and portal vein ligation for staged hepatectomy or yttrium-90 microsphere radioembolization. The indications of any combinations of conversion therapies and the subsequent salvage surgery time still need to be carefully and comprehensively evaluated.
CONCLUSION Conversion therapy is recommended for the treatment of initially unresectable HCC, and the suitable subsequent salvage surgery time should be reappraised and is closely related to its previous therapeutic effect.
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Affiliation(s)
- Ze-Feng Zhang
- Department of Gastroenterology and Hepatology, Guangdong Geriatrics Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Yu-Jun Luo
- Department of Gastroenterology and Hepatology, Guangdong Geriatrics Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Quan Lu
- Department of Gastroenterology and Hepatology, Guangdong Geriatrics Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Shi-Xue Dai
- Department of Gastroenterology and Hepatology, Guangdong Geriatrics Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Wei-Hong Sha
- Department of Gastroenterology and Hepatology, Guangdong Geriatrics Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
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12
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McCluney SJ, Giakoustidis AA, Segler A, Bissel J, Miller RL, Valente R, Hutchins RR, Abraham A, Bhattacharya S, Kocher HM. Predicting complications in hepatic resection for colorectal liver metastasis: the lymphocyte-to-monocyte ratio. ANZ J Surg 2018; 88:E782-E786. [PMID: 30014560 DOI: 10.1111/ans.14725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/01/2018] [Accepted: 05/05/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Colorectal cancer is one of the most common malignancies worldwide; whilst approximately 20% of patients have hepatic disease at presentation. Hepatic resection remains the gold standard of care; however, it is associated with significant morbidity. We sought to establish whether the lymphocyte-to-monocyte ratio (LMR) could help predict post-operative complications, thus improving patient outcomes. METHODS We performed a retrospective cohort study of patients undergoing hepatic resection at a single centre. Baseline demographics and complications within 30 days following surgery were recorded. White blood cell counts and C-reactive protein (CRP) were recorded pre-operatively, and until post-operative day 7. RESULTS A total of 188 operations were included. About 47.3% of resections had a complicated recovery, of which 31.46% were major. The median LMR was 1.29 across the cohort, 1.60 for uncomplicated procedures, 1.14 for those with complications and 0.85 in major complications. For detecting major complications versus an uncomplicated recovery, median LMR was the best parameter (area under the curve 0.78), whilst it was the only parameter to accurately predict such complications within 48 hours of surgery (area under the curve 0.72 on day 1). It was consistently the most accurate parameter at detecting uncomplicated versus complicated recovery, minor versus major complications, and major complications versus an uncomplicated recovery, at numerous timepoints over the post-operative period. CONCLUSION The LMR appears better at predicting complications following hepatic resection for colorectal liver metastases, as opposed to conventionally measured parameters.
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Affiliation(s)
- Simon J McCluney
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital, Barts Health NHS Trust, London, UK.,Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Alexandros A Giakoustidis
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Angela Segler
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Juliane Bissel
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Robert L Miller
- The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Roberto Valente
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Robert R Hutchins
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Ajit Abraham
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Satyajit Bhattacharya
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Hemant M Kocher
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital, Barts Health NHS Trust, London, UK.,Barts Cancer Institute, Queen Mary University of London, London, UK
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13
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Lang H, Baumgart J, Mittler J. Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy in the Treatment of Colorectal Liver Metastases: Current Scenario. Dig Surg 2018; 35:294-302. [PMID: 29621745 DOI: 10.1159/000488097] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 02/20/2018] [Indexed: 12/13/2022]
Abstract
Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) has expanded the surgical armamentarium for patients with advanced and bilateral colorectal liver metastases. However, the enthusiasm that the medical fraternity had about ALPPS was hampered by a high mortality rate and early and frequent tumor recurrence. While surgical safety has improved, mainly due to technical refinements and a better patient selection, the oncological value in the face of early tumor recurrence remains unclear. The only randomized controlled trial on ALPPS versus two-stage hepatectomy (TSH) so far confirmed that ALPPS led to higher resectability with comparable perioperative complication rate, but oncological outcome was not measured. Robust data regarding long-term outcome are still missing. TSH and ALPPS might be complementary strategies for the resection of colorectal liver metatsases (CRLM) with ALPPS being reserved for patients with no other surgical option, that is, after failed portal vein embolization or those with an extremely small future liver remnant. In other words, ALPPS can be considered a supplementary tool and a last resort in the liver surgeon's hand to offer resectability in otherwise nonresectable CRLM. In these individual cases, and always embedded into a multimodal treatment setting, ALPPS may offer a chance of complete tumor removal and prolonged survival and even a chance for cure.
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14
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Pak LM, Chakraborty J, Gonen M, Chapman WC, Do RKG, Groot Koerkamp B, Verhoef K, Lee SY, Massani M, van der Stok EP, Simpson AL. Quantitative Imaging Features and Postoperative Hepatic Insufficiency: A Multi-Institutional Expanded Cohort. J Am Coll Surg 2018; 226:835-843. [PMID: 29454098 DOI: 10.1016/j.jamcollsurg.2018.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 11/22/2017] [Accepted: 02/06/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Post-hepatectomy liver insufficiency (PHLI) is a significant cause of morbidity and mortality after liver resection. Quantitative imaging analysis using CT scans measures variations in pixel intensity related to perfusion. A preliminary study demonstrated a correlation between quantitative imaging features of the future liver remnant (FLR) parenchyma from preoperative CT scans and PHLI. The objective of this study was to explore the potential application of quantitative imaging analysis in PHLI in an expanded, multi-institutional cohort. STUDY DESIGN We retrospectively identified patients from 5 high-volume academic centers who developed PHLI after major hepatectomy, and matched them to control patients without PHLI (by extent of resection, preoperative chemotherapy treatment, age [±5 years], and sex). Quantitative imaging features were extracted from the FLR in the preoperative CT scan, and the most discriminatory features were identified using conditional logistic regression. Percent remnant liver volume (RLV) was defined as follows: (FLR volume)/(total liver volume) × 100. Significant clinical and imaging features were combined in a multivariate analysis using conditional logistic regression. RESULTS From 2000 to 2015, 74 patients with PHLI and 74 matched controls were identified. The most common indications for surgery were colorectal liver metastases (53%), hepatocellular carcinoma (37%), and cholangiocarcinoma (9%). Two CT imaging features (FD1_4: image complexity; ACM1_10: spatial distribution of pixel intensity) were strongly associated with PHLI and remained associated with PHLI on multivariate analysis (p = 0.018 and p = 0.023, respectively), independent of clinical variables, including preoperative bilirubin and %RLV. CONCLUSIONS Quantitative imaging features are independently associated with PHLI and are a promising preoperative risk stratification tool.
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Affiliation(s)
- Linda M Pak
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - William C Chapman
- Department of Surgery, Washington University in St Louis, St Louis, MO
| | - Richard K G Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Kees Verhoef
- Department of Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - Ser Yee Lee
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore; Duke-National University of Singapore Medical School, Singapore
| | - Marco Massani
- Regional Center for HPB Surgery, Regional Hospital of Treviso, Treviso, Italy
| | | | - Amber L Simpson
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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15
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Binnebösel M, Bruners P, Klink CD, Kuhl C, Neumann UP. [Oligometastasized stage IV colorectal cancer : Surgical resection and local ablative procedures]. Chirurg 2018; 87:371-9. [PMID: 27146386 DOI: 10.1007/s00104-016-0187-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND By the intensified combination of systemic, surgical and local ablative therapies a significant improvement in therapy results for metastasized colorectal cancer has been achieved in the last decade. Downstaging with subsequent resection is nowadays a standard for oligometastasized primarily unresectable colorectal cancer. MATERIAL AND METHODS The value of combining resection and local ablation is unclear; therefore, this article gives an overview of the available literature dealing with the combination of surgery and local ablative methods for oligometastasized stage IV colorectal cancer. RESULTS The best results were obtained following surgical resection alone. Whereas nowadays cryoablation is of minor importance, the most successful results are achieved following local ablative methods by radiofrequency and microwave ablation. In the future irreversible electroporation will be the most promising local ablative method. A combination of surgical resection and local ablation appears to be rational in patients if an R0 resection can be achieved. CONCLUSION Surgical resection of colorectal liver metastases is the gold standard for oncological therapy whenever possible. The rational combination of non-curative surgical resection and local ablation should be considered in the context of a multimodal therapeutic strategy, particularly in patients with primarily resectable disease.
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Affiliation(s)
- M Binnebösel
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Uniklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - P Bruners
- Klinik für Diagnostische und Interventionelle Radiologie, Uniklinik der RWTH Aachen, Aachen, Deutschland
| | - C D Klink
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Uniklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - C Kuhl
- Klinik für Diagnostische und Interventionelle Radiologie, Uniklinik der RWTH Aachen, Aachen, Deutschland
| | - U P Neumann
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Uniklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
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16
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Pak LM, Kemeny NE, Capanu M, Chou JF, Boucher T, Cercek A, Balachandran VP, Kingham TP, Allen PJ, DeMatteo RP, Jarnagin WR, D'Angelica MI. Prospective phase II trial of combination hepatic artery infusion and systemic chemotherapy for unresectable colorectal liver metastases: Long term results and curative potential. J Surg Oncol 2017; 117:634-643. [PMID: 29165816 DOI: 10.1002/jso.24898] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 10/09/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND/OBJECTIVES Combination hepatic artery infusion (HAI) and systemic (SYS) chemotherapy for unresectable CRLM results in high tumor-response rates. This study represents an update of long-term survival and conversion to resectability in patients with unresectable CRLM treated with HAI and SYS chemotherapy in a phase II study. METHOD The primary endpoint was complete resection. Multivariate and landmark analysis assessed the effect of complete resection on progression-free (PFS) and overall survival (OS). RESULTS From 2007 to 2012, 64 patients with median of 13 tumors were enrolled; 67% had prior chemotherapy. 33 patients (52%) were converted to resection. Median follow-up among survivors was 81 months. Median PFS and OS were 13 and 38 months, respectively, with 5-year-OS of 36%. Chemotherapy-naïve patients had 5-year-OS of 51%. Conversion to resection was the only independent factor prognostic of improved PFS and OS. Nine of 64 patients (14%) are NED (five since initial resection, three after resection of recurrent disease, one from chemotherapy alone) at median follow-up of 86 months from treatment initiation, and 72 months from last operative intervention. CONCLUSION Combination HAI and SYS is an effective therapy for high-volume unresectable CRLM, resulting in a high rate of resection, long-term survival, and the potential for cure.
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Affiliation(s)
- Linda M Pak
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy E Kemeny
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marinela Capanu
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joanne F Chou
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Taryn Boucher
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrea Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vinod P Balachandran
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter J Allen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ronald P DeMatteo
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - William R Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael I D'Angelica
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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17
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Angelsen JH, Horn A, Sorbye H, Eide GE, Løes IM, Viste A. Population-based study on resection rates and survival in patients with colorectal liver metastasis in Norway. Br J Surg 2017; 104:580-589. [DOI: 10.1002/bjs.10457] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/29/2016] [Accepted: 11/14/2016] [Indexed: 12/13/2022]
Abstract
Abstract
Background
Detailed knowledge about the proportion of patients with colorectal liver metastases (CLM) undergoing resection is sparse. The aim of this study was to analyse cumulative resection rates and survival in patients with CLM.
Methods
For this population-based study of patients developing CLM during 2011–2013, data were extracted from the Norwegian Patient Registry and the Cancer Registry of Norway.
Results
A total of 2960 patients had CLM; their median overall survival was 10·9 months. Liver resection was performed in 538 patients. The cumulative resection rate was 20·0 per cent. The cumulative resection rate was 23·3 per cent in patients aged less than 40 years, 31·1 per cent in patients aged 40–59 years, 24·7 per cent in those aged 60–74 years, 17·9 per cent in those aged 75–79 years and 4·7 per cent in patients aged 80 years or more (P < 0·001). In multivariable analysis, resection rate was associated with age, extrahepatic metastases, disease-free interval and geographical region. Overall survival after diagnosis of CLM was affected by liver resection (hazard ratio (HR) 0·54, 95 per cent c.i. 0·34 to 0·86), rectal cancer (HR 0·82, 0·74 to 0·90), metachronous disease (HR 0·66, 0·60 to 0·74), increasing age (HR 1·32, 1·28 to 1·37), region, and extrahepatic metastases (HR 1·90, 1·74 to 2·07). Three- and 4-year overall survival rates after hepatectomy were 73·2 and 54·8 per cent respectively.
Conclusion
The cumulative resection rate in patients with CLM in Norway between 2011 and 2013 was 20 per cent. Resection rates varied across geographical regions, and with patient and disease characteristics.
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Affiliation(s)
- J-H Angelsen
- Department of Acute and Digestive Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - A Horn
- Department of Acute and Digestive Surgery, Haukeland University Hospital, Bergen, Norway
| | - H Sorbye
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - G E Eide
- Centre for Clinical Research, Department of Research and Development, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - I M Løes
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - A Viste
- Department of Acute and Digestive Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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18
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Imai K, Allard MA, Castro Benitez C, Vibert E, Sa Cunha A, Cherqui D, Castaing D, Baba H, Adam R. Long-term outcomes of radiofrequency ablation combined with hepatectomy compared with hepatectomy alone for colorectal liver metastases. Br J Surg 2017; 104:570-579. [DOI: 10.1002/bjs.10447] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 10/23/2016] [Accepted: 10/31/2016] [Indexed: 12/15/2022]
Abstract
Abstract
Background
Combining radiofrequency ablation (RFA) with hepatectomy may enable treatment with curative intent for patients with colorectal liver metastasis (CRLM). However, the oncological outcomes in comparison with resection alone remain to be clarified.
Methods
Patients who underwent a first hepatectomy between 2001 and 2012 for CRLM were enrolled. Short- and long-term outcomes of patients who underwent hepatectomy plus RFA were compared with those of patients who had hepatectomy alone using propensity score matching.
Results
Of a total of 553 patients, hepatectomy + RFA and hepatectomy alone were performed in 37 and 516 respectively. Before matching, patients in the hepatectomy + RFA group were characterized primarily by a larger tumour burden. After matching of 31 patients who underwent hepatectomy + RFA with 93 who had hepatectomy alone, background characteristics were well balanced. In the matched cohort, overall and disease-free survival in the hepatectomy + RFA group were no different from those among patients who had hepatectomy alone (5-year overall survival rate 57 versus 61 per cent, P = 0·649; 5-year disease-free survival rate 19 versus 17 per cent, P = 0·865). Local recurrence at the ablated site was observed in four of 31 patients (13 per cent). Although overall local recurrence (ablated site and/or cut surface) was more frequent in the hepatectomy + RFA group (9 of 31 (29 per cent) versus 11 of 93 (12 per cent); P = 0·032), there was no difference in intrahepatic disease-free survival between the two groups (P = 0·705).
Conclusion
Hepatectomy + RFA achieved outcomes comparable to hepatectomy alone. Combining RFA with hepatectomy should be considered as an option to achieve cure.
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Affiliation(s)
- K Imai
- Centre Hépato-Biliaire, Assistance Publique – Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 935, Villejuif, France
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - M-A Allard
- Centre Hépato-Biliaire, Assistance Publique – Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 935, Villejuif, France
- Université Paris-Sud, Villejuif, France
| | - C Castro Benitez
- Centre Hépato-Biliaire, Assistance Publique – Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 935, Villejuif, France
- Université Paris-Sud, Villejuif, France
| | - E Vibert
- Centre Hépato-Biliaire, Assistance Publique – Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, Villejuif, France
- INSERM Unité 785, Villejuif, France
- Université Paris-Sud, Villejuif, France
| | - A Sa Cunha
- Centre Hépato-Biliaire, Assistance Publique – Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 935, Villejuif, France
- Université Paris-Sud, Villejuif, France
| | - D Cherqui
- Centre Hépato-Biliaire, Assistance Publique – Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, Villejuif, France
- INSERM Unité 785, Villejuif, France
- Université Paris-Sud, Villejuif, France
| | - D Castaing
- Centre Hépato-Biliaire, Assistance Publique – Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, Villejuif, France
- INSERM Unité 785, Villejuif, France
- Université Paris-Sud, Villejuif, France
| | - H Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - R Adam
- Centre Hépato-Biliaire, Assistance Publique – Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 935, Villejuif, France
- Université Paris-Sud, Villejuif, France
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19
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Lang H. ALPPS for Colorectal Liver Metastases. J Gastrointest Surg 2017; 21:190-192. [PMID: 27659789 DOI: 10.1007/s11605-016-3251-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/10/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Hauke Lang
- Klinik für Allgemein-, Viszeral- und Transplantationschriurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
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20
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Olthof PB, Huiskens J, Wicherts DA, Huespe PE, Ardiles V, Robles-Campos R, Adam R, Linecker M, Clavien PA, Koopman M, Verhoef C, Punt CJA, van Gulik TM, de Santibanes E. Survival after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for advanced colorectal liver metastases: A case-matched comparison with palliative systemic therapy. Surgery 2016; 161:909-919. [PMID: 28038862 DOI: 10.1016/j.surg.2016.10.032] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 10/06/2016] [Accepted: 10/19/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) allows the resection of colorectal liver metastases with curative intent which would otherwise be unresectable and only eligible for palliative systemic therapy. This study aimed to compare outcomes of ALPPS in patients with otherwise unresectable colorectal liver metastases with matched historic controls treated with palliative systemic treatment. METHODS All patients with colorectal liver metastases from the international ALPPS registry were identified and analyzed. Survival data were compared according to the extent of disease. Otherwise unresectable ALPPS patients were defined by at least 2 of the following criteria: ≥6 metastasis, ≥2 future remnant liver metastasis, ≥6 involved segments excluding segment 1. These patients were matched with patients included in 2, phase 3, metastatic, colorectal cancer trials (CAIRO and CAIRO2) using propensity scoring in order to compare survival. RESULTS Of 295 patients with colorectal liver metastases in the ALPPS registry, 70 patients had otherwise unresectable disease defined by the proposed criteria. Two-year overall survival was 49% and 72% for patients with ≥2 and <2 criteria, respectively (P = .002). Median disease-free survival was 6 months compared to 12 months (P < .001) in the ≥2 and <2 criteria groups, respectively. Median overall survival was comparable between ALPPS patients with ≥2 criteria and case-matched patients who received palliative treatment (24.0 vs 17.6 months, P = .088). CONCLUSION Early oncologic outcomes of patients with advanced liver metastases undergoing ALPPS were not superior to results of matched patients receiving systemic treatment with palliative intent. Careful patient selection is essential in order to improve outcomes.
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Affiliation(s)
- Pim B Olthof
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
| | - Joost Huiskens
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Dennis A Wicherts
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Pablo E Huespe
- Department of Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Victoria Ardiles
- Department of Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Robles-Campos
- Servicio de Cirugía General y Aparato Digestivo, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - René Adam
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France
| | - Michael Linecker
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Switzerland
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Switzerland
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Cornelis J A Punt
- Department of Medical Oncology, Academic Medical Center, Amsterdam, the Netherlands
| | - Thomas M van Gulik
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
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Two-stage hepatectomy in two regional district community hospitals: perioperative safety and long-term survival. TUMORI JOURNAL 2016; 103:170-176. [PMID: 28058712 DOI: 10.5301/tj.5000589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Surgical resection offers the best chance of cure for patients with colorectal liver metastases (CRLMs). Two-stage hepatectomy (TSH) has been demonstrated to be safe and effective to obtain curative resection in patients with multiple, bilobar CRLMs that are unresectable in a single procedure. Up to now TSH has been the prerogative of dedicated liver surgery centers. The aim of this study was to assess the safety and effectiveness of TSH also in community hospitals. METHODS Of 294 patients operated on for CRLMs between September 1997 and June 2012 in 2 district community hospitals (belonging to the same regional healthcare district), 43 (14.6%) were scheduled for TSH. Thirty-eight/43 received neoadjuvant and/or bridge chemotherapy (2 neoadjuvant only, 4 neoadjuvant and bridge, 32 bridge only). RESULTS The mean follow-up was 35.74 ± 29.53 months. Five-year overall survival (OS) was 31.4%, with a median survival time of 31 months. Twenty-nine patients completed the planned procedure (OS: 42.9%; median 47 months), while 14 did not because of disease progression (OS: 0%; median 13 months). No operative mortality occurred within the first 90 days either after the first or second stage. CONCLUSIONS Our results suggest good efficacy and safety of TSH even when performed in a community hospital setting. Shifting patient selection from neoadjuvant to bridge chemotherapy had no impact on outcome once the clearing of the liver had been achieved. In patients presenting with synchronous CRLMs, simultaneous colorectal resection and clearing of the less involved hemiliver as the first surgical step is feasible without any negative impact on outcome.
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Kouri BE, Abrams RA, Al-Refaie WB, Azad N, Farrell J, Gaba RC, Gervais DA, Gipson MG, Kolbeck KJ, Marshalleck FE, Pinchot JW, Small W, Ray CE, Hohenwalter EJ. ACR Appropriateness Criteria Radiologic Management of Hepatic Malignancy. J Am Coll Radiol 2016; 13:265-73. [PMID: 26944037 DOI: 10.1016/j.jacr.2015.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 12/04/2015] [Indexed: 12/18/2022]
Abstract
Management of primary and secondary hepatic malignancy is a complex problem. Achieving optimal care for this challenging population often requires the involvement of multiple medical and surgical disciplines. Because of the wide variety of potential therapies, treatment protocols for various malignancies continue to evolve. Consequently, development of appropriate therapeutic algorithms necessitates consideration of medical options, such as systemic chemotherapy; surgical options, such as resection or transplantation; and loco-regional therapies, such as thermal ablation and transarterial embolization techniques. This article provides a review of treatment strategies for the three most common subtypes of hepatic malignancy treated with loco-regional therapies: hepatocellular carcinoma, neuroendocrine metastases, and colorectal metastases. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Affiliation(s)
- Brian E Kouri
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina.
| | | | - Waddah B Al-Refaie
- Georgetown University Hospital, Washington, District of Columbia, American College of Surgeons
| | - Nilofer Azad
- Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, Maryland, American Society of Clinical Oncology
| | - James Farrell
- Interventional Endoscopy and Pancreatic Diseases, New Haven, Connecticut, American Gastroenterological Association
| | - Ron C Gaba
- University of Illinois Hospital, Chicago, Illinois
| | | | - Matthew G Gipson
- University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | | | | | | | - William Small
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Charles E Ray
- University of Illinois Hospital and Health Science System, Chicago, Illinois
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Giuliante F, Panettieri E, Ardito F. The impact of intraoperative ultrasonography on the management of disappearing colorectal liver metastases. Hepat Oncol 2015; 2:325-328. [PMID: 30191012 DOI: 10.2217/hep.15.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Felice Giuliante
- Hepatobiliary Surgery Unit, Agostino Gemelli Hospital, Catholic University of the Sacred Heart, Rome, Largo Agostino Gemelli, 8-I-00168 Rome, Italy
| | - Elena Panettieri
- Hepatobiliary Surgery Unit, Agostino Gemelli Hospital, Catholic University of the Sacred Heart, Rome, Largo Agostino Gemelli, 8-I-00168 Rome, Italy
| | - Francesco Ardito
- Hepatobiliary Surgery Unit, Agostino Gemelli Hospital, Catholic University of the Sacred Heart, Rome, Largo Agostino Gemelli, 8-I-00168 Rome, Italy
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Konda B, Shum H, Rajdev L. Anti-angiogenic agents in metastatic colorectal cancer. World J Gastrointest Oncol 2015; 7:71-86. [PMID: 26191351 PMCID: PMC4501927 DOI: 10.4251/wjgo.v7.i7.71] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/13/2015] [Accepted: 06/01/2015] [Indexed: 02/05/2023] Open
Abstract
Colorectal cancer (CRC) is a major public health concern being the third leading cause of cancer mortality in the United States. The availability of better therapeutic options has led to a decline in cancer mortality in these patients. Surgical resection should be considered in all stages of the disease. The use of conversion therapy has made surgery a potentially curative option even in patients with initially unresectable metastatic disease. In this review we discuss the role of various anti-angiogenic agents in patients with metastatic CRC (mCRC). We describe the mechanism of action of these agents, and the rationale for their use in combination with chemotherapy. We also review important clinical studies that have evaluated the safety and efficacy of these agents in mCRC patients. Despite the discovery of several promising anti-angiogenic agents, mCRC remains an incurable disease with a median overall survival of just over 2 years in patients exposed to all available treatment regimens. Further insights into tumor biology and tumor microenvironment may help improve outcomes in these patients.
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Safety and Efficacy Compared between Irinotecan-Loaded Microspheres HepaSphere and DC Bead in a Model of VX2 Liver Metastases in the Rabbit. J Vasc Interv Radiol 2015; 26:1067-1075.e3. [DOI: 10.1016/j.jvir.2015.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 03/05/2015] [Accepted: 03/17/2015] [Indexed: 11/18/2022] Open
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Pietrantonio F, Orlandi A, Inno A, Da Prat V, Spada D, Iaculli A, Di Bartolomeo M, Morosi C, de Braud F. Bevacizumab-based neoadjuvant chemotherapy for colorectal cancer liver metastases: Pitfalls and helpful tricks in a review for clinicians. Crit Rev Oncol Hematol 2015; 95:272-81. [PMID: 25958297 DOI: 10.1016/j.critrevonc.2015.04.008] [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: 04/11/2014] [Revised: 02/01/2015] [Accepted: 04/14/2015] [Indexed: 12/16/2022] Open
Abstract
Bevacizumab added to chemotherapy has shown encouraging efficacy in the neoadjuvant therapy of colorectal cancer liver metastases. In absence of biological predictor factors of efficacy to bevacizumab-based treatment, the assessment of response may be a crucial point to select patients who may benefit the most from surgery. At the same time the pathological response after liver resection could represent a guide for the next therapeutic plan. In the pre-surgical phase, conventional computed tomography and response evaluation with RECIST criteria may underestimate the response to anti-angiogenic drugs. Modified computed tomography criteria of response, morphologic changes as well as novel imaging techniques and metabolic assessment by fluorodeoxyglucose positron emission tomography seem to be promising methods for the assessment of response and for leading the clinical choices. Pathological response at the time of surgery is an important prognostic factor and a surrogate of survival for resected patients. Different classification criteria to assess pathological response have been developed, residual viable tumor, tumor regression grade (TRG), modified TRG and tumor thickness at the tumor-normal interface, but to date a superiority of one approach over the others has not been clearly established. In this review, we evaluate the available data with the aim to help the clinicians in the pre- and post-surgical care of patient with colorectal cancer liver metastases treated with bevacizumab-based neoadjuvant strategy.
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Affiliation(s)
- Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Armando Orlandi
- Medical Oncology Department, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Inno
- Medical Oncology, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Valentina Da Prat
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniele Spada
- Medical Oncology Department, Hospital of Urbino, Urbino, Italy
| | | | - Maria Di Bartolomeo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Morosi
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Kuo IM, Huang SF, Chiang JM, Yeh CY, Chan KM, Chen JS, Yu MC. Clinical features and prognosis in hepatectomy for colorectal cancer with centrally located liver metastasis. World J Surg Oncol 2015; 13:92. [PMID: 25889950 PMCID: PMC4354756 DOI: 10.1186/s12957-015-0497-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 02/01/2015] [Indexed: 12/24/2022] Open
Abstract
Background Hepatic metastasectomy for patients with primary colorectal cancer offers better long-term outcome, and chemotherapy can increase the rate of hepatic resectability for patients with initially inoperable disease. The pattern of liver metastasis and status of the primary tumor are rarely discussed in the analysis of long-term outcome. In this report, we evaluate the influence of the pattern of metastasis on clinical features and prognosis. Methods One hundred and fifty-nine patients who underwent hepatic metastasectomy with curative intent for liver metastasis of colorectal cancer between October 1991 and December 2006 were enrolled. Patients were grouped according to whether liver metastasis was centrally or peripherally located, based on imaging and operative findings. Patient demographics, characteristics of the primary and metastatic tumors, and surgical outcomes were analyzed for long-term survival. Results A greater proportion of patients with centrally located metastases were male, as compared with those with peripherally located metastases. Compared with patients with peripherally located metastases, patients with centrally located metastases were more likely to have multiple lesions (P = 0.016), involvement of multiple segments (P = 0.006), large metastases (P < 0.001), and bilobar distribution of metastases (P < 0.001). The estimated 5-year recurrence-free and overall survival rates were 22.4% and 34.2%, respectively. Univariate analysis revealed that centrally located metastasis, primary tumor in the transverse colon, metastasis in regional lymph nodes, initial extrahepatic metastasis, synchronous liver metastasis, multiple lesions, poorly differentiated tumor, and resection margin <10 mm were significant poor prognostic factors for recurrence-free survival and overall survival. Cox regression analysis showed that inadequate resection margin and centrally located liver metastasis were significant predictors of shorter overall survival. Conclusions In colorectal cancer, centrally located liver metastasis represents a poor prognostic factor after hepatectomy, and is associated with early recurrence. Neoadjuvant chemotherapy may be used to downstage centrally located liver metastases to improve outcome.
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Affiliation(s)
- I-Ming Kuo
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan.
| | - Song-Fong Huang
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan.
| | - Jy-Ming Chiang
- Division of Colorectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan.
| | - Chien-Yuh Yeh
- Division of Colorectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan.
| | - Kun-Ming Chan
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan.
| | - Jinn-Shiun Chen
- Division of Colorectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan.
| | - Ming-Chin Yu
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan.
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Meriggi F, Bertocchi P, Zaniboni A. Management of potentially resectable colorectal cancer liver metastases. World J Gastrointest Surg 2013; 5:138-145. [PMID: 23710291 PMCID: PMC3662870 DOI: 10.4240/wjgs.v5.i5.138] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 03/23/2013] [Accepted: 04/28/2013] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer is a very common malignancy worldwide and development of liver metastases, both synchronous or metachronous, is a common event. Of all patients with metastatic colorectal cancer, up to 77% have a liver-only disease and approximately 10%-20% of patients with colorectal liver metastases are considered resectable at the time of diagnosis. Surgical resection of liver metastases remains the best treatment option and it is associated with a survival plateau and a 20%-25% of long-term survivors. Perioperative chemotherapy for resectable liver metastases may improve resecability of liver metastases and disease free survival, but its impact on overall survival is still unclear and more studies are needed. Moreover, preoperative chemotherapy can increase postoperative complications. Further studies are needed to define the role of adjuvant chemotherapy after a R0 resection of liver metastases and to define the criteria for a better selection of patients candidate to hepatectomy. New strategies such as targeted therapies are emerging with promising results. Optimal management requires a multidisciplinary approach, local and systemic, but it is a still pending question. Colorectal liver metastases represent a major challenge for oncologists and surgeons. In this review will be analyzed available data about assessment and management of the patients with potentially resectable colorectal liver metastases.
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Chance of cure following liver resection for initially unresectable colorectal metastases: analysis of actual 5-year survival. J Gastrointest Surg 2013; 17:352-9. [PMID: 23225196 DOI: 10.1007/s11605-012-2103-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 11/19/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Survival with long-term follow-up following liver resection for unresectable colorectal liver metastases (CRLM) downsized by chemotherapy has rarely been reported. The aim of this study was to determine the chance of cure following liver resection for initially unresectable CRLM. METHODS Between January 2000 and December 2009, 61 patients underwent hepatectomy for unresectable liver-only CRLM downsized after chemotherapy. Cure was defined as a recurrence-free interval of at least 5 years after primary hepatectomy. RESULTS Resectability of CRLM was achieved after a mean number of 11 courses, and 42.6 % of patients underwent liver resection after ≥10 courses. Postoperative mortality was nil, and morbidity rate was 19.7 %. The 5- and 10-year actuarial overall survival rates were 42.6 and 16.0 %. Of 30 patients with a follow-up ≥5 years, 11 were alive, yielding a 5-year actual overall survival rate of 36.7 %, and 7 (23.3 %) were considered cured because they are alive without recurrence. On multivariate analysis, response to chemotherapy was the only independent predictor of both overall and disease-free survival. CONCLUSIONS Cure can be achieved in about 23 % of patients resected for initially unresectable CRLM downsized by chemotherapy. Liver resection can be safely performed in selected patients even after multiple courses of chemotherapy.
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Metrakos P, Kakiashvili E, Aljiffry M, Hassanain M, Chaudhury P. Role of Surgery in the Diagnosis and Management of Metastatic Cancer. EXPERIMENTAL AND CLINICAL METASTASIS 2013:381-399. [DOI: 10.1007/978-1-4614-3685-0_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
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Bittoni A, Scartozzi M, Giampieri R, Faloppi L, Maccaroni E, Del Prete M, Bianconi M, Cascinu S. The Tower of Babel of liver metastases from colorectal cancer: are we ready for one language? Crit Rev Oncol Hematol 2012; 85:332-41. [PMID: 22964298 DOI: 10.1016/j.critrevonc.2012.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 06/30/2012] [Accepted: 08/09/2012] [Indexed: 10/27/2022] Open
Abstract
Advances in surgical and medical treatments have significantly changed the management of colorectal cancer liver metastases (CRCLMs). In particular, new drugs and modern combination chemotherapy regimens, together with the improvement of surgical techniques, allow a potentially curative approach in an increasing number of patients. Nevertheless, there is no strong evidence for an optimal treatment strategy for CRCLMs, mainly because of the extensive heterogeneity in the patients. In fact, although we consider them a population, they represent different clinical and biological subtypes requiring different approaches. Furthermore, results from different studies in this setting may be difficult to interpret, also because the definitions of different patient subgroups are unclear and overlapping. In this review we discuss the results of clinical trials evaluating the role of chemotherapy in the multimodal management of CRCLMs, in either the pre- or postoperative setting. Then we identify three main categories of CRCLM patients, providing clinical recommendations for each.
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Affiliation(s)
- Alessandro Bittoni
- Scuola di Specializzazione in Oncologia, Università Politecnica delle Marche, Via Tronto 10/A, 60100 Ancona, Italy.
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Mima K, Beppu T, Chikamoto A, Miyamoto Y, Nakagawa S, Kuroki H, Okabe H, Hayashi H, Sakamoto Y, Watanabe M, Kikuchi K, Baba H. Hepatic resection combined with radiofrequency ablation for initially unresectable colorectal liver metastases after effective chemotherapy is a safe procedure with a low incidence of local recurrence. Int J Clin Oncol 2012; 18:847-55. [DOI: 10.1007/s10147-012-0471-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 08/14/2012] [Indexed: 02/06/2023]
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Individual fluorouracil dose adjustment in FOLFOX based on pharmacokinetic follow-up compared with conventional body-area-surface dosing: a phase II, proof-of-concept study. Clin Colorectal Cancer 2012; 11:263-7. [PMID: 22683364 DOI: 10.1016/j.clcc.2012.05.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 05/02/2012] [Indexed: 01/15/2023]
Abstract
BACKGROUND To compare the efficacy and safety of pharmacokinetically (PK) guided fluorouracil (5-FU) dose adjustment vs. standard body-surface-area (BSA) dosing in a FOLFOX (folinic acid, fluorouracil, oxaliplatin) regimen in metastatic colorectal cancer (mCRC). PATIENTS AND METHODS A total of 118 patients with mCRC were administered individually determined PK-adjusted 5-FU in first-line FOLFOX chemotherapy. The comparison arm consisted of 39 patients, and these patients were also treated with FOLFOX with 5-FU by BSA. For the PK-adjusted arm 5-FU was monitored during infusion, and the dose for the next cycle was based on a dose-adjustment chart to achieve a therapeutic area under curve range (5-FU(ODPM Protocol)). RESULTS The objective response rate was 69.7% in the PK-adjusted arm, and median overall survival and median progression-free survival were 28 and 16 months, respectively. In the traditional patients who received BSA dosage, objective response rate was 46%, and overall survival and progression-free survival were 22 and 10 months, respectively. Grade 3/4 toxicity was 1.7% for diarrhea, 0.8% for mucositis, and 18% for neutropenia in the dose-monitored group; they were 12%, 15%, and 25%, respectively, in the BSA group. CONCLUSIONS Efficacy and tolerability of PK-adjusted FOLFOX dosing was much higher than traditional BSA dosing in agreement with previous reports for 5-FU monotherapy PK-adjusted dosing. Analysis of these results suggests that PK-guided 5-FU therapy offers added value to combination therapy for mCRC.
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Boone BA, Bartlett DL, Zureikat AH. Isolated Hepatic Perfusion for the Treatment of Liver Metastases. Curr Probl Cancer 2012; 36:27-76. [DOI: 10.1016/j.currproblcancer.2011.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Abdalla EK. Who Benefits from Portal Vein Embolization Prior to Major Hepatectomy for Colorectal Cancer Liver Metastases? CURRENT COLORECTAL CANCER REPORTS 2011. [DOI: 10.1007/s11888-011-0094-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abdalla EK. Portal vein embolization (prior to major hepatectomy) effects on regeneration, resectability, and outcome. J Surg Oncol 2011; 102:960-7. [PMID: 21165999 DOI: 10.1002/jso.21654] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Portal vein embolization (PVE) is used to increase the volume and function of the liver that will remain after extensive liver resection. Operative outcomes are improved in properly selected patients who undergo PVE and experience adequate future liver remnant (FLR) hypertrophy. Absolute volume and volume change of the FLR after PVE (interpreted in context of liver disease) predict adequate liver function postresection. Oncologic outcomes following resection in patients with appropriately applied PVE are excellent.
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Affiliation(s)
- Eddie K Abdalla
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, 1400 Holcombe Boulevard-Unit 444, Houston, Texas 77030, USA.
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Wicherts DA, de Haas RJ, Sebagh M, Saenz Corrales E, Gorden DL, Lévi F, Paule B, Azoulay D, Castaing D, Adam R. Impact of bevacizumab on functional recovery and histology of the liver after resection of colorectal metastases. Br J Surg 2010; 98:399-407. [PMID: 21254017 DOI: 10.1002/bjs.7368] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND The impact of bevacizumab on functional recovery and histology of the liver was evaluated in patients undergoing hepatic resection for colorectal liver metastases (CLM) following bevacizumab treatment. METHODS Consecutive patients who had resection of CLM between July 2005 and July 2009 following preoperative chemotherapy were identified retrospectively from a prospectively collected database. Patients who had received bevacizumab before the last chemotherapy line were excluded. Postoperative liver function and histology were compared between patients with and without bevacizumab treatment. Recorded parameters included serum prothrombin time, total bilirubin concentration, and levels of aspartate and alanine aminotransferase and γ-glutamyltransferase. RESULTS Of 208 patients identified, 67 had received last-line bevacizumab, 44 were excluded and 97 had not received bevacizumab. Most patients in the bevacizumab group (66 per cent) received a single line of chemotherapy. Bevacizumab was most often combined with 5-flurouracil/leucovorin and irinotecan (68 per cent). The median number of bevacizumab cycles was 8·6 (range 1-34). Bevacizumab administration was stopped a median of 8 (range 3-19) weeks before surgery. There were no deaths. Postoperative morbidity occurred in 43 and 36 per cent of patients in the bevacizumab and no-bevacizumab groups respectively (P = 0·353). The mean(s.d.) degree of tumour necrosis was significantly higher in the bevacizumab group (55(27) versus 32(29) per cent; P = 0·001). Complete pathological response rates were comparable (3 versus 8 per cent; P = 0·307). Postoperative changes in functional parameters and objective signs of hepatic toxicity were similar in both groups. CONCLUSION Preoperative administration of bevacizumab does not seem to affect functional recovery of the liver after resection of CLM. Tumour necrosis is increased following bevacizumab treatment.
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Affiliation(s)
- D A Wicherts
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris Hôpital Paul Brousse, France
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Abstract
Surgical and oncological treatment of liver metastases of CRC has made a significant progress in the last twenty years. Although chemotherapy has developed enormously, only successfully resected (R0) patients may hope a long-term survival. The almost 60% recurrence rate after resection is a significant challenge. Authors review patients data operated at the Surgical Department of Uzsoki Teaching Hospital between 1995 and 2008 with hepatic metastases of colorectal origin. Oncological and surgical principles are summarized in the sight of the recent literature review and authors own experience with repeat hepatic resection. Recent literature data demonstrate--which is confirmed by our experience--that R0 resection of recurrent hepatic metastases provides similar overall 5 year survival rate than that of patients who underwent a single resection only. In the case of recurrent CLM, the oncoteam should prepare a surgically resectable situation.
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Affiliation(s)
- Ferenc Jakab
- Fovárosi Onkormányzat Uzsoki utcai Kórház, Sebészeti-Ersebészeti Osztály, 1145 Budapest, Uzsoki u. 29
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Tiernan J, Briggs CD, Irving GRB, Swinscoe MT, Peterson M, Cameron IC. Evaluation of the introduction of a standardised protocol for the staging and follow-up of colorectal cancer on resection rates for liver metastases. Ann R Coll Surg Engl 2010; 92:225-30. [PMID: 20223052 DOI: 10.1308/003588410x12628812458419] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In 2004, an audit in our unit demonstrated wide variation in liver resection rates for colorectal cancer (CRC) metastases within the cancer network. Subsequently, a network-wide CT-based follow-up and referral policy was introduced for all patients. A second audit was performed to assess the impact of the guidelines on liver resection rates. SUBJECTS AND METHODS Analysis of prospective liver resection database between 1997 and 2004 and after the introduction of standardised guidelines between January 2005 and April 2008. RESULTS A total of 362 patients underwent liver resection for CRC metastases between 1997 and 2008, 237 prior to the introduction of the referral guidelines and 125 after. Liver resection rates according to referring hospital varied from 0.92 to 2.32 per 100,000 population before guidelines were introduced. After 2005, resection rates from the four district hospitals standardised (1.68-1.84 per 100,000 population), but the central unit rate (Sheffield) remained significantly higher (2.67 per 100,000 population). No significant difference in 1-year disease-free survival between patients from Sheffield and the out-lying hospitals was found (P = 0.553). CONCLUSIONS Introduction of a referral protocol standardised resection rates from the four district hospitals, but these remain lower compared to the specialist centre. The wide-spread adoption of a policy to discuss all patients with liver metastases at an advanced disease multidisciplinary team meeting, in the presence of hepatobiliary specialists, may further increase resection rates across the UK.
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Affiliation(s)
- J Tiernan
- Department of Hepatobiliary and Pancreatic Surgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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MIMA KOSUKE, BEPPU TORU, MASUDA TOSHIRO, OTAO RYU, MIYAKE KEISUKE, OKABE HIROHISA, CHIKAMOTO AKIRA, HAYASHI NAOKO, ISHIKO TAKATOSHI, TAKAMORI HIROSHI, BABA HIDEO. The Role of Thermal Ablation for Colorectal Liver Metastases in the Era of Effective Chemotherapy. ACTA ACUST UNITED AC 2010. [DOI: 10.3191/thermalmed.27.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hepatic Toxicities Associated with the Use of Preoperative Systemic Therapy in Patients with Metastatic Colorectal Adenocarcinoma to the Liver. Oncologist 2009; 14:1095-105. [DOI: 10.1634/theoncologist.2009-0152] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Abstract
Neuroendocrine malignancies encompass a variety of tumors that differ considerably in origin, hormonal activity, and biological behavior. Because of their rarity most therapeutic recommendations have been based on limited evidence from small retrospective series observing miscellaneous patient cohorts. Only in recent years proposals for TNM and histological grading systems have been elaborated that allow further stratification of patients suffering from these tumors. Especially patients with well and moderately differentiated neuroendocrine malignancies benefit from resection of liver metastases, improving the 5-year survival rate from <50% to 80%. Orthotopic liver transplantation can likewise improve survival in carefully selected patients. New developments in imaging modalities, intensive care treatment, and in liver surgery itself have broadened the selection of potentially resectable tumors.
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Reddy SK, Barbas AS, Clary BM. Synchronous colorectal liver metastases: is it time to reconsider traditional paradigms of management? Ann Surg Oncol 2009; 16:2395-410. [PMID: 19506963 DOI: 10.1245/s10434-009-0372-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 10/14/2008] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patients with synchronous colorectal liver metastases (CLM) are typically treated with initial colorectal resection followed by arbitrary and prolonged courses of chemotherapy. Partial hepatectomy is considered only for patients without interval disease progression. This review describes the rationale for this treatment approach and the recent developments suggesting that this management paradigm should be reconsidered. RESULTS Because asymptomatic colorectal cancer often does not lead to complications, and given the potential benefit of chemotherapy in downsizing unresectable to resectable liver disease, most patients with asymptomatic primary tumors and unresectable synchronous CLM should be first treated with chemotherapy. In contrast, initial hepatic resection should be considered for resectable synchronous CLM. Survival benefits from prehepatectomy chemotherapy have not been established. Several reports demonstrate morbidity after hepatic resection from extended durations of irinotecan- and/or oxaliplatin-based prehepatectomy chemotherapy. Although shorter treatment periods may not have these deleterious effects on subsequent hepatic resection, prospective studies reveal that most patients with supposedly aggressive disease with short treatment durations will not be identified. Moreover, a complete radiologic response to prehepatectomy chemotherapy is not only rare but also does not equate with a complete pathological response. Finally, several studies suggest that simultaneous colorectal and minor hepatic resections can performed safely with benefits in total morbidity when compared with traditional staged procedures. CONCLUSIONS The traditional treatment paradigm centering on the utility of prehepatectomy chemotherapy for resectable synchronous CLM should be reconsidered. Recent developments underscore the need for prospective randomized controlled trials evaluating the optimal timing of hepatectomy relative to chemotherapy.
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Affiliation(s)
- Srinevas K Reddy
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
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Marshall JL. Integrating targeted agents into therapeutic regimens for patients with resectable colorectal cancer. Clin Colorectal Cancer 2008; 7 Suppl 2:S63-6. [PMID: 19064409 DOI: 10.3816/ccc.2008.s.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
New surgical techniques and new systemic treatments have come together to increase the number of patients with metastatic colorectal cancer who have been cured. There is great hope that new targeted agents will further increase our success, both through improved therapeutic outcomes and better selection of patients for this more invasive and aggressive approach. A summary of this current clinical data is presented herein to establish our current standards and to guide us toward our future goals. We are increasingly managing patients with a multidisciplinary approach, a critical element in our success. Biologic therapies will continue to play an important role in the management of these patients.
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Affiliation(s)
- John L Marshall
- Division of Hematology/Oncology, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC 20007, USA.
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Ryan DP. Chemotherapeutic Strategies for Resectable Colorectal Liver Metastases. SEMINARS IN COLON AND RECTAL SURGERY 2008. [DOI: 10.1053/j.scrs.2008.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Nikfarjam M, Shereef S, Kimchi ET, Gusani NJ, Jiang Y, Avella DM, Mahraj RP, Staveley-O’Carroll KF. Survival Outcomes of Patients with Colorectal Liver Metastases Following Hepatic Resection or Ablation in the Era of Effective Chemotherapy. Ann Surg Oncol 2008; 16:1860-7. [DOI: 10.1245/s10434-008-0225-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Revised: 09/23/2008] [Accepted: 09/24/2008] [Indexed: 12/21/2022]
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Zeh HJ, Brown CK, Holtzman MP, Egorin MJ, Holleran JL, Potter DM, Bartlett DL. A phase I study of hyperthermic isolated hepatic perfusion with oxaliplatin in the treatment of unresectable liver metastases from colorectal cancer. Ann Surg Oncol 2008; 16:385-94. [PMID: 19034580 DOI: 10.1245/s10434-008-0179-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 09/07/2008] [Accepted: 09/08/2008] [Indexed: 12/22/2022]
Abstract
Isolated hepatic perfusion (IHP) is a proven approach for regional delivery of chemotherapy in patients with unresectable primary and metastatic tumors of the liver. Most trials of IHP have utilized melphalan as the active drug in the perfusate. We performed a phase I trial to evaluate the efficacy, safety, and maximum tolerated dose (MTD) of oxaliplatin delivered by hyperthermic isolated hepatic perfusion. A phase I dose-escalation trial of hyperthermic IHP with oxaliplatin in patients with unresectable metastatic colorectal cancer scheduled to undergo placement of a hepatic arterial infusion (HAI) pump was carried out. Thirteen patients were enrolled between November 2003 and September 2006. Dose-limiting veno-occlusive disease was observed at 60 mg/m(2). At the MTD of 40 mg/m(2) only minor transient liver dysfunction was observed. Ultrafilterable platinum area under the curve and maximum concentration delivered by IHP increased nonlinearly with dose as did platinum concentrations in liver biopsies obtained at the end of the 60 min IHP. Seventy-seven percent of patients had a >50% decrease in serum carcinoembryonic antigen (CEA) after IHP. The overall response rate to the combined IHP and HAI therapy was 66%. One patient had a durable complete response (>4 years). We conclude that hyperthermic IHP with oxaliplatin was safe and feasible at a dose of 40 mg/m(2). The ability to obtain complete vascular isolation with open IHP was confirmed. The response rate in this small phase I study was encouraging.
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Affiliation(s)
- Herbert J Zeh
- Department of Surgery, University of Pittsburgh School of Medicine, PA 15232, USA.
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Garcea G, Ong SL, Maddern GJ. Inoperable colorectal liver metastases: a declining entity? Eur J Cancer 2008; 44:2555-72. [PMID: 18755585 DOI: 10.1016/j.ejca.2008.07.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Revised: 07/14/2008] [Accepted: 07/17/2008] [Indexed: 12/19/2022]
Abstract
BACKGROUND Untreated colorectal liver metastases (CLMs) have a dismal prognosis. Surgery remains the gold standard of treatment, but many patients will have inoperable disease at presentation. Until recently, the outlook for such patients was bleak. The purpose of this review was to report on available options in the treatment CLMs, which would be considered unresectable by conventional evaluation. METHODS Inclusion criteria were articles published in English-language journals reporting on either retrospective or prospective cohorts of patients undergoing treatment for conventionally inoperable CLM. Main outcome measures were survival, resectability rates, morbidity and mortality following treatment of the patients' disease. RESULTS Improved chemotherapy regimes and other innovative treatments have opened up new options for such patients and may even render conventionally inoperable disease resectable. The aim of treatment should be down-staging of metastases to achieve resectability, however, other treatments such as ablation may be also be used (either alone or in conjunction with resection). CONCLUSION A nihilistic attitude to the patient with seemingly inoperable liver metastases should be discouraged. Discussion of such patients at multi-disciplinary meetings is essential in order to plan and monitor treatments.
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Affiliation(s)
- G Garcea
- Department of Hepatobiliary and Upper Gastrointestinal Surgery, The Queen Elizabeth Hospital, Adelaide, SA, Australia.
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49
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First-line chemotherapy in metastatic colorectal cancer: new approaches and therapeutic algorithms. Always hit hard first? Curr Opin Oncol 2008; 20:459-65. [DOI: 10.1097/cco.0b013e32830218ea] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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50
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Lenz HJ. First-line combination treatment of colorectal cancer with hepatic metastases: Choosing a targeted agent. Cancer Treat Rev 2008; 34 Suppl 2:S3-7. [DOI: 10.1016/s0305-7372(08)70002-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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