1
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Panni RZ, D'Angelica M. Stage IV Rectal Cancer and Timing of Surgical Approach. Clin Colon Rectal Surg 2024; 37:248-255. [PMID: 38882938 PMCID: PMC11178389 DOI: 10.1055/s-0043-1770719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Liver metastases are seen in at least 60% of patients with colorectal cancer at some point during the course of their disease. The management of both primary and liver disease is uniquely challenging in rectal cancer due to competing treatments and complex sequence of treatments depending on the clinical presentation of disease. Recently, several novel concepts are shaping new treatment paradigms, including changes in timing, sequence, and duration of therapies combined with potential deescalation of treatment components. Overall, the treatment of this clinical scenario mandates multidisciplinary evaluation and personalization of care; however, there is still considerable debate regarding the timing of liver metastasectomy in the context of the overall treatment plan. Herein, we will discuss the current literature on management of rectal cancer with synchronous liver metastasis, current treatment approaches with respect to chemotherapy, and role of hepatic artery infusion therapy.
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Affiliation(s)
- Roheena Z Panni
- Complex General Surgical Oncology, Hepatopancreatobiliary Surgery, Memorial Sloan Kettering Cancer Center, New York
| | - Michael D'Angelica
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, Cornell University, New York
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2
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Li Y, Xu J, Hu X, Chen Y, Liu F, Chen Y, Ma X, Dong Q, Sun L, Mo S, Zhang L, He X, Tong S, Wu H, Li W, Cai S, Zhu S, Pan Q, Peng J. Personalized circulating tumor DNA monitoring improves recurrence surveillance and management after curative resection of colorectal liver metastases: a prospective cohort study. Int J Surg 2024; 110:2776-2787. [PMID: 38445460 DOI: 10.1097/js9.0000000000001236] [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: 10/21/2023] [Accepted: 02/15/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Approximately 60% of patients with colorectal liver metastases (CRLM) experience relapse within 2 years after radical resection, previous studies have proven that repeat local treatment (LT) could prolong survival, however, it is difficult to seize the window for LT due to the lack of a high-sensitive surveillance method. In this study, the authors aim to examine the value of longitudinal circulating tumor DNA (ctDNA) in guiding adjuvant chemotherapy, optimizing clinical surveillance strategy, and thereby improving CRLM outcomes. MATERIALS AND METHODS The authors conducted a prospective clinical trial using a personalized, tumor-informed ctDNA assay to monitor 60 CRLM patients undergoing resection with curative intent. Formalin-fixed paraffin-embedded tumor samples were collected after surgery. Blood samples were collected before surgery, 30 days after surgery (post-OP), and every third month until relapse or up to 2 years. RESULTS A total of 394 plasma samples from 60 eligible patients were analyzed, with a median follow-up time of 31.3 months. Landmark analyses revealed that detectable ctDNA at post-OP (HR, 4.8), postadjuvant chemotherapy (HR, 6.0), and end-of-treatment (HR, 5.6) were associated with higher recurrence risk ( P <0.001). Post-OP ctDNA positivity served as the only independent prognostic marker in the multivariant analysis (HR, 5.1; P <0.001). Longitudinal ctDNA analysis identified relapsed patients at both sensitivity and specificity of 100%. Most (75%) patients were found with radiological relapse within 6 months after the first detectable ctDNA with a median lead time of 3.5 months. In relapsed patients, 73.2% had oligometastatic disease and 61% were liver-restricted, of which 72.0% received repeat LTs, and 60.0% achieved a secondary no evidence of disease status. CONCLUSIONS Longitudinal ctDNA monitoring assists in early prediction of relapse, and thereby improves survival of CRLM patients by increased secondary resection rate and secondary no evidence of disease rate.
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Affiliation(s)
- Yaqi Li
- Department of Colorectal Surgery
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai
| | - Jing Xu
- BGI Genomics, BGI-Shenzhen, Shenzhen, People's Republic of China
| | - Xiang Hu
- Department of Colorectal Surgery
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai
| | - Yikuan Chen
- Department of Colorectal Surgery
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai
| | - Fangqi Liu
- Department of Colorectal Surgery
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai
| | - Yun Chen
- BGI Genomics, BGI-Shenzhen, Shenzhen, People's Republic of China
| | - Xiaoji Ma
- Department of Colorectal Surgery
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai
| | - Qiduo Dong
- BGI Genomics, BGI-Shenzhen, Shenzhen, People's Republic of China
| | - Lei Sun
- Tianjin Medical Laboratory BGI, BGI-Tianjin, Tianjin
| | - Shaobo Mo
- Department of Colorectal Surgery
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai
| | - Long Zhang
- Department of Colorectal Surgery
- Cancer Institute, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai
| | - Xingfeng He
- Department of Colorectal Surgery
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai
| | - Shanyou Tong
- Department of Colorectal Surgery
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai
| | - Huizi Wu
- BGI Genomics, BGI-Shenzhen, Shenzhen, People's Republic of China
| | - Wenhua Li
- Department of Medical Oncology
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai
| | - Sanjun Cai
- Department of Colorectal Surgery
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai
| | - Shida Zhu
- Shenzhen Engineering Laboratory for Innovative Molecular Diagnostics
- BGI Genomics, BGI-Shenzhen, Shenzhen, People's Republic of China
| | - Qi Pan
- Department of Hepatic Surgery
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai
| | - Junjie Peng
- Department of Colorectal Surgery
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai
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3
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Su YC, Wu CC, Chen YH, Su CC, Chang YC, Hsieh MC, Kao Yang YH. Assessing the effectiveness of targeted agents in adjuvant therapy for patients with metastatic colorectal cancer undergoing surgical resection: a retrospective cohort study. Ther Adv Med Oncol 2024; 16:17588359241246427. [PMID: 38655393 PMCID: PMC11036930 DOI: 10.1177/17588359241246427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
Background Primary tumor resection and metastasectomy may be beneficial for many patients with metastatic colorectal cancer (mCRC). Objective To assess the differences in postoperative survival outcomes between adjuvant therapy with chemotherapy alone and chemotherapy plus targeted agents (TAs). Design Retrospective cohort study. Methods Patients with mCRC who underwent surgical resection for primary colorectal tumor and distant metastases and received adjuvant therapy from 1 January 2010 to 31 December 2017 were enrolled in the Taiwan Cancer Registry. We analyzed the overall survival of patients with resectable or initially unresectable mCRC who received adjuvant chemotherapy alone and chemotherapy plus TAs. Results We enrolled 1124 and 542 patients with resectable and initially unresectable mCRC, respectively. Adjuvant chemotherapy plus TAs and chemotherapy alone resulted in similar mortality rates among patients with resectable mCRC [adjusted hazard ratio (aHR) = 1.13; 95% confidence interval (CI), 0.93-1.36]; however, it marginally reduced the mortality rate among patients with initially unresectable mCRC who underwent conversion surgery after neoadjuvant therapy (aHR = 0.81; 95% CI, 0.62-1.06). The subgroup analysis of patients who received more than nine cycles of TAs preoperatively and anti-epidermal growth factor receptor agents revealed aHRs of 0.48 (95% CI, 0.27-0.87) and 0.33 (95% CI, 0.18-0.60), respectively. Conclusion Adjuvant chemotherapy plus TAs may improve survival in patients with initially unresectable tumors who underwent conversion surgery following neoadjuvant therapy with TAs, especially in those who respond well to the targeted therapy. Our study underscores the importance of stratifying patients with mCRC based on tumor resectability when selecting the adjuvant therapy regimen.
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Affiliation(s)
- Yi-Chia Su
- Department of Pharmacy, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Chih-Chien Wu
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Hsun Chen
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chien-Chou Su
- Clinical Innovation Center, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
- Department of Pharmacy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Ching Chang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Meng-Che Hsieh
- Department of Hematology and Oncology, E-Da Cancer Hospital, Kaohsiung, Taiwan
- College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yea-Huei Kao Yang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan 701, Taiwan
- Health Outcome Research Center, National Cheng Kung University, Tainan, Taiwan
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4
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Chandra P, Sacks GD. Contemporary Surgical Management of Colorectal Liver Metastases. Cancers (Basel) 2024; 16:941. [PMID: 38473303 DOI: 10.3390/cancers16050941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Colorectal cancer is the third most common cancer in the United States and the second most common cause of cancer-related death. Approximately 20-30% of patients will develop hepatic metastasis in the form of synchronous or metachronous disease. The treatment of colorectal liver metastasis (CRLM) has evolved into a multidisciplinary approach, with chemotherapy and a variety of locoregional treatments, such as ablation and portal vein embolization, playing a crucial role. However, resection remains a core tenet of management, serving as the gold standard for a curative-intent therapy. As such, the input of a dedicated hepatobiliary surgeon is paramount for appropriate patient selection and choice of surgical approach, as significant advances in the field have made management decisions extremely nuanced and complex. We herein aim to review the contemporary surgical management of colorectal liver metastasis with respect to both perioperative and operative considerations.
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Affiliation(s)
- Pratik Chandra
- Department of Surgery, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Greg D Sacks
- Department of Surgery, NYU Grossman School of Medicine, New York, NY 10016, USA
- VA New York Harbor Healthcare System, New York, NY 10010, USA
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5
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Audisio A, Fazio R, Daprà V, Assaf I, Hendlisz A, Sclafani F. Neoadjuvant chemotherapy for early-stage colon cancer. Cancer Treat Rev 2024; 123:102676. [PMID: 38160535 DOI: 10.1016/j.ctrv.2023.102676] [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: 10/31/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
Surgery with or without adjuvant chemotherapy is the standard treatment for early-stage colon cancer. However, evidence has recently emerged for neoadjuvant chemotherapy, with the results of randomised clinical trials sparking debates within multidisciplinary teams and splitting the gastrointestinal oncology community. Further to a systematic search of the literature, we provide a thorough and in-depth analysis of the findings from these trials, highlighting the advantages and disadvantages of neoadjuvant chemotherapy. We conclude that, while there is a potential value of moving systemic therapy from the post-operative to the pre-operative setting, the available evidence does not justify a shift in the treatment paradigm of early-stage colon cancer, and surgery with or without adjuvant chemotherapy should remain the standard approach for these patients.
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Affiliation(s)
- Alessandro Audisio
- Institut Jules Bordet, The Brussels University Hospital (HUB), Brussels, Belgium
| | - Roberta Fazio
- Institut Jules Bordet, The Brussels University Hospital (HUB), Brussels, Belgium
| | - Valentina Daprà
- Institut Jules Bordet, The Brussels University Hospital (HUB), Brussels, Belgium
| | - Irene Assaf
- Institut Jules Bordet, The Brussels University Hospital (HUB), Brussels, Belgium; Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Alain Hendlisz
- Institut Jules Bordet, The Brussels University Hospital (HUB), Brussels, Belgium; Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Francesco Sclafani
- Institut Jules Bordet, The Brussels University Hospital (HUB), Brussels, Belgium; Université Libre de Bruxelles (ULB), Brussels, Belgium.
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6
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Adams AM, Vreeland TJ, Newhook TE. Circulating Tumor DNA: Towards More Individualized Treatment for Patients with Resectable Colorectal Cancer. J Gastrointest Cancer 2023; 54:1071-1081. [PMID: 36562938 DOI: 10.1007/s12029-022-00888-y] [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] [Accepted: 11/13/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Despite curative-intent treatment, recurrence is common for patients with colorectal cancer (CRC). Currently, prediction of disease recurrence and prognostication following surgery is based upon vague clinical factors and more precise and dynamic biomarkers for risk stratification and treatment decisions are urgently needed. Circulating tumor DNA (ctDNA) is a promising biomarker for patients undergoing treatment for resectable CRC. METHODS In this review, we provide an overview of the data supporting current uses of ctDNA for CRC, including localized CRC and resectable colorectal liver metastases (CLM), as well as descriptions of important ongoing clinical trials using ctDNA in the care of patients with CRC. RESULTS The detection of ctDNA following curative-intent therapy is associated with disease recurrence, and multiple trials are investigating its role in determining need and duration for adjuvant therapy for localized CRC. In addition, ctDNA reliably predicts prognosis for patients with CLM, with trials underway studying ctDNA-guided treatment sequencing and intensity. CONCLUSION The detection of ctDNA is a sensitive and dynamic biomarker for disease recurrence in CRC. Many investigations are underway into ctDNA's potential role in surveillance and treatment algorithms, and it has the potential to become a critical biomarker to determine individualized strategies for treatment sequencing, choice, and duration of therapies.
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Affiliation(s)
- Alexandra M Adams
- Department of Surgery, Brooke Army Medical Center, San Antonio, TX, USA
| | - Timothy J Vreeland
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD, USA
- Department of Surgical Oncology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Timothy E Newhook
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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7
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Kataoka K, Takahashi K, Takeuchi J, Ito K, Beppu N, Ceelen W, Kanemitsu Y, Ajioka Y, Endo I, Hasegawa K, Takahashi K, Ikeda M. Correlation between recurrence-free survival and overall survival after upfront surgery for resected colorectal liver metastases. Br J Surg 2023; 110:864-869. [PMID: 37196147 DOI: 10.1093/bjs/znad127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/11/2023] [Accepted: 04/28/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND The role of recurrence-free survival (RFS) as a valid surrogate endpoint for overall survival (OS) in patients who underwent upfront surgery for colorectal liver metastases remains uncertain. The aim of the study was to compare the two survival measures in a nationwide cohort of upfront resected colorectal liver metastasis. METHODS Data from patients with colorectal liver metastases without extrahepatic metastases who underwent curative surgery for liver metastases were retrieved from the Japanese nationwide database (data collection 2005-2007 and 2013-2014). RFS, OS, and survival after recurrence were estimated using the Kaplan-Meier method. The correlation (ρ) between RFS and OS was assessed using the rank correlation method combined with iterative multiple imputation, to account for censoring. As a secondary analysis, the correlation was evaluated according to adjuvant chemotherapy regimen. In sensitivity analysis, the pairwise correlation between RFS and OS was calculated. RESULTS A total of 2385 patients with colorectal liver metastases were included. In the primary analysis, there was a moderately strong correlation between RFS and OS (ρ = 0.73, 95 per cent c.i. 0.70 to 0.76). The strength of the correlation was similar regardless of the adjuvant treatment regimen (oxaliplatin plus 5-fluorouracil: ρ = 0.72, 0.67 to 0.77; 5-fluorouracil alone: ρ = 0.72, 0.66 to 0.76; observation: ρ = 0.74, 0.69 to 0.78). The mean(s.d.) pairwise correlation coefficient between 3-year RFS and 5-year OS was 0.87(0.06). CONCLUSION In surgically treated patients with colorectal liver metastases, there was a moderately strong correlation between RFS and OS, which was unaffected by the treatment regimen. Further validation using a trial-level analysis is required.
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Affiliation(s)
- Kozo Kataoka
- Division of Lower Gastrointestinal, Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Japan
| | - Kanae Takahashi
- Department of Biostatistics, Hyogo Medical University, Nishinomiya, Japan
| | - Jiro Takeuchi
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
| | - Kazuma Ito
- Division of Lower Gastrointestinal, Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Japan
| | - Naohito Beppu
- Division of Lower Gastrointestinal, Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Japan
| | - Wim Ceelen
- Department of Gastrointestinal Surgery, Ghent University Hospital, and Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Centre Hospital, Tokyo, Japan
| | - Yoichi Ajioka
- Division of Molecular and Diagnostic Pathology, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Kiyoshi Hasegawa
- Department of Surgery, Hepato-Biliary-Pancreatic Surgery Division, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Keiichi Takahashi
- Department of Surgery, Tokyo Metropolitan Ohkubo Hospital, Tokyo, Japan
| | - Masataka Ikeda
- Division of Lower Gastrointestinal, Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Japan
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Carconi C, Cerreti M, Roberto M, Arrivi G, D'Ambrosio G, De Felice F, Di Civita MA, Iafrate F, Lucatelli P, Magliocca FM, Picchetto A, Picone V, Catalano C, Cortesi E, Tombolini V, Mazzuca F, Tomao S. The Management of Oligometastatic Disease in Colorectal Cancer: Present Strategies and Future Perspectives. Crit Rev Oncol Hematol 2023; 186:103990. [PMID: 37061075 DOI: 10.1016/j.critrevonc.2023.103990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/29/2023] [Accepted: 04/11/2023] [Indexed: 04/17/2023] Open
Abstract
Oligometastatic disease has been described as an intermediate clinical state between localized cancer and systemically metastasized disease. Recent clinical studies have shown prolonged survival when aggressive locoregional approaches are added to systemic therapies in patients with oligometastases. The aim of this review is to outline the newest options to treat oligometastatic colorectal cancer (CRC), also considering its molecular patterns. We present an overview of the available local treatment strategies, including surgical procedures, stereotactic body radiation therapy (SBRT), thermal ablation, as well as trans-arterial chemoembolization (TACE) and selective internal radiotherapy (SIRT). Moreover, since imaging methods provide crucial information for the early diagnosis and management of oligometastatic CRC, we discuss the role of modern radiologic techniques in selecting patients that are amenable to potentially curative locoregional treatments.
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Affiliation(s)
- Catia Carconi
- Sant'Andrea University Hospital, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Micaela Cerreti
- Sant'Andrea University Hospital, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Michela Roberto
- UOC Oncologia A, Department of radiological, Oncological and Anathomo-patological Science, Policlinico Umberto I, "Sapienza" University of Rome, 00161 Rome, Italy.
| | - Giulia Arrivi
- Oncology Unit, Sant' Andrea University Hospital, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Giancarlo D'Ambrosio
- Department of General Surgery, Surgical Specialties and Organ Transplantation, Policlinico Umberto I, "Sapienza" University of Rome, 00161 Rome, Italy
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Mattia Alberto Di Civita
- UOC Oncologia A, Department of radiological, Oncological and Anathomo-patological Science, Policlinico Umberto I, "Sapienza" University of Rome, 00161 Rome, Italy
| | - Franco Iafrate
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Pierleone Lucatelli
- Vascular and Interventional radiology Unit, Department of radiological, Oncological and Anathomo-patological Science, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Fabio Massimo Magliocca
- Vascular and Interventional radiology Unit, Department of radiological, Oncological and Anathomo-patological Science, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Andrea Picchetto
- Emergency Department, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Vincenzo Picone
- UOC Oncologia B, Department of radiological, Oncological and Anathomo-patological Science, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Carlo Catalano
- Vascular and Interventional radiology Unit, Department of radiological, Oncological and Anathomo-patological Science, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Enrico Cortesi
- UOC Oncologia B, Department of radiological, Oncological and Anathomo-patological Science, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Vincenzo Tombolini
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Federica Mazzuca
- Oncology Unit, Sant' Andrea University Hospital, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Silverio Tomao
- Oncology Unit, Sant' Andrea University Hospital, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
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9
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Georgilis E, Gavriatopoulou M, Tsilimigras DI, Malandrakis P, Theodosopoulos T, Ntanasis-Stathopoulos I. Optimizing Adjuvant Therapy after Surgery for Colorectal Cancer Liver Metastases: A Systematic Review. J Clin Med 2023; 12:jcm12062401. [PMID: 36983401 PMCID: PMC10051548 DOI: 10.3390/jcm12062401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/09/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
The liver is the most common site of colorectal cancer metastatic spread. Although metastasectomy is the gold standard for fit patients with resectable colorectal cancer liver metastases (CRLMs), their management after surgical treatment remains controversial. The objective of this systematic review was to collate the currently available data of the agents used in the adjuvant setting in order to define the most optimal therapeutic strategy. A systematic review of the literature was conducted by searching PubMed/Medline and Cochrane library databases. We included studies that evaluated the efficacy, the tolerability and the safety profile of various chemotherapeutic agents that are used as adjuvant treatment after surgical resection of CRLMs. The outcomes of interest were regression-free survival (RFS), disease-free survival (DFS), overall survival (OS) and severe toxicities. From 543 initial articles, 29 publications with 7028 patients were finally included. In general, the results of the eligible studies indicated that adjuvant therapy after resection of CRLMs led to improved RFS/DFS rates, but this benefit did not contribute to a statistically significant prolongation of OS. Moreover, the choice of the therapeutic strategy, namely systematic or regional chemotherapy or the combination of both, did not seem to have a differential impact on patient outcomes. However, these results should be interpreted with caution since the majority of the chosen studies are of low or moderate quality. In this context, further high-quality clinical trials conducted on patient sub-populations with modern therapies are required in order to reduce in-study and between-study heterogeneity and determine which patients are expected to derive the maximum benefit from adjuvant therapy after surgery for CRLMs.
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Affiliation(s)
- Emmanouil Georgilis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH 43210, USA
| | - Panagiotis Malandrakis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Theodosios Theodosopoulos
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
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10
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Sonbol MB, Siddiqi R, Uson PLS, Pathak S, Firwana B, Botrus G, Almader-Douglas D, Ahn DH, Borad MJ, Starr J, Jones J, Stucky CC, Smoot R, Riaz IB, Bekaii-Saab T. The Role of Systemic Therapy in Resectable Colorectal Liver Metastases: Systematic Review and Network Meta-Analysis. Oncologist 2022; 27:1034-1040. [PMID: 36239399 PMCID: PMC9732220 DOI: 10.1093/oncolo/oyac212] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/12/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite multiple randomized trials, the role of perioperative chemotherapy in colorectal cancer liver metastasis (CRLM) is still under debate. In this systematic review and network meta-analysis (NMA), we aim to evaluate the efficacy of perioperative systemic therapies for patients with CRLM. METHODS We searched various databases for abstracts and full-text articles published from database inception through May 2021.We included randomized controlled trials (RCTs) comparing the addition of perioperative (post, pre, or both) systemic therapies to surgery alone in patients with CRLM. The outcomes were compared according to the chemotherapy regimen using a random effects model. Outcomes of interest included disease-free survival (DFS) and overall survival (OS). RESULTS Seven RCTs with a total of 1504 patients with CRLM were included. Six studies included post-operative treatment and one evaluated perioperative (pre- and postoperative) therapy. Fluoropyrimidine-based chemotherapy was the most used systemic therapy. NMA showed benefit of adding perioperative therapy to surgery in terms of DFS (HR 0.73, 95% CI 0.63 to 0.84). However, these findings did not translate into a statistically significant OS benefit (HR 0.88, 95% CI 0.74 to 1.05). NMA did not show any advantage of one regimen over another including oxaliplatin or irinotecan. CONCLUSIONS This systematic review and NMA of 7 RCTs found that the addition of perioperative systemic treatment for resectable CRLM could improve disease-free survival but not overall survival. Based on the findings, addition of perioperative treatment in resectable CRLM should be individualized weighing the risks and benefits.
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Affiliation(s)
| | - Rabbia Siddiqi
- Department of Medicine, Dow University of Health Sciences, Karachi city, Sindh, Pakistan
| | - Pedro Luiz Serrano Uson
- Department of Oncology Mayo Clinic Cancer Center, Phoenix, AZ, USA,Department of Oncology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Belal Firwana
- Heartland Cancer Research, Missouri Baptist Medical Center, St Louis, MO, USA
| | - Gehan Botrus
- Department of Medicine, Honorhealth Research Institute, Scottsdale, AZ, USA
| | | | - Daniel H Ahn
- Department of Oncology Mayo Clinic Cancer Center, Phoenix, AZ, USA
| | - Mitesh J Borad
- Department of Oncology Mayo Clinic Cancer Center, Phoenix, AZ, USA
| | - Jason Starr
- Mayo Clinic Cancer Center, Jacksonville, FL, USA
| | - Jeremy Jones
- Mayo Clinic Cancer Center, Jacksonville, FL, USA
| | - Chee-Chee Stucky
- Department of Oncology Mayo Clinic Cancer Center, Phoenix, AZ, USA
| | - Rory Smoot
- Mayo Clinic Cancer Center, Rochester, MN, USA
| | - Irbaz Bin Riaz
- Department of Oncology Mayo Clinic Cancer Center, Phoenix, AZ, USA,Mayo Clinic Cancer Center, Rochester, MN, USA
| | - Tanios Bekaii-Saab
- Corresponding author: Tanios Bekaii-Saab, MD, Mayo Clinic College of Medicine and Science, 5777 East Mayo Boulevard Phoenix, AZ 85054, USA. Tel: +1 480 342 4800; Email address:
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11
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Hao Z, Parasramka S, Chen Q, Jacob A, Huang B, Mullett T, Benson AB. Neoadjuvant Versus Adjuvant Chemotherapy for Resectable Metastatic Colon Cancer in Non-academic and Academic Programs. Oncologist 2022; 28:48-58. [PMID: 36200844 PMCID: PMC9847538 DOI: 10.1093/oncolo/oyac209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Overall survival advantage of chemotherapy before versus after metastasectomy of liver or lung lesion is not clear for colon cancer with synchronous liver or lung metastasis. MATERIALS AND METHODS Adults 20 years or older with primary colon cancer and single organ metastatic disease either in the liver or lung at diagnosis were identified between 2010 and 2015 through the National Cancer Database (NCDB). Patients were categorized into 2 cohorts: pre-operative/peri-operative chemotherapy (neoadjuvant -[NAC]) or post-operative chemotherapy (adjuvant [AC]). Survivals and factors associated with were compared between the 2 groups. RESULTS A total of 3038 patients with colon cancer with liver or lung metastases were identified. The percentage of patients receiving NAC had steadily increased from 12.29% to 28.31%, mostly in academic programs. On multivariate analysis, patients who received NAC had an overall survival advantage in the non-academic setting whereas no advantage is seen in the patients treated in the academic settings. The median overall survival for patients receiving NAC and AC was 47.24 months and 38.08 months, respectively. Factors associated with overall survival advantage in NAC patients treated in non-academic programs included age 20-49 years, CEA value of >30, right-sided colon primary, liver metastasis, and clear resection margins. CONCLUSIONS Metastatic colon cancer with single organ liver or lung lesions benefits from neoadjuvant chemotherapy, especially in -non-academic settings. The overall survival advantage in this setting has not been shown before.
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Affiliation(s)
- Zhonglin Hao
- Corresponding author: Zhonglin Hao, MD, PhD, Department of Internal Medicine, Markey Cancer Center, University of Kentucky; 800 Rose Street, Lexington, KY 40536, USA;
| | - Saurabh Parasramka
- Department of Internal Medicine, Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Quan Chen
- Biostatistics and Bioinformatics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Aasems Jacob
- Department of Internal Medicine, Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Bin Huang
- Biostatistics and Bioinformatics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, KY, USA,Division of Cancer Biostatistics, Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Timothy Mullett
- Department of Surgery, Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Al B Benson
- Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
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12
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Ecker BL, Lee J, Saadat LV, Aparicio T, Buisman FE, Balachandran VP, Drebin JA, Hasegawa K, Jarnagin WR, Kemeny NE, Kingham TP, Groot Koerkamp B, Kokudo N, Matsuyama Y, Portier G, Saltz LB, Soares KC, Wei AC, Gonen M, D'Angelica MI. Recurrence-free survival versus overall survival as a primary endpoint for studies of resected colorectal liver metastasis: a retrospective study and meta-analysis. Lancet Oncol 2022; 23:1332-1342. [PMID: 36058227 DOI: 10.1016/s1470-2045(22)00506-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recurrence-free survival has been used as a surrogate endpoint for overall survival in trials involving patients with resected colorectal liver metastases. We aimed to assess the correlation between recurrence-free survival and overall survival after resection of colorectal liver metastases to determine the adequacy of this surrogate endpoint. METHODS In this retrospective study and meta-analysis, we compiled an institutional cohort of consecutive patients who had complete resection of colorectal liver metastases from the Memorial Sloan Kettering Cancer Center (New York, NY, USA) prospective database. Patients were eligible for inclusion if they were aged 18 years or older, and underwent hepatectomy, with or without operative ablation, between Jan 1, 1991, and April 30, 2019. We estimated overall survival and recurrence-free survival probabilities at various timepoints using the Kaplan-Meier method, and we assessed pairwise associations between these endpoints using Spearman's rank correlation. We also did a meta-analysis of adjuvant phase 3 clinical trials for colorectal liver metastases to assess the correlation between hazard ratios (HRs) for recurrence-free survival and overall survival. We searched MEDLINE for articles of phase 3 randomised controlled trials analysing adjuvant treatment strategies for resected colorectal metastases from database inception to Jan 1, 2022. The titles and abstracts of identified studies were screened before full-text screening and summary data were either recalculated or extracted manually from the published Kaplan-Meier curves (depending on data availability). FINDINGS Data were available for 3299 patients in the institutional database, of whom 2983 were eligible for inclusion in our cohort. Median follow-up was 8·4 years (95% CI 7·9-9·1) , during which time there were 1995 (67%) disease recurrences and 1684 (56%) deaths. Median recurrence-free survival was 1·3 years (95% CI 1·3-1·4) and median overall survival was 5·2 years (95% CI 5·0-5·5). 1428 (85%) of 1684 deaths were preceded by recurrence, and median time from recurrence to death was 2·0 years (IQR 1·0-3·4). Pairwise correlations between recurrence-free survival and overall survival were low to moderate, with a correlation estimate ranging from 0·30 (SD 0·17) to 0·56 (0·13). In the meta-analysis of adjuvant clinical trials, the Spearman's correlation coefficient between recurrence-free survival HR and overall survival HR was r=0·20 (p=0·71). INTERPRETATION We found a minimal correlation between recurrence-free survival and overall survival after resection of colorectal liver metastases. Recurrence-free survival is an inadequate surrogate endpoint for overall survival in this disease setting. FUNDING US National Cancer Institute.
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Affiliation(s)
- Brett L Ecker
- Department of Surgery, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Jasme Lee
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lily V Saadat
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Thomas Aparicio
- Gastroenterology and Digestive Oncology Department, Centre Hospitalo-Universitaire Saint Louis, Paris, France
| | - Florian E Buisman
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Vinod P Balachandran
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeffrey A Drebin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - William R Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nancy E Kemeny
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Norihiro Kokudo
- Department of Hepato-Biliary-Pancreatic Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yutaka Matsuyama
- Department of Biostatistics, The University of Tokyo, Tokyo, Japan
| | | | - Leonard B Saltz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kevin C Soares
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alice C Wei
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael I D'Angelica
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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13
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Riesco-Martinez MC, Modrego A, Espinosa-Olarte P, La Salvia A, Garcia-Carbonero R. Perioperative Chemotherapy for Liver Metastasis of Colorectal Cancer: Lessons Learned and Future Perspectives. Curr Treat Options Oncol 2022; 23:1320-1337. [PMID: 35980520 DOI: 10.1007/s11864-022-01008-5] [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] [Accepted: 08/01/2022] [Indexed: 11/27/2022]
Abstract
OPINION STATEMENT Colorectal cancer (CRC) is a major public health problem and the 2nd leading-cause of cancer-related death worldwide. Around 30% of patients present with metastatic disease and 50% of those with early disease will eventually relapse. The metastatic spread occurs mainly to the liver, which is the exclusive site in 30-40% of the cases. Surgery is the main curative option for liver recurrence, but only one out of five patients are eligible for resection. Moreover, even if surgery is feasible, recurrence rate is high, occurring in up to 75% of patients. Therefore, additional treatment to improve these disappointing outcomes has been sought. Adjuvant and perioperative chemotherapy aim to eradicate early micrometastatic disease, decreasing recurrence rates, and improving survival outcomes. Different chemotherapy regimens, mainly extrapolated from the adjuvant experience, have showed conflicting results, with improvements in disease free but not in overall survival. The addition of targeted therapies to chemotherapy has improved response rates and resectability when administered preoperatively, but did not have an impact on survival in the adjuvant setting. There is a need to critically synthetize the available evidence on perioperative and conversion therapy from the past years, and appraise areas of current research and potential future directions.
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Affiliation(s)
- Maria C Riesco-Martinez
- Medical Oncology Department, Hospital Universitario 12 de Octubre, imas 12, UCM, Avda Cordoba km 5.4, 28041, Madrid, Spain
| | - Andrea Modrego
- Medical Oncology Department, Hospital Universitario 12 de Octubre, imas 12, UCM, Avda Cordoba km 5.4, 28041, Madrid, Spain
| | - Paula Espinosa-Olarte
- Medical Oncology Department, Hospital Universitario 12 de Octubre, imas 12, UCM, Avda Cordoba km 5.4, 28041, Madrid, Spain
| | - Anna La Salvia
- Medical Oncology Department, Hospital Universitario 12 de Octubre, imas 12, UCM, Avda Cordoba km 5.4, 28041, Madrid, Spain
| | - Rocio Garcia-Carbonero
- Medical Oncology Department, Hospital Universitario 12 de Octubre, imas 12, UCM, Avda Cordoba km 5.4, 28041, Madrid, Spain.
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14
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Maruyama K, Tominaga T, Nonaka T, Moriyama M, Oyama S, Ishii M, Sawai T, Nagayasu T. Efficacy of risk-stratified indicators for adjuvant chemotherapy with fluorouracil and oxaliplatin after hepatectomy for colorectal cancer liver metastasis. Int J Colorectal Dis 2022; 37:1545-1552. [PMID: 35624174 DOI: 10.1007/s00384-022-04189-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The recurrence rate after hepatectomy for colorectal cancer liver metastasis (CRLM) is high, and there is no consensus regarding the effect of adjuvant chemotherapy (AC) using oxaliplatin (doublet AC) in these patients. METHODS The present study included 91 patients who underwent hepatectomy for complete resection at our hospitals between 2008 and 2018. Based on whether or not they had undergone doublet AC, patients were divided into AC (n = 35) and non-AC (n = 56) groups. The recurrent risk was evaluated by the Memorial Sloan Kettering Cancer Center clinical risk score (MSKCC-CRS). RESULTS The number of females and median age were higher in the AC group (51.4% vs 25.0%, p = 0.010 and 67 vs 61 years, p = 0.012, respectively). The median follow-up period was 45 months (range, 6-101 months). Doublet AC was an independent prognostic factor for 5-year relapse-free survival (hazard ratio, 0.225; 95%CI, 0.097-0.522; p < 0.001) and for 5-year overall survival (hazard ratio, 0.165; 95%CI, 0.057-0.476; p < 0.001) in multivariate analysis. In patients with a high risk of recurrence (MSKCC-CRS 3-5), 5-year relapse-free survival and 5-year overall survival was higher in the doublet AC group than in the non-AC group (p < 0.01). In low-risk patients (MSKCC-CRS 0-2), 5-year relapse-free survival and 5-year overall survival were similar between the groups. CONCLUSIONS Doublet AC could have a positive effect on prognosis after curative resection of CRLM, especially in high-risk patients. The selection of patients and AC regimen should take into consideration the risk of recurrence.
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Affiliation(s)
- Keizaburo Maruyama
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Tetsuro Tominaga
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Takashi Nonaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Masaaki Moriyama
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Shosaburo Oyama
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Mitsutoshi Ishii
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Terumitsu Sawai
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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15
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Repeat Resection for Advanced Colorectal Liver Metastases-Does it have the Potential for Cure? World J Surg 2022; 46:2253-2261. [PMID: 35691969 DOI: 10.1007/s00268-022-06616-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although surgical resection is the only potential treatment for patients with colorectal liver metastases (CLM), the actual cure is rare in patients with advanced CLM. Repeat resection (RR) is the most effective treatment in patients with recurrence; however, whether patients with initially advanced CLM achieve cure throughout RR or experience repeated recurrence even after RR remains unclear. In this study, we analyzed whether patients with advanced CLM achieve cure after RR. METHODS Consecutive patients who underwent initial hepatectomy with curative intent for CLM from January 1999 to August 2007 were included. Patients who were alive at 10 years from the initial hepatectomy without any evidence of recurrence were defined as cured. Cure rates were compared between patients with Fong's clinical risk score (CRS) of ≥ 3 and those with CRS of ≤ 2. RESULTS A total of 257 patients were included and followed up. Among them, 93 (36.2%) patients achieved actual cure postoperatively. The cure rate of patients with a CRS of ≥ 3 was 32.4% (33/102), which was not different from that of patients with a CRS of ≤ 2 (38.7% [60/155]; p = 0.299), although former patients had higher recurrence rate after the initial hepatectomy than latter ones (85.3% vs. 72.3%; p = 0.014). The cure rates after the initial, second, and third resections were 23.0% (59/257), 30.0% (24/80), and 22.5% (7/31), respectively. In multivariate analysis, RR was determined as an independent favorable factor of achieving cure. CONCLUSIONS RR had a potential to cure patients with advanced CLM, and one-third of them achieved cure.
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16
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Buisman FE, Giardiello D, Kemeny NE, Steyerberg EW, Höppener DJ, Galjart B, Nierop PMH, Balachandran VP, Cercek A, Drebin JA, Gönen M, Jarnagin WR, Kingham TP, Vermeulen PB, Wei AC, Grünhagen DJ, Verhoef C, D'Angelica MI, Koerkamp BG. Predicting 10-year survival after resection of colorectal liver metastases; an international study including biomarkers and perioperative treatment. Eur J Cancer 2022; 168:25-33. [PMID: 35430383 PMCID: PMC9117473 DOI: 10.1016/j.ejca.2022.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/18/2021] [Accepted: 01/05/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this study was to develop a prediction model for 10-year overall survival (OS) after resection of colorectal liver metastasis (CRLM) based on patient, tumour and treatment characteristics. METHODS Consecutive patients after complete resection of CRLM were included from two centres (1992-2019). A prediction model providing 10-year OS probabilities was developed using Cox regression analysis, including KRAS, BRAF and histopathological growth patterns. Discrimination and calibration were assessed using cross-validation. A web-based calculator was built to predict individual 10-year OS probabilities. RESULTS A total of 4112 patients were included. The estimated 10-year OS was 30% (95% CI 29-32). Fifteen patient, tumour and treatment characteristics were independent prognostic factors for 10-year OS; age, gender, location and nodal status of the primary tumour, disease-free interval, number and diameter of CRLM, preoperative CEA, resection margin, extrahepatic disease, KRAS and BRAF mutation status, histopathological growth patterns, perioperative systemic chemotherapy and hepatic arterial infusion pump chemotherapy. The discrimination at 10-years was 0.73 for both centres. A simplified risk score identified four risk groups with a 10-year OS of 57%, 38%, 24%, and 12%. CONCLUSIONS Ten-year OS after resection of CRLM is best predicted with a model including 15 patient, tumour, and treatment characteristics. The web-based calculator can be used to inform patients. This model serves as a benchmark to determine the prognostic value of novel biomarkers.
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Affiliation(s)
- Florian E Buisman
- Department of Surgery, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, the Netherlands
| | - Daniele Giardiello
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands; Department of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Nancy E Kemeny
- Department Medical Oncology, Memorial Sloan Kettering Cancer Centre, New York, USA
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands; Department of Public Health, Erasmus MC, PO Box 20400, 3000 CA Rotterdam, the Netherlands
| | - Diederik J Höppener
- Department of Surgery, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, the Netherlands
| | - Boris Galjart
- Department of Surgery, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, the Netherlands
| | - Pieter M H Nierop
- Department of Surgery, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, the Netherlands
| | | | - Andrea Cercek
- Department Medical Oncology, Memorial Sloan Kettering Cancer Centre, New York, USA
| | - Jeffrey A Drebin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Mithat Gönen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - William R Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - T P Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Peter B Vermeulen
- Translational Cancer Research Unit (GZA Hospitals and University of Antwerp), Antwerp, Belgium
| | - Alice C Wei
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Dirk J Grünhagen
- Department of Surgery, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, the Netherlands
| | - Cornelis Verhoef
- Department of Surgery, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, the Netherlands
| | | | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, the Netherlands.
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17
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Newhook TE, Vauthey JN. Colorectal liver metastases: state-of-the-art management and surgical approaches. Langenbecks Arch Surg 2022; 407:1765-1778. [DOI: 10.1007/s00423-022-02496-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/10/2022] [Indexed: 02/06/2023]
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18
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THINKING TOO FAST ABOUT CHEMOTHERAPY FOR RESECTABLE COLORECTAL CANCER LIVER METASTASES? Clin Colorectal Cancer 2022; 21:e187-e188. [DOI: 10.1016/j.clcc.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 11/22/2022]
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19
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Ahmed S, Bosma N, Moser M, Ahmed S, Brunet B, Davies J, Doll C, Dueck DA, Kim CA, Ji S, Le D, Lee-Ying R, Lim H, McGhie JP, Mulder K, Park J, Ravi D, Renouf DJ, Schellenberg D, Wong RPW, Zaidi A. Systemic Therapy and Its Surgical Implications in Patients with Resectable Liver Colorectal Cancer Metastases. A Report from the Western Canadian Gastrointestinal Cancer Consensus Conference. Curr Oncol 2022; 29:1796-1807. [PMID: 35323347 PMCID: PMC8947455 DOI: 10.3390/curroncol29030147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/20/2022] [Accepted: 03/04/2022] [Indexed: 11/24/2022] Open
Abstract
The Western Canadian Gastrointestinal Cancer Consensus Conference (WCGCCC) convened virtually on 4 November 2021. The WCGCCC is an interactive multi-disciplinary conference attended by health care professionals, including surgical, medical, and radiation oncologists; pathologists; radiologists; and allied health care professionals from across four Western Canadian provinces, British Columbia, Alberta, Saskatchewan, and Manitoba, who are involved in the care of patients with gastrointestinal cancer. They participated in presentation and discussion sessions for the purpose of developing recommendations on the role of systemic therapy and its optimal sequence in patients with resectable metastatic colorectal cancer.
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Affiliation(s)
- Shahid Ahmed
- Saskatoon Cancer Center, Saskatchewan Cancer Agency, 20 Campus Drive, University of Saskatchewan, Saskatoon, SK S7N 4H4, Canada; (B.B.); (D.-A.D.); (D.L.)
| | - Nicholas Bosma
- British Columbia Cancer Agency, Vancouver, BC V5Z 4E6, Canada; (N.B.); (J.D.); (H.L.); (D.J.R.)
| | - Michael Moser
- Department of Surgery, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada;
| | - Shahida Ahmed
- CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada; (S.A.); (C.A.K.); (R.P.W.W.)
| | - Bryan Brunet
- Saskatoon Cancer Center, Saskatchewan Cancer Agency, 20 Campus Drive, University of Saskatchewan, Saskatoon, SK S7N 4H4, Canada; (B.B.); (D.-A.D.); (D.L.)
- Department of Radiation Oncology, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - Janine Davies
- British Columbia Cancer Agency, Vancouver, BC V5Z 4E6, Canada; (N.B.); (J.D.); (H.L.); (D.J.R.)
| | - Corinne Doll
- Arnie Charbonneau Cancer Institute, Alberta Health Service, Calgary, AB T2N 4Z6, Canada; (C.D.); (R.L.-Y.)
| | - Dorie-Anna Dueck
- Saskatoon Cancer Center, Saskatchewan Cancer Agency, 20 Campus Drive, University of Saskatchewan, Saskatoon, SK S7N 4H4, Canada; (B.B.); (D.-A.D.); (D.L.)
- Department of Medical Oncology, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - Christina A. Kim
- CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada; (S.A.); (C.A.K.); (R.P.W.W.)
| | - Shuying Ji
- Shared Health, Winnipeg, MB R3B 2K6, Canada;
| | - Duc Le
- Saskatoon Cancer Center, Saskatchewan Cancer Agency, 20 Campus Drive, University of Saskatchewan, Saskatoon, SK S7N 4H4, Canada; (B.B.); (D.-A.D.); (D.L.)
- Department of Radiation Oncology, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - Richard Lee-Ying
- Arnie Charbonneau Cancer Institute, Alberta Health Service, Calgary, AB T2N 4Z6, Canada; (C.D.); (R.L.-Y.)
| | - Howard Lim
- British Columbia Cancer Agency, Vancouver, BC V5Z 4E6, Canada; (N.B.); (J.D.); (H.L.); (D.J.R.)
| | | | - Karen Mulder
- Cross Cancer Institute, Alberta Health Services, Edmonton, AB T6G 1Z2, Canada;
| | - Jason Park
- Department of Surgery, University of Manitoba, Winnipeg, MB R3T 2N2, Canada;
| | - Deepti Ravi
- Saskatchewan Health Authority, Saskatoon, SK S7K 0M7, Canada;
| | - Daniel J. Renouf
- British Columbia Cancer Agency, Vancouver, BC V5Z 4E6, Canada; (N.B.); (J.D.); (H.L.); (D.J.R.)
| | | | - Ralph P. W. Wong
- CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada; (S.A.); (C.A.K.); (R.P.W.W.)
| | - Adnan Zaidi
- Saskatoon Cancer Center, Saskatchewan Cancer Agency, 20 Campus Drive, University of Saskatchewan, Saskatoon, SK S7N 4H4, Canada; (B.B.); (D.-A.D.); (D.L.)
- Department of Medical Oncology, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
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20
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Samoon Z, Naher SK, Sjoquist KM, Zalcberg J. Chemotherapy in resectable or potentially resectable colon cancer with liver metastases. Expert Opin Pharmacother 2022; 23:663-672. [PMID: 35196945 DOI: 10.1080/14656566.2022.2043276] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The treatment of colorectal cancer liver metastases has seen significant improvement in recent years and, for certain patients, the long-term survival and even cure are possible. Despite this improvement, many more questions are yet to be answered: the optimal combination, duration, sequence of therapies, role of biologics and the timing of surgical resection are debated in the literature, with conflicting trial results. AREAS COVERED In this review, the authors highlight the current trial evidence for systemic chemotherapy and biologic therapy for colorectal cancer liver metastases in both the pre and post-resection setting. EXPERT OPINION The treatment of colorectal liver metastases requires a multidisciplinary approach. The role of adjuvant chemotherapy with 5 fluorouracil and oxaliplatin in stage 3 colon cancer is well established. However, the options for patients with resectable or borderline liver metastases, either in the neoadjuvant or adjuvant settings, require further study. For patients with borderline resectable metastases, the combination of triplet chemotherapy with 5 fluorouracil, oxaliplatin and irinotecan (FOLFOXIRI) offers the best conversion rate. The role of biologic agents such as bevacizumab and EGFR inhibitors in these settings is less clear based on current evidence.
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Affiliation(s)
- Zarka Samoon
- The Crown Princess Mary Cancer Care Centre, Medical Oncology Clinical Trials Unit, Westmead Hospital, NSW, Australia
| | - Sayeda Kamrun Naher
- National Health and Medical Research Council Clinical Trials Centre (NHMRC CTC), University of Sydney, Campbelltown, NSW, Australia
| | - Katrin M Sjoquist
- National Health and Medical Research Council Clinical Trials Centre (NHMRC CTC), University of Sydney, Campbelltown, NSW, Australia
| | - John Zalcberg
- Cancer Research Program, School of Public Health and Preventive Medicine, Faculty of Medicine, Monash University, Melbourne, Australia
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Yao Y, Liu Z, Zhang H, Li J, Peng Z, Yu J, Cao B, Shen L. Serious Adverse Events Reporting in Phase III Randomized Clinical Trials of Colorectal Cancer Treatments: A Systematic Analysis. Front Pharmacol 2021; 12:754858. [PMID: 34867369 PMCID: PMC8636814 DOI: 10.3389/fphar.2021.754858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/25/2021] [Indexed: 12/22/2022] Open
Abstract
Objective: The occurrence, development, and prognosis of serious adverse events (SAEs) associated with anticancer drugs in clinical trials have important guiding significance for real-world clinical applications. However, to date, there have been no studies investigating SAEs reporting in randomized clinical trials of colorectal cancer treatments. This article systematically reviewed the SAEs reporting of phase III randomized clinical trials of colorectal cancer treatments and analyzed the influencing factors. Methods: We reviewed all articles about phase III randomized clinical trials of colorectal cancer treatments published in the PubMed, Embase, Medline, and New England Journal of Medicine databases from January 1, 1993, to December 31, 2018, and searched the registration information of clinical trials via the internet sites such as "clinicaltrials.gov". We analyzed the correlation between the reported proportion (RP) of SAEs in the literature and nine elements, including the clinical trial sponsor and the publication time. Chi-square tests and binary logistic regression were used to identify the factors associated with improved SAEs reports. This study was registered on PROSPERO. Results: Of 1560 articles identified, 160 were eligible, with an RP of SAEs of 25.5% (41/160). In forty-one publications reporting SAEs, only 14.6% (6/41) described the pattern of SAEs in detail. In clinical trials sponsored by pharmaceutical companies, the RP of SAEs was significantly higher than that in those sponsored by investigators (57.6 versus 20.7%, p < 0.001). From 1993 to 2018, the RP of SAEs gradually increased (none (0/6) before 2000, 17.1% (12/70) from 2000 to 2009, and 34.5% (29/84) after 2009). The average RP of SAEs published in the New England Journal of Medicine (N Engl J Med), the Lancet, the Journal of the American Medical Association (JAMA), the Lancet Oncology (Lancet Oncol), and the Journal of Clinical Oncology (J Clin Oncol) was significantly higher than that published in other journals (31.9 versus 16.7%, p = 0.030). In the clinical trials referenced by clinical guidelines, the RP of SAEs was higher than that in non-referenced clinical trials (32.0 versus 15.9%, p = 0.023). Binary logistic regression analysis showed that pharmaceutical company sponsorship, new drug research, and sample size greater than 1000 were positive influencing factors for SAEs reporting. Conclusion: Although the RP of SAEs increased over time, SAEs reporting in clinical trials needs to be further improved. The performance, outcomes and prognosis of SAEs should be reported in detail to guide clinical practice in the real world.
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Affiliation(s)
- Yanhong Yao
- Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing, China.,Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhentao Liu
- Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing, China
| | - Hua Zhang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Jian Li
- Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhi Peng
- Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jinyu Yu
- Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing, China
| | - Baoshan Cao
- Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing, China
| | - Lin Shen
- Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing, China
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22
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Moslim MA, Jeyarajah DR. Narrative review of the role of yttrium-90 selective internal radiation therapy in the surgical management of colorectal liver metastases. J Gastrointest Oncol 2021; 12:2438-2446. [PMID: 34790404 DOI: 10.21037/jgo-21-96] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/08/2021] [Indexed: 11/06/2022] Open
Abstract
The management of colorectal liver metastasis (CRLM) is complicated and benefits from a multidisciplinary team approach. Liver-directed therapy has been emerging as a modality for better progression-free control. In its early years, selective internal radiation therapy (SIRT) with yttrium-90 (Y-90) was confined as an end-of-line therapy. However, literature has supported other roles including: a first-line treatment for CRLM alone or in combination with systemic chemotherapy; an adjunct to second or third-line chemotherapy; and a salvage treatment for chemo-refractory disease. Although future liver remnant (FLR) hypertrophy may take 3-12 months, the SIRT effect on loco-regional disease control has rendered it to be a useful tool in some pathologies with certain strategic goals. This paper reviews the use of SIRT with Y-90 in a surgical treatment pathway. This includes: (I) an element of multidisciplinary treatment of low-volume CRLMs, (II) convert an R1 to R0 resection by sterilizing the margins of tumor near critical structures, and (III) radiation lobectomy to induce contralateral hypertrophy in order to aid in a safer resection. There are many opportunities to validate the role of SIRT as a first-line therapy along with surgical resection including an umbrella clinical trial design.
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23
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Lee HY, Woo IS. Perioperative Systemic Chemotherapy for Colorectal Liver Metastasis: Recent Updates. Cancers (Basel) 2021; 13:cancers13184590. [PMID: 34572817 PMCID: PMC8464667 DOI: 10.3390/cancers13184590] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/10/2021] [Indexed: 12/29/2022] Open
Abstract
Simple Summary The development of cytotoxic chemotherapy, targeted agents and immune check point inhibitors has improved survival outcomes and quality of life in patients diagnosed with metastatic colorectal cancer (CRC). Long-term survival and cure are possible in well-selected CRC patients with liver metastases (LM). The criteria for resectable LM and the eligibility of patients should be evaluated at the time of diagnosis or during the clinical course via a multidisciplinary team approach. The advantages of adjuvant chemotherapy after curative resection of LM are uncertain currently. Systemic preoperative chemotherapy may convert unresectable LM to a resectable type. However, the optimal combination of systemic drugs and treatment strategy has yet to be established. This article summarizes recent reports of perioperative systemic treatment for patients with colorectal liver metastases (CLM). This review provides an update for physicians involved in managing patients with CLM. Abstract The liver is the most common site of metastases for colorectal cancer. Complete resection in some patients with resectable liver metastases (LM) can lead to long-term survival and cure. Adjuvant systemic chemotherapy after complete resection of LM improves recurrence-free survival; however, the overall survival benefit is not clear. In selected patients, preoperative systemic treatment for metastatic colorectal cancer can convert unresectable to resectable cancer. This review will focus on patient selection, and integration of perioperative and postoperative systemic treatment to surgery in resectable and initially unresectable LM. Additionally, new drugs and biomarkers will be discussed.
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24
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Moslim MA, Bastawrous AL, Jeyarajah DR. Neoadjuvant Pelvic Radiotherapy in the Management of Rectal Cancer with Synchronous Liver Metastases: Is It Worth It? J Gastrointest Surg 2021; 25:2411-2422. [PMID: 34100244 DOI: 10.1007/s11605-021-05042-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/12/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND The use of neoadjuvant pelvic radiotherapy was a major advance in oncologic care for locally advanced rectal cancer in the twentieth century. The extrapolation of the care of locally advanced rectal cancer to the management of rectal cancer with treatable liver metastases is controversial. The aim of this review is to examine the available data on the role of pelvic radiotherapy and chemoradiation in the setting of treatable metastatic liver disease. METHODS A systematic search of MEDLINE was performed to report the landmark randomized controlled trials between 1993 and 2021. RESULTS Attaining liver clearance and total mesorectal excision with R0 margin remains the mainstay of cure. There is uncertainty regarding the sequencing of treatment. The literature lacks randomized clinical trials comparing the rectal first, liver first, interval strategy, and simultaneous surgical approaches. A multidisciplinary discussion regarding the utility of radiotherapy is emphasized to achieve the goals of treatment. Short-course radiotherapy has proved comparable disease-control outcomes to long-course chemoradiation with a significantly improved cost-performance. The implementation of short-course radiotherapy in the interval strategy and simultaneous surgical approach is promising. Neoadjuvant pelvic radiotherapy can be omitted in patients with metastatic rectal cancer if adequate margin clearance is achievable. CONCLUSION The use of radiotherapy in metastatic rectal cancer is popular but is based on limited data. Treatment should be tailored to the local extent of rectal cancer and priority of liver metastasis management. The optimal treatment strategy in patients with rectal cancer and synchronous liver metastatic disease needs to be studied in randomized trials.
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Affiliation(s)
- Maitham A Moslim
- Methodist Richardson Medical Center, 2805 E. President George Bush Highway, Richardson, TX, USA
| | | | - D Rohan Jeyarajah
- Methodist Richardson Medical Center, 2805 E. President George Bush Highway, Richardson, TX, USA. .,TCU/UNTHSC School of Medicine, Fort Worth, TX, USA.
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25
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Bosma NA, Keehn AR, Lee-Ying R, Karim S, MacLean AR, Brenner DR. Efficacy of perioperative chemotherapy in resected colorectal liver metastasis: A systematic review and meta-analysis. Eur J Surg Oncol 2021; 47:3113-3122. [PMID: 34420823 DOI: 10.1016/j.ejso.2021.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Nearly half of patients with colorectal cancer develop liver metastases. Radical resection of colorectal liver metastases (CRLM) offers the best chance of cure, significantly improving 5-year survival. Recurrence of metastatic disease is common, occurring in 60 % or more of patients. Clinical equipoise exists regarding the role of perioperative chemotherapy in patients with resected CRLM. This investigation sought to clarify the efficacy of perioperative chemotherapy in patients that have undergone curative-intent resection of CRLM. METHODS A systematic review and meta-analysis was completed of randomized controlled trials (RCTs) comparing perioperative chemotherapy to surgery alone in patients with resected CRLM. MEDLINE (Ovid), EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched, as well as abstracts from recent oncology conferences. A meta-analysis was performed pooling the hazard ratios for disease-free survival (DFS) and overall survival (OS), using a random-effects model. RESULTS A total of five, phase 3, open-label, RCTs were included resulting in a pooled analysis of 1119 of the total 1146 enrolled patients. 559 patients were randomized to perioperative chemotherapy and 560 to surgery alone. Pooled estimates demonstrated a statistically significant improvement in DFS (HR 0.71, 95 % CI: 0.61-0.82; p < 0.001) but not OS (HR 0.87, 95 % CI: 0.73-1.04; p = 0.136). CONCLUSION Perioperative chemotherapy in the setting of resected CRLM resulted in an improvement in DFS, however this did not translate into an OS benefit. Poor compliance to post-hepatectomy oxaliplatin-based chemotherapy regimens was identified. Further investigation into the optimal regimen and sequencing of perioperative chemotherapy is justified.
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Affiliation(s)
- Nicholas A Bosma
- Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada.
| | - Alysha R Keehn
- Department of Surgery, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada; Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Richard Lee-Ying
- Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Safiya Karim
- Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Anthony R MacLean
- Department of Surgery, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada
| | - Darren R Brenner
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
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Kawaguchi Y, Kopetz S, Kwong L, Xiao L, Morris JS, Tran Cao HS, Tzeng CWD, Chun YS, Lee JE, Vauthey JN. Genomic Sequencing and Insight into Clinical Heterogeneity and Prognostic Pathway Genes in Patients with Metastatic Colorectal Cancer. J Am Coll Surg 2021; 233:272-284.e13. [PMID: 34111531 DOI: 10.1016/j.jamcollsurg.2021.05.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND An understanding of signaling pathways has not been fully incorporated into prognostication and therapeutic options. We evaluated the hypothesis that information about cancer-related signaling pathways can improve prognostic stratification and explain some of the clinical heterogeneity in patients with metastatic colorectal cancer. STUDY DESIGN We analyzed prognostic relevance of signaling pathways in patients undergoing resection of colorectal liver metastases (CLM) from 2004-2017, and clinical actionability of gene alterations in 7 signaling pathways: p53, Wnt, RTK-RAS, PI3K, TGFβ, Notch, and cell cycle. To assess the wide applicability, the results were validated in an external retrospective cohort including patients with unresectable metastatic colorectal cancer. RESULTS Of 579 patients, the numbers of patients with pathway alterations were as follows: p53, n = 420 (72.5%); Wnt, 340 (58.7%); RTK-RAS, 333 (57.5%); PI3K, 110 (19.0%); TGFβ, 65 (11.2%); Notch, 41 (7.1%); and cell cycle, 15 (2.6%). More than 80% of alterations in each pathway occurred in a single predominant gene TP53, APC, KRAS, PIK3CA, FBXW7, and RB1 in p53, Wnt, RTK-RAS, PI3K, Notch, and cell cycle pathways, respectively. Alterations of 4 pathways (p53, RTK-RAS, TGFβ, and Notch) and corresponding predominant genes (TP53, RAS/BRAF, SMAD4, and FBXW7) were significantly associated with worse overall survival (OS), and alterations of Wnt pathway (APC) were associated with better OS in the median follow-up duration of 3.8 years. Similarly, in the external cohort, alterations of p53 (TP53) and RTK-RAS (RAS/BRAF) were significantly associated with worse OS, whereas alteration of Wnt (APC) was associated with better OS in the median follow-up duration of 2.6 years. CONCLUSIONS Genomic sequencing provides insights into clinical heterogeneity and permits finer prognostic stratification in patients with metastatic colorectal cancer.
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Affiliation(s)
- Yoshikuni Kawaguchi
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Scott Kopetz
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lawrence Kwong
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lianchun Xiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey S Morris
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hop S Tran Cao
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yun Shin Chun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey E Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Molla M, Fernandez-Plana J, Albiol S, Fondevila C, Vollmer I, Cases C, Garcia-Criado A, Capdevila J, Conill C, Fundora Y, Fernandez-Martos C, Pineda E. Limited Liver or Lung Colorectal Cancer Metastases. Systemic Treatment, Surgery, Ablation or SBRT. J Clin Med 2021; 10:jcm10102131. [PMID: 34069240 PMCID: PMC8157146 DOI: 10.3390/jcm10102131] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/07/2021] [Indexed: 12/25/2022] Open
Abstract
The prognosis for oligometastatic colorectal cancer has improved in recent years, mostly because of recent advances in new techniques and approaches to the treatment of oligometastases, including new surgical procedures, better systemic treatments, percutaneous ablation, and stereotactic body radiation therapy (SBRT). There are several factors to consider when deciding on the better approach for each patient: tumor factors (metachronous or synchronous metastases, RAS mutation, BRAF mutation, disease-free interval, size and number of metastases), patient factors (age, frailty, comorbidities, patient preferences), and physicians' factors (local expertise). These advances have presented major challenges and opportunities for oncologic multidisciplinary teams to treat patients with limited liver and lung metastases from colorectal cancer with a curative intention. In this review, we describe the different treatment options in patients with limited liver and lung metastases from colorectal cancer, and the possible combination of three approaches: systemic treatment, surgery, and local ablative treatments.
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Affiliation(s)
- Meritxell Molla
- Department of Radiation Oncology, Hospital Clinic Barcelona, Barcelona 08036, Spain; (M.M.); (C.C.); (C.C.)
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona 08036, Spain
| | | | - Santiago Albiol
- Department of Medical Oncology, Hospital Clinic de Barcelona, Barcelona 08036, Spain;
| | - Constantino Fondevila
- Department of General and Digestive Surgery, Hospital Clinic de Barcelona, Barcelona 08036, Spain; (C.F.); (Y.F.)
| | - Ivan Vollmer
- Department of Radiology, Hospital Clinic Barcelona, Barcelona 08036, Spain; (I.V.); (A.G.-C.)
| | - Carla Cases
- Department of Radiation Oncology, Hospital Clinic Barcelona, Barcelona 08036, Spain; (M.M.); (C.C.); (C.C.)
| | - Angeles Garcia-Criado
- Department of Radiology, Hospital Clinic Barcelona, Barcelona 08036, Spain; (I.V.); (A.G.-C.)
| | - Jaume Capdevila
- Department of Medical Oncology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona 08035, Spain;
| | - Carles Conill
- Department of Radiation Oncology, Hospital Clinic Barcelona, Barcelona 08036, Spain; (M.M.); (C.C.); (C.C.)
| | - Yliam Fundora
- Department of General and Digestive Surgery, Hospital Clinic de Barcelona, Barcelona 08036, Spain; (C.F.); (Y.F.)
| | | | - Estela Pineda
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona 08036, Spain
- Department of Medical Oncology, Hospital Clinic de Barcelona, Barcelona 08036, Spain;
- Correspondence:
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Bae HW, Kim HS, Yang SY, Kim HS, Shin SJ, Chang JS, Koom WS, Kim NK. Upfront chemotherapy and short-course radiotherapy with delayed surgery for locally advanced rectal cancer with synchronous liver metastases. Eur J Surg Oncol 2021; 47:2814-2820. [PMID: 34024668 DOI: 10.1016/j.ejso.2021.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/28/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND The optimal treatment of locally advanced rectal cancer with synchronous liver metastases remains controversial. In this study, we aimed to evaluate the safety, efficacy, and oncologic outcomes of upfront chemotherapy and short-course radiotherapy with delayed surgery in patients with locally advanced rectal cancer and synchronous liver metastases. METHODS Forty-four patients who underwent upfront chemotherapy and short-course radiotherapy with delayed surgery for locally advanced rectal cancer (cT3/4, <2.0 mm from the mesorectal fascia) with synchronous liver metastases between January 2010 and June 2017 were reviewed retrospectively. Primary and metastatic liver lesions were resected with curative intent. Upfront chemotherapy and short-course radiotherapy were administered. Thereafter, restaging, surgery only, or additional chemotherapy followed by surgery was performed. RESULTS At the time of initial diagnosis, 20 patients had <3 liver metastases; 24 patients had ≥3 liver metastases. Twenty-three patients had hemi-liver metastases; 21 patients had bilobar liver metastases. R0 resection of rectal lesions was achieved in 43 patients. Synchronous R0 resection of liver metastases was achieved in 41 patients. Postoperative complications (Clavien-Dindo Grade ≥ III) were noted in 5 patients. Grade 3/4 adverse events were observed in 26 patients. All adverse events were managed effectively with medication and supportive care. The 3-year overall survival and progression-free survival rates were 65.3% and 26.9%, respectively. CONCLUSION Upfront chemotherapy and short-course radiotherapy with delayed surgery appear to be safe and effective in patients with locally advanced rectal cancer and synchronous liver metastases without substantially increasing treatment induced morbidity.
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Affiliation(s)
- Hyeon Woo Bae
- The Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Ho Seung Kim
- The Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Yoon Yang
- The Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Han Sang Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Joon Shin
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Nam Kyu Kim
- The Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
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Circulating tumor DNA dynamics and recurrence risk in patients undergoing curative intent resection of colorectal cancer liver metastases: A prospective cohort study. PLoS Med 2021; 18:e1003620. [PMID: 33939694 PMCID: PMC8128260 DOI: 10.1371/journal.pmed.1003620] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 05/17/2021] [Accepted: 04/12/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In patients with resectable colorectal liver metastases (CRLM), the role of pre- and postoperative systemic therapy continues to be debated. Previous studies have shown that circulating tumor DNA (ctDNA) analysis, as a marker of minimal residual disease, is a powerful prognostic factor in patients with nonmetastatic colorectal cancer (CRC). Serial analysis of ctDNA in patients with resectable CRLM could inform the optimal use of perioperative chemotherapy. Here, we performed a validation study to confirm the prognostic impact of postoperative ctDNA in resectable CRLM observed in a previous discovery study. METHODS AND FINDINGS We prospectively collected plasma samples from patients with resectable CRLM, including presurgical and postsurgical samples, serial samples during any pre- or postoperative chemotherapy, and serial samples in follow-up. Via targeted sequencing of 15 genes commonly mutated in CRC, we identified at least 1 somatic mutation in each patient's tumor. We then designed a personalized assay to assess 1 mutation in plasma samples using the Safe-SeqS assay. A total of 380 plasma samples from 54 patients recruited from July 2011 to Dec 2014 were included in our analysis. Twenty-three (43%) patients received neoadjuvant chemotherapy, and 42 patients (78%) received adjuvant chemotherapy after surgery. Median follow-up was 51 months (interquartile range, 31 to 60 months). At least 1 somatic mutation was identified in all patients' tumor tissue. ctDNA was detectable in 46/54 (85%) patients prior to any treatment and 12/49 (24%) patients after surgery. There was a median 40.93-fold (19.10 to 87.73, P < 0.001) decrease in ctDNA mutant allele fraction with neoadjuvant chemotherapy, but ctDNA clearance during neoadjuvant chemotherapy was not associated with a better recurrence-free survival (RFS). Patients with detectable postoperative ctDNA experienced a significantly lower RFS (HR 6.3; 95% CI 2.58 to 15.2; P < 0.001) and overall survival (HR 4.2; 95% CI 1.5 to 11.8; P < 0.001) compared to patients with undetectable ctDNA. For the 11 patients with detectable postoperative ctDNA who had serial ctDNA sampling during adjuvant chemotherapy, ctDNA clearance was observed in 3 patients, 2 of whom remained disease-free. All 8 patients with persistently detectable ctDNA after adjuvant chemotherapy have recurred. End-of-treatment (surgery +/- adjuvant chemotherapy) ctDNA detection was associated with a 5-year RFS of 0% compared to 75.6% for patients with an undetectable end-of-treatment ctDNA (HR 14.9; 95% CI 4.94 to 44.7; P < 0.001). Key limitations of the study include the small sample size and the potential for false-positive findings with multiple hypothesis testing. CONCLUSIONS We confirmed the prognostic impact of postsurgery and posttreatment ctDNA in patients with resected CRLM. The potential utility of serial ctDNA analysis during adjuvant chemotherapy as an early marker of treatment efficacy was also demonstrated. Further studies are required to define how to optimally integrate ctDNA analyses into decision-making regarding the use and timing of adjuvant therapy for resectable CRLM. TRIAL REGISTRATION ACTRN12612000345886.
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Bosma NA, Cheung WY, Thiessen M, Speers C, Renouf DJ, Tilley D, Tang PA, Ball CG, Dixon E, Lee-Ying RM. Real-World Outcomes of Oxaliplatin-Based Chemotherapy on R0 Resected Colonic Liver Metastasis. Clin Colorectal Cancer 2021; 20:e201-e209. [PMID: 34016533 DOI: 10.1016/j.clcc.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION In resected colonic liver metastasis (CLM), randomized studies of oxaliplatin-based chemotherapy have demonstrated improvements in disease-free survival (DFS), but not overall survival (OS). Additionally, oxaliplatin regimens have not been compared to non-oxaliplatin chemotherapy. Despite limited evidence, perioperative chemotherapy is often used in the management of CLM. The primary aim of this study was to assess the impact of oxaliplatin chemotherapy regimens on OS in patients who have undergone resection of CLM in a real-world setting. PATIENTS AND METHODS Patients who underwent resection of CLM in the provinces of Alberta and British Columbia, Canada, were identified from 1996 to 2016. Perioperative (pre- and/or post-) systemic therapy was categorized as oxaliplatin or non-oxaliplatin-based chemotherapy or no chemotherapy. The primary and secondary outcomes were OS and DFS, respectively. RESULTS We identified 511 patients who underwent R0 resection of CLM. A significant difference in median OS was identified among the oxaliplatin, non-oxaliplatin, and no-chemotherapy groups of 100, 60, and 59 months, respectively (P = .009). In multivariate analysis, patients who received oxaliplatin regimens had a lower risk of death (hazard ratio, 0.68; 95% confidence interval, 0.51-0.92; P = .012), whereas the non-oxaliplatin chemotherapy group did not (hazard ratio, 0.88; 95% confidence interval, 0.65-1.20; P = .422) compared with no chemotherapy. CONCLUSIONS In this multicenter, retrospective, population-based study, perioperative oxaliplatin-based chemotherapy was associated with improved OS in conjunction with R0 resection of CLM. Further studies should evaluate the optimal duration and sequencing of perioperative chemotherapy in relation to curative-intent surgical resection of CLM.
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Affiliation(s)
- Nicholas A Bosma
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada.
| | - Winson Y Cheung
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Maclean Thiessen
- Research Institute in Hematology and Oncology, Cancer Care Manitoba, Winnipeg, MB, Canada
| | - Caroline Speers
- Gastrointestinal Cancer Outcomes Unit, BC Cancer, Vancouver, BC, Canada
| | - Daniel J Renouf
- Department of Oncology, University of British Columbia, BC Cancer, Vancouver, BC
| | - Derek Tilley
- Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Patricia A Tang
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Chad G Ball
- Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Elijah Dixon
- Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Richard M Lee-Ying
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
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Boerner T, Zambirinis C, Gagnière J, Chou JF, Gonen M, Kemeny NE, Cercek A, Connell LC, Kingham TP, Allen PJ, Balachandran VP, Drebin J, Jarnagin WR, D’Angelica MI. Early liver metastases after "failure" of adjuvant chemotherapy for stage III colorectal cancer: is there a role for additional adjuvant therapy? HPB (Oxford) 2021; 23:601-608. [PMID: 32943326 PMCID: PMC8385642 DOI: 10.1016/j.hpb.2020.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The utility of adjuvant chemotherapy after resection of colorectal liver metastasis (CLM) in patients with rapid recurrence after adjuvant chemotherapy for their primary tumor is unclear. The aim of this study was to evaluate the oncologic benefit of adjuvant hepatic arterial plus systemic chemotherapy (HAIC + Sys) in patients with early CLM. METHODS A retrospective analysis of patients with early CLM (≤12 months of adjuvant chemotherapy for primary tumor) who received either HAIC + Sys, adjuvant systemic chemotherapy alone (Sys), or active surveillance (Surgery alone) following resection of CLM was performed. Recurrence and survival were compared between treatment groups using Kaplan-Meier methods and Cox proportional hazards models. RESULTS Of 239 patients undergoing resection of early CLM, 79 (33.1%) received HAIC + Sys, 77 (32.2%) received Sys, and 83 (34.7%) had Surgery alone. HAIC + Sys was independently associated with reduced risk of RFS events (adjusted hazard ratio [HRadj]: 0.64, 95%CI:0.44-0.94, p = 0.022) and all-cause mortality (HRadj: 0.54, 95%CI:0.36-0.81, p = 0.003) compared to Surgery alone patients. Largest tumor >5 cm (HRadj: 2.03, 95%CI: 1.41-2.93, p < 0.001) and right-sided colon tumors (HRadj: 1.93, 95%CI: 1.29-2.89, p = 0.002) were independently associated with worse OS. CONCLUSION Adjuvant HAIC + Sys after resection of early CLM that occur after chemotherapy for node-positive primary is associated with improved outcomes.
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Affiliation(s)
- Thomas Boerner
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Johan Gagnière
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY,Current affiliations: Department of Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France, U1071 Inserm / Clermont-Auvergne University, Clermont-Ferrand, France
| | - Joanne F. Chou
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nancy E. Kemeny
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrea Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Louise C. Connell
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - T. Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Peter J. Allen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY,Current affiliation: Department of Surgery, Duke University, Durham, NC
| | | | - Jeffrey Drebin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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32
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Rocha FG. Repeat hepatectomy for recurrence of colorectal liver metastases: To whom and what to give? Am J Surg 2021; 221:1112-1113. [PMID: 33814110 DOI: 10.1016/j.amjsurg.2021.03.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Flavio G Rocha
- Division of Surgical Oncology, Knight Cancer Institute, Oregon Health and Science University, 3181 Sam Jackson Park Road, Portland, OR, 97239, United States.
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33
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Total neoadjuvant therapy for rectal cancer: Making sense of the results from the RAPIDO and PRODIGE 23 trials. Cancer Treat Rev 2021; 96:102177. [PMID: 33798955 DOI: 10.1016/j.ctrv.2021.102177] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 02/07/2023]
Abstract
A few months ago, results from two randomised phase III trials of total neoadjuvant therapy (TNT) in locally advanced rectal cancer were presented (RAPIDO and PRODIGE 23), consistently showing better short- and long-term outcomes with TNT as compared with standard neoadjuvant long-course chemoradiotherapy (CRT) or short-course radiotherapy (SCRT). These results represent corroborating evidence in support of a practice that many centres had already implemented based on promising preliminary data. Also, they provide new, high-level evidence to endorse TNT as a new management option in the treatment algorithm of stage II-III rectal cancer in those centres where CRT and SCRT have long remained the only accepted standard neoadjuvant treatments. Having two consistently positive trials is certainly reassuring regarding the potential of TNT as a general treatment approach. Nevertheless, substantial differences between these trials pose important challenges in relation to the generalisability and applicability of their results, and translation of the same into practical clinical recommendations. In this article, we address a number of key questions that the RAPIDO and PRODIGE 23 trials have raised among the broad community of gastrointestinal oncologists, proposing an interpretation of the data that may help the decision making, and highlighting grey areas that warrant further investigation.
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34
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Liu C, Hu C, Huang J, Xiang K, Li Z, Qu J, Chen Y, Yang B, Qu X, Liu Y, Zhang G, Wen T. A Prognostic Nomogram of Colon Cancer With Liver Metastasis: A Study of the US SEER Database and a Chinese Cohort. Front Oncol 2021; 11:591009. [PMID: 33738248 PMCID: PMC7962604 DOI: 10.3389/fonc.2021.591009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 01/25/2021] [Indexed: 12/12/2022] Open
Abstract
Background Among colon cancer patients, liver metastasis is a commonly deadly phenomenon, but there are few prognostic models for these patients. Methods The clinicopathologic data of colon cancer with liver metastasis (CCLM) patients were downloaded from the Surveillance, Epidemiology and End Results (SEER) database. All patients were randomly divided into training and internal validation sets based on the ratio of 7:3. A prognostic nomogram was established with Cox analysis in the training set, which was validated by two independent validation sets. Results A total of 5,700 CCLM patients were included. Age, race, tumor size, tumor site, histological type, grade, AJCC N status, carcinoembryonic antigen (CEA), lung metastasis, bone metastasis, surgery, and chemotherapy were independently associated with the overall survival (OS) of CCLM in the training set, which were used to establish a nomogram. The AUCs of 1-, 2- and 3-year were higher than or equal to 0.700 in the training, internal validation, and external validation sets, indicating the favorable effects of our nomogram. Besides, whether in overall or subgroup analysis, the risk score calculated by this nomogram can divide CCLM patients into high-, middle- and low-risk groups, which suggested that the nomogram can significantly determine patients with different prognosis and is suitable for different patients. Conclusion Higher age, the race of black, larger tumor size, higher grade, histological type of mucinous adenocarcinoma and signet ring cell carcinoma, higher N stage, RCC, lung metastasis, bone metastasis, without surgery, without chemotherapy, and elevated CEA were independently associated with poor prognosis of CCLM patients. A nomogram incorporating the above variables could accurately predict the prognosis of CCLM.
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Affiliation(s)
- Chuan Liu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, China.,Liaoning Province Clinical Research Center for Cancer, Shenyang, China
| | - Chuan Hu
- Medical College, Qingdao University, Qingdao, China
| | - Jiale Huang
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, China.,Liaoning Province Clinical Research Center for Cancer, Shenyang, China
| | - Kanghui Xiang
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, China.,Liaoning Province Clinical Research Center for Cancer, Shenyang, China
| | - Zhi Li
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, China.,Liaoning Province Clinical Research Center for Cancer, Shenyang, China
| | - Jinglei Qu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, China.,Liaoning Province Clinical Research Center for Cancer, Shenyang, China
| | - Ying Chen
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, China.,Liaoning Province Clinical Research Center for Cancer, Shenyang, China
| | - Bowen Yang
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, China.,Liaoning Province Clinical Research Center for Cancer, Shenyang, China
| | - Xiujuan Qu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, China.,Liaoning Province Clinical Research Center for Cancer, Shenyang, China
| | - Yunpeng Liu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, China.,Liaoning Province Clinical Research Center for Cancer, Shenyang, China
| | - Guangwei Zhang
- Smart Hospital Management Department, The First Hospital of China Medical University, Shenyang, China
| | - Ti Wen
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, China.,Liaoning Province Clinical Research Center for Cancer, Shenyang, China
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35
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Jones RP, Pugh SA, Graham J, Primrose JN, Barriuso J. Circulating tumour DNA as a biomarker in resectable and irresectable stage IV colorectal cancer; a systematic review and meta-analysis. Eur J Cancer 2021; 144:368-381. [PMID: 33422803 DOI: 10.1016/j.ejca.2020.11.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/01/2020] [Accepted: 11/15/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND For patients with metastatic colorectal cancer, stratification for treatment (surgery or chemotherapy) is often based on crude clinicopathological characteristics like tumour size and number of lesions. Circulating tumour DNA (ctDNA) acts as a potential biomarker of disease trajectory and biology, allowing better stratification. This study aims to systematically review ctDNA in stage IV colorectal cancer to assess its potential role as a prospective biomarker to guide management decisions. METHODS A literature search was performed to identify studies where the measurement of ctDNA in stage IV colorectal cancer was correlated with a clinical outcome (radiological response, secondary resection rate, PFS, DFS or OS). RESULTS Twenty-eight studies were included, reporting on 2823 patients. Circulating tumour DNA was detectable in between 80% and 90% of patients prior to treatment. Meta-analysis identified a strong correlation between detectable ctDNA after treatment (surgery or chemotherapy) and overall survival (HR 2.2, 95% CI 1.79-2.69, p < 0.00001), as well as progression-free survival (HR 3.15, 95% CI 2.10-4.73, p < 0.00001). ctDNA consistently offered an early marker of long-term prognosis in irresectable disease, with changes after one cycle of systemic therapy demonstrating prognostic value. In resectable disease treated with curative intent, detection of ctDNA offered a lead time over radiological recurrence of 10 months. CONCLUSION Circulating tumour DNA is detectable in the majority of resectable and irresectable patients. The presence of ctDNA is clearly associated with shorter overall survival, with changes in ctDNA an early biomarker of adverse disease behaviour. Prospective trials are essential to test its clinical efficacy.
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Affiliation(s)
- Robert P Jones
- School of Cancer Studies, Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Department of Hepatobiliary Surgery, Liverpool University Teaching Hospitals NHS Foundation Trust, Liverpool, UK.
| | | | - Janet Graham
- Beatson West of Scotland Cancer Centre, Glasgow, UK; University of Glasgow, UK
| | | | - Jorge Barriuso
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
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36
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Kawaguchi Y, De Bellis M, Panettieri E, Duwe G, Vauthey JN. Debate: Improvements in Systemic Therapies for Liver Metastases Will Increase the Role of Locoregional Treatments. Surg Oncol Clin N Am 2021; 30:205-218. [PMID: 33220806 PMCID: PMC7709757 DOI: 10.1016/j.soc.2020.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The benefit of resection of liver metastases depends on primary diseases. Neuroendocrine tumors are associated with favorable prognosis after resection of liver metastases. Gastric cancer has worse tumor biology, and resection of gastric liver metastases should be performed in selected patients. A multidisciplinary approach is well established for colorectal liver metastases (CLMs). Resection remains the only curative treatment of CLM. Chemotherapy and molecular-targeted therapy have improved survival in unresectable metastatic colorectal cancer. Understanding of the following two strategies, conversion therapy and two-stage hepatectomy, are important to make this patient group to be candidates for curative-intent surgery.
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Affiliation(s)
- Yoshikuni Kawaguchi
- Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Mario De Bellis
- Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Elena Panettieri
- Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Gregor Duwe
- Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
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37
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Padmanabhan C, Nussbaum DP, D'Angelica M. Surgical Management of Colorectal Cancer Liver Metastases. Surg Oncol Clin N Am 2021; 30:1-25. [PMID: 33220799 DOI: 10.1016/j.soc.2020.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Approximately 50% of colorectal cancer patients develop liver metastases. Hepatic metastases represent the most common cause of colorectal cancer-related mortality. Metastasectomy, if possible, represents the most effective treatment strategy; 20% of patients will be cured and more than 50% survive at least 5 years. Nuances to treatment planning hinge on whether patients present with resectable disease upfront, whether the future liver remnant is adequate, and whether the primary tumor, if present, is colon versus rectal in origin. This article discusses considerations impacting our approach to patients with colorectal liver metastases and the role for various multimodal treatment options.
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Affiliation(s)
- Chandrasekhar Padmanabhan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C-1272, New York, NY 10065, USA
| | - Daniel P Nussbaum
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C-1272, New York, NY 10065, USA
| | - Michael D'Angelica
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C-898, New York, NY 10065, USA.
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38
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Statistical aspects in adjuvant and neoadjuvant trials for gastrointestinal cancer in 2020: focus on time-to-event endpoints. Curr Opin Oncol 2020; 32:384-390. [PMID: 32541329 DOI: 10.1097/cco.0000000000000636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW Clinical-trial design, analysis, and interpretation entails the use of efficient and reliable endpoints. Statistical issues related to endpoints warrant continued attention, as they may have a substantial impact on the conduct of clinical trials and on interpretation of their results. RECENT FINDINGS We review concepts and discuss recent developments related to the use of time-to-event endpoints in studies on adjuvant and neoadjuvant therapy for colon, pancreatic, and gastric adenocarcinomas. The definition of endpoints has varied to a considerable extent in these settings. Although these variations are relevant in interpreting results from individual trials, they probably have a small impact when considered in aggregate. In terms of surrogacy, most published reports so far have used aggregated data. A few studies based on the preferred method of a metaanalysis of individual-patient data have shown that disease-free survival (DFS) is a surrogate for overall survival in the adjuvant therapy of stage III colon cancer and in gastric cancer, whereas DFS with a landmark of six months is a surrogate for overall survival in the neoadjuvant therapy of adenocarcinoma of the esophagus, gastroesophageal junction, or stomach. SUMMARY Testing novel agents in gastrointestinal cancer requires continued attention to statistical issues related to endpoints.
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39
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Krasnodebski M, Kim BJ, Wei SH, Velasco JD, Nishioka Y, Vauthey JN. Chemotherapy in combination with resection for colorectal liver metastases – current evidence. SURGERY IN PRACTICE AND SCIENCE 2020. [DOI: 10.1016/j.sipas.2020.100021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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40
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Perioperative Chemotherapy for Liver Metastasis of Colorectal Cancer. Cancers (Basel) 2020; 12:cancers12123535. [PMID: 33256170 PMCID: PMC7760826 DOI: 10.3390/cancers12123535] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/28/2020] [Accepted: 11/12/2020] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Survival outcomes for resectable metastatic colorectal cancer have improved over the past decade. This is due in part to improvements made in imaging technology, locoregional treatment, and systemic treatment. The focus of this review is to summarize and analyze the existing information available on systemic therapy in the setting of colorectal cancer with liver metastases. It is written with structured viewpoints including patient selection, sequencing of treatment, choice of systemic therapy for upfront resectable disease and conversion chemotherapy for unresectable colorectal cancer. Post-treatment surveillance and future research directions are also discussed. This review will help treating physicians make decisions for the treatment of liver metastases of colorectal cancer. Abstract The liver is the dominant site of metastasis for patients with colorectal cancer. For those with isolated liver metastases, surgical resection with systemic therapy has led to long-term remission in as high as 80% of patients in well-selected cohorts. This review will focus on how systemic therapy should be integrated with resection of liver metastases; in particular, the use of clinical risk scores based on clinicopathological features that help with patient selection, various approaches to the treatment of micro-metastatic disease (peri-operative versus post-operative chemotherapy), as well as conversion chemotherapy for those with initially upfront unresectable disease will be discussed.
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41
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Statistical Considerations for Trials in Adjuvant Treatment of Colorectal Cancer. Cancers (Basel) 2020; 12:cancers12113442. [PMID: 33228149 PMCID: PMC7699469 DOI: 10.3390/cancers12113442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/29/2020] [Accepted: 11/17/2020] [Indexed: 12/26/2022] Open
Abstract
The design of the best possible clinical trials of adjuvant interventions in colorectal cancer will entail the use of both time-tested and novel methods that allow efficient, reliable and patient-relevant therapeutic development. The ultimate goal of this endeavor is to safely and expeditiously bring to clinical practice novel interventions that impact patient lives. In this paper, we discuss statistical aspects and provide suggestions to optimize trial design, data collection, study implementation, and the use of predictive biomarkers and endpoints in phase 3 trials of systemic adjuvant therapy. We also discuss the issues of collaboration and patient centricity, expecting that several novel agents with activity in the (neo)adjuvant therapy of colon and rectal cancers will become available in the near future.
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42
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Nassar A, Phelip JM, Goéré D, Loriau J, Gallois C, Michel P, Penna C, Taieb J, Brouquet A, Benoist S. What is the Best Therapeutic Strategy for Metachronous Resectable Colorectal Liver Metastases After Adjuvant Oxaliplatin-Based Chemotherapy? A Multidisciplinary Inter-Group Survey. World J Surg 2020; 45:822-830. [PMID: 33210163 DOI: 10.1007/s00268-020-05837-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND To report the current clinical practice of French physicians for metachronous resectable liver metastasis (LM) occurring after a FOLFOX adjuvant chemotherapy for primary cancer. METHODS Twenty four clinical situations were proposed to a panel of experts via 4 learned societies. Clinical situations varied according time of recurrence (early between 6 and 12 month or > 12 month), extension of LM (limited ≤ 2 or extended > 2 lesions), presence of a neuropathy or not, and of a RAS or BRAF mutation. RESULTS A total of 157 physicians participated in this study. A consensus was reached in 17 (71%) clinical situations. For an early limited recurrence, whatever presence of neuropathy, the preferred therapeutic approach (45%) was upfront surgery. For an early extended recurrence, whatever presence of neuropathy, there was a consensus (64%) for a preoperative chemotherapy by FOLFIRI + biologic agent. For a late recurrence without neuropathy, there was a consensus (50%) for a preoperative FOLFOX chemotherapy, whatever the extension of LM. For a late recurrence with neuropathy, upfront surgery was chosen (52%) for limited LM, and preoperative chemotherapy by FOLFIRI + biologic agent (73%) for extended LM. No response was influenced by the RAS mutation status. There was a strong consensus for intensified preoperative chemotherapy in all clinical situations for BRAF-mutated LM. CONCLUSIONS This national survey provides an overview of the practice patterns in the treatment of LM occurring after adjuvant FOLFOX for primary. It could be a basis to establish expert's recommendations for the clinical practice.
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Affiliation(s)
- Alexandra Nassar
- Department of Digestive Surgery and Surgical Oncology, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Jean Marc Phelip
- Department of Hepato-Gastroenterology and Digestive Oncology, St Etienne University Hospital, St Etienne, France
| | - Diane Goéré
- Department of Digestive Surgery, Saint Louis Hospital, APHP, Paris, France
| | - Jérôme Loriau
- Department of Digestive Surgery, St-Joseph Hospital, Paris, France
| | - Claire Gallois
- Department of Gastroenterology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Pierre Michel
- Department of Hepato-Gastroenterology, Rouen University Hospital, Rouen, France
| | - Christophe Penna
- Department of Digestive Surgery and Surgical Oncology, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Julien Taieb
- Department of Gastroenterology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Antoine Brouquet
- Department of Digestive Surgery and Surgical Oncology, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Stéphane Benoist
- Department of Digestive Surgery and Surgical Oncology, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France.
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43
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Bhudia J, Glynne-Jones R, Smith T, Hall M. Neoadjuvant Chemotherapy without Radiation in Colorectal Cancer. Clin Colon Rectal Surg 2020; 33:287-297. [PMID: 32968364 PMCID: PMC7500967 DOI: 10.1055/s-0040-1713746] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In colon cancer, primary surgery followed by postoperative chemotherapy represents the standard of care. In rectal cancer, the standard of care is preoperative radiotherapy or chemoradiation, which significantly reduces local recurrence but has no impact on subsequent metastatic disease or overall survival. The administration of neoadjuvant chemotherapy (NACT) before surgery can increase the chance of a curative resection and improves long-term outcomes in patients with liver metastases. Hence, NACT is being explored in both primary rectal and colon cancers as an alternative strategy to shrink the tumor, facilitate a curative resection, and simultaneously counter the risk of metastases. Yet, this lack of clarity regarding the precise aims of NACT (downstaging, maximizing response, or improving survival) is hindering progress. The appropriate cytotoxic agents, the optimal regimen, the number of cycles, or duration of NACT prior to surgery or in the postoperative setting remains undefined. Several potential strategies for integrating NACT are discussed with their advantages and disadvantages.
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Affiliation(s)
- Jyotsna Bhudia
- Department of Radiotherapy, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, United Kingdom
| | - Rob Glynne-Jones
- Department of Radiotherapy, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, United Kingdom
| | - Thomas Smith
- Department of Radiotherapy, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, United Kingdom
| | - Marcia Hall
- Department of Medical Oncology, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, United Kingdom
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44
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Kawaguchi Y, Vauthey JN. The Landmark Series: Randomized Control Trials Examining Perioperative Chemotherapy and Postoperative Adjuvant Chemotherapy for Resectable Colorectal Liver Metastasis. Ann Surg Oncol 2020; 27:4263-4270. [PMID: 32803551 DOI: 10.1245/s10434-020-08777-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Indexed: 12/22/2022]
Abstract
Surgical resection remains the only curative treatment option for patients with colorectal liver metastases (CLM). However, the high recurrence rate after resection has led physicians to investigate multidisciplinary treatments combining surgery and medical therapy. Currently, the evidence to support medical therapy in patients with resectable CLM is limited. For patients with resectable CLM, the National Comprehensive Cancer Network Guidelines (version 2.2020) for colon and rectal cancer recommends either upfront surgery and postoperative adjuvant chemotherapy or preoperative chemotherapy followed by surgery and postoperative adjuvant chemotherapy. This article reviews randomized control trials regarding medical therapy before and after curative resection of CLM, and summarizes the updated long-term report of the New EPOC trial which investigated the addition of cetuximab to perioperative chemotherapy for patients with resectable CLM.
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Affiliation(s)
- Yoshikuni Kawaguchi
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard Unit 1484, Houston, TX, 77030, USA.,Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard Unit 1484, Houston, TX, 77030, USA.
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45
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Histopathological growth patterns as biomarker for adjuvant systemic chemotherapy in patients with resected colorectal liver metastases. Clin Exp Metastasis 2020; 37:593-605. [PMID: 32691187 PMCID: PMC7497305 DOI: 10.1007/s10585-020-10048-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/21/2020] [Indexed: 02/07/2023]
Abstract
Adjuvant systemic chemotherapy (CTx) is widely administered in patients with colorectal liver metastases (CRLM). Histopathological growth patterns (HGPs) are an independent prognostic factor for survival after complete resection. This study evaluates whether HGPs can predict the effectiveness of adjuvant CTx in patients with resected CRLM. Two main types of HGPs can be distinguished; the desmoplastic type and the non-desmoplastic type. Uni- and multivariable analyses for overall survival (OS) and disease-free survival (DFS) were performed, in both patients treated with and without preoperative chemotherapy. A total of 1236 patients from two tertiary centers (Memorial Sloan Kettering Cancer Center, New York, USA; Erasmus MC Cancer Institute, Rotterdam, The Netherlands) were included (period 2000–2016). A total of 656 patients (53.1%) patients received preoperative chemotherapy. Adjuvant CTx was only associated with a superior OS in non-desmoplastic patients that had not been pretreated (adjusted hazard ratio (HR) 0.52, 95% confidence interval (CI) 0.37–0.73, p < 0.001), and not in desmoplastic patients (adjusted HR 1.78, 95% CI 0.75–4.21, p = 0.19). In pretreated patients no significant effect of adjuvant CTx was observed, neither in the desmoplastic group (adjusted HR 0.83, 95% CI 0.49–1.42, p = 0.50) nor in the non-desmoplastic group (adjusted HR 0.96, 95% CI 0.71–1.29, p = 0.79). Similar results were found for DFS, with a superior DFS in non-desmoplastic patients treated with adjuvant CTx (HR 0.71, 95% CI 0.55–0.93, p < 0.001) that were not pretreated. Adjuvant CTx seems to improve OS and DFS after resection of non-desmoplastic CRLM. However, this effect was only observed in patients that were not treated with chemotherapy.
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46
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Batra A, Rigo R, Sheka D, Cheung WY. Real-world evidence on adjuvant chemotherapy in older adults with stage II/III colon cancer. World J Gastrointest Oncol 2020; 12:604-618. [PMID: 32699576 PMCID: PMC7340998 DOI: 10.4251/wjgo.v12.i6.604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/08/2020] [Accepted: 05/29/2020] [Indexed: 02/06/2023] Open
Abstract
Colon cancer represents one of the most common cancers diagnosed in older adults worldwide. The standard of care in resected stage II and stage III colon cancer continues to evolve. While there is unequivocal evidence to suggest both disease free and overall survival benefits with the use of combination chemotherapy in patients with stage III colon cancer, data regarding its use in patients with stage II colon cancer are less clear. Further, although colon cancer is a disease that affects older adults, there is considerable debate on the value of adjuvant chemotherapy in the aging population. In particular, many older patients are undertreated when compared to their younger counterparts. In this review, we will describe the clinical trials that contributed to the current adjuvant chemotherapy approach in colon cancer, discuss representation of older adults in trials and the specific challenges associated with the management of this sub-population, and highlight the role of comprehensive geriatric assessments. We will also review how real-world evidence complements the data gaps from clinical trials of early stage colon cancer.
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Affiliation(s)
- Atul Batra
- Department of Medicine, Tom Baker Cancer Centre, Calgary, Alberta T2N 1N4, Canada
| | - Rodrigo Rigo
- Department of Medicine, Tom Baker Cancer Centre, Calgary, Alberta T2N 1N4, Canada
| | - Dropen Sheka
- Department of Medicine, Tom Baker Cancer Centre, Calgary, Alberta T2N 1N4, Canada
| | - Winson Y Cheung
- Department of Oncology, University of Calgary, Calgary, Alberta T2N 4N2, Canada
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47
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Matsui S, Okabayashi K, Hasegawa H, Tsuruta M, Shigeta K, Ishida T, Yamada T, Kondo T, Yamauchi S, Sugihara K, Kitagawa Y. Effect of high ligation on survival of patients undergoing surgery for primary colorectal cancer and synchronous liver metastases. BJS Open 2020; 4:508-515. [PMID: 32243733 PMCID: PMC7260402 DOI: 10.1002/bjs5.50274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/29/2020] [Accepted: 02/03/2020] [Indexed: 11/25/2022] Open
Abstract
Background Although R0 surgery is recommended for stage IV colorectal cancer, the degree of required lymphadenectomy has not been established. The aim of this study was to investigate the prognostic impact of high ligation (HL) of the feeding artery and the number of retrieved lymph nodes after R0 surgery for colorectal cancer and synchronous colorectal cancer liver metastasis (CRLM). Methods This was a multi‐institutional retrospective analysis of patients with colorectal cancer and synchronous CRLM who had R0 surgery between January 1997 and December 2007. Clinical and pathological features were compared in patients who underwent HL and those who had a low ligation (LL). Kaplan–Meier analysis was performed to estimate the effect of HL on overall survival (OS). The impact of several risk factors on survival was analysed using the Cox proportional hazards model. Results Of 549 patients, 409 (74·5 per cent) had HL. Median follow‐up was 51·4 months. HL significantly improved the 5‐year OS rate (58·2 per cent versus 49·3 per cent for LL; P = 0·017). Multivariable analysis revealed HL to be a significant prognostic factor compared with LL (5‐year mortality: hazard ratio (HR) 0·68, 95 per cent c.i. 0·51 to 0·90; P = 0·007). In subgroup analysis, the positive effect of HL on OS was greatest in patients with lymph node metastasis. Conclusion HL of the feeding artery was associated with improved OS in patients with colorectal cancer and synchronous CRLM after R0 surgery.
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Affiliation(s)
- S Matsui
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - K Okabayashi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - H Hasegawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan.,Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - M Tsuruta
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - K Shigeta
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - T Ishida
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - T Yamada
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - T Kondo
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - S Yamauchi
- Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo, Japan
| | - K Sugihara
- Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Y Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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48
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Greally M, Pilson K, Linehan A, O'Keane C, Shields CJ, Conneely JB, McCaffrey JA. Indolent Nodal Relapse of Colon Carcinoma with Associated Tumor Thrombus Invading the Superior Mesenteric Vein. J Gastrointest Cancer 2020; 50:660-664. [PMID: 29663116 DOI: 10.1007/s12029-018-0101-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Megan Greally
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland. .,Gastrointestinal Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Keith Pilson
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Anna Linehan
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Conor O'Keane
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Conor J Shields
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - John B Conneely
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - John A McCaffrey
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
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49
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Lillemoe HA, Vauthey JN. Surgical approach to synchronous colorectal liver metastases: staged, combined, or reverse strategy. Hepatobiliary Surg Nutr 2020; 9:25-34. [PMID: 32140476 DOI: 10.21037/hbsn.2019.05.14] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
An increasing number of patients with colorectal cancer (CRC) are presenting with synchronous disease to the liver. The optimal surgical approach for this complex patient group is controversial, but ultimately depends on individual patient characteristics and institutional practices. Surgical strategies include the traditional staged approach, a combined colorectal and liver resection, or a liver-first reverse approach. In this review, the authors will provide an overview of each strategy, including case examples demonstrating the benefits of the more recently described liver-first approach, while arguing for individualized planning and multidisciplinary discussion for every patient.
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Affiliation(s)
- Heather A Lillemoe
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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