1
|
Cheng XF, Zhao F, Chen D, Liu FL. Current landscape of preoperative neoadjuvant therapies for initial resectable colorectal cancer liver metastasis. World J Gastroenterol 2024; 30:663-672. [PMID: 38515943 PMCID: PMC10950626 DOI: 10.3748/wjg.v30.i7.663] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 12/22/2023] [Accepted: 01/22/2024] [Indexed: 02/21/2024] Open
Abstract
Colorectal cancer liver metastasis (CRLM) presents a clinical challenge, and optimizing treatment strategies is crucial for improving patient outcomes. Surgical resection, a key element in achieving prolonged survival, is often linked to a heightened risk of recurrence. Acknowledging the potential benefits of preoperative neoadjuvant chemotherapy in managing resectable liver metastases, this approach has gained attention for its role in tumor downsizing, assessing biological behavior, and reducing the risk of postoperative recurrence. However, the use of neoadjuvant chemotherapy in initially resectable CRLM sparks ongoing debates. The balance between tumor reduction and the risk of hepatic injury, coupled with concerns about delaying surgery, necessitates a nuanced approach. This article explores recent research insights and draws upon the practical experiences at our center to address critical issues regarding considerations for initially resectable cases. Examining the criteria for patient selection and the judicious choice of neoadjuvant regimens are pivotal areas of discussion. Striking the right balance between maximizing treatment efficacy and minimizing adverse effects is imperative. The dynamic landscape of precision medicine is also reflected in the evolving role of gene testing, such as RAS/BRAF and PIK3CA, in tailoring neoadjuvant regimens. Furthermore, the review emphasizes the need for a multidisciplinary approach to navigate the complexities of CRLM. Integrating technical expertise and biological insights is crucial in refining neoadjuvant strategies. The management of progression following neoadjuvant chemotherapy requires a tailored approach, acknowledging the diverse biological behaviors that may emerge. In conclusion, this review aims to provide a comprehensive perspective on the considerations, challenges, and advancements in the use of neoadjuvant chemotherapy for initially resectable CRLM. By combining evidence-based insights with practical experiences, we aspire to contribute to the ongoing discourse on refining treatment paradigms for improved outcomes in patients with CRLM.
Collapse
Affiliation(s)
- Xiao-Fei Cheng
- Department of Colorectal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Feng Zhao
- Department of Radiation Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Dong Chen
- Department of Colorectal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Fan-Long Liu
- Department of Colorectal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| |
Collapse
|
2
|
The Italian Consensus on minimally invasive simultaneous resections for synchronous liver metastasis and primary colorectal cancer: A Delphi methodology. Updates Surg 2021; 73:1247-1265. [PMID: 34089501 DOI: 10.1007/s13304-021-01100-9] [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: 05/03/2021] [Accepted: 05/12/2021] [Indexed: 12/17/2022]
Abstract
At the time of diagnosis synchronous colorectal cancer, liver metastases (SCRLM) account for 15-25% of patients. If primary tumour and synchronous liver metastases are resectable, good results may be achieved performing surgical treatment incorporated into the chemotherapy regimen. So far, the possibility of simultaneous minimally invasive (MI) surgery for SCRLM has not been extensively investigated. The Italian surgical community has captured the need and undertaken the effort to establish a National Consensus on this topic. Four main areas of interest have been analysed: patients' selection, procedures, techniques, and implementations. To establish consensus, an adapted Delphi method was used through as many reiterative rounds were needed. Systematic literature reviews were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses instructions. The Consensus took place between February 2019 and July 2020. Twenty-six Italian centres participated. Eighteen clinically relevant items were identified. After a total of three Delphi rounds, 30-tree recommendations reached expert consensus establishing the herein presented guidelines. The Italian Consensus on MI surgery for SCRLM indicates possible pathways to optimise the treatment for these patients as consensus papers express a trend that is likely to become shortly a standard procedure for clinical pictures still on debate. As matter of fact, no RCT or relevant case series on simultaneous treatment of SCRLM are available in the literature to suggest guidelines. It remains to be investigated whether the MI technique for the simultaneous treatment of SCRLM maintain the already documented benefit of the two separate surgeries.
Collapse
|
3
|
Wang L, Zhu H, Zhao Y, Pan Q, Mao A, Zhu W, Zhang N, Lin Z, Zhou J, Wang Y, Zhang Y, Wang M, Feng Y, He X, Xu W, Wang L. Comprehensive molecular profiling of intrahepatic cholangiocarcinoma in the Chinese population and therapeutic experience. J Transl Med 2020; 18:273. [PMID: 32631434 PMCID: PMC7336472 DOI: 10.1186/s12967-020-02437-2] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/24/2020] [Indexed: 02/07/2023] Open
Abstract
Background The genomic alterations of intrahepatic cholangiocarcinoma (ICC) in the Chinese population have not been fully revealed. Molecular profiling may provide a reference for clinical management, especially targeted therapy. Methods A retrospective study was conducted in 122 ICC patients. All patients’ samples underwent next-generation sequencing (NGS), which analyzed 417 genes. The genetic characteristics, clinical management and therapeutic responses were analyzed. Results The most commonly mutated genes were TP53 (34%), KRAS (25%) and ARID1A (17%). Targeted agents were used referring to molecular profiling, in combination with chemotherapy. Twenty-two patients with wild-type KRAS/NRAS/BRAF were treated with cetuximab. The disease control and response rates were 78% and 47%, respectively, which were higher than those achieved with chemotherapy alone (72% and 11%, P = 0.16). Fifty-four patients underwent anti-VEGF treatment with bevacizumab. The disease control and response rates were 85% and 60%, respectively. Better therapeutic efficiency (P = 0.001) and longer progression-free survival (PFS) were observed in the bevacizumab-treated group compared to chemotherapy alone group (15.4 and 6.7 months, respectively; P = 0.04). The PFS of ten patients who underwent hepatectomy after combined treatment with chemotherapy and bevacizumab was longer than that of 139 patients who underwent surgical treatment (28.9 vs 18.0 months, P = 0.03). Two patients (1.6%) had signatures of microsatellite instability (MSI-H), and both benefited from immunotherapy. Conclusions This study provides an overview of genetic alterations in Chinese ICC patients and indicates the potential clinical implications for NGS-based personalized therapies.
Collapse
Affiliation(s)
- Longrong Wang
- Liver Surgery Department, Shanghai Cancer Center, Fudan University, No. 270 Dongan Rd., Shanghai, 200032, People's Republic of China
| | - Hongxu Zhu
- Shanghai Cancer Center, Fudan University, Shanghai, People's Republic of China
| | - Yiming Zhao
- Liver Surgery Department, Shanghai Cancer Center, Fudan University, No. 270 Dongan Rd., Shanghai, 200032, People's Republic of China
| | - Qi Pan
- Liver Surgery Department, Shanghai Cancer Center, Fudan University, No. 270 Dongan Rd., Shanghai, 200032, People's Republic of China
| | - Anrong Mao
- Liver Surgery Department, Shanghai Cancer Center, Fudan University, No. 270 Dongan Rd., Shanghai, 200032, People's Republic of China
| | - Weiping Zhu
- Liver Surgery Department, Shanghai Cancer Center, Fudan University, No. 270 Dongan Rd., Shanghai, 200032, People's Republic of China
| | - Ning Zhang
- Liver Surgery Department, Shanghai Cancer Center, Fudan University, No. 270 Dongan Rd., Shanghai, 200032, People's Republic of China
| | - Zhenhai Lin
- Liver Surgery Department, Shanghai Cancer Center, Fudan University, No. 270 Dongan Rd., Shanghai, 200032, People's Republic of China
| | - Jiamin Zhou
- Liver Surgery Department, Shanghai Cancer Center, Fudan University, No. 270 Dongan Rd., Shanghai, 200032, People's Republic of China
| | - Yilin Wang
- Liver Surgery Department, Shanghai Cancer Center, Fudan University, No. 270 Dongan Rd., Shanghai, 200032, People's Republic of China
| | - Yongfa Zhang
- Liver Surgery Department, Shanghai Cancer Center, Fudan University, No. 270 Dongan Rd., Shanghai, 200032, People's Republic of China
| | - Miao Wang
- Liver Surgery Department, Shanghai Cancer Center, Fudan University, No. 270 Dongan Rd., Shanghai, 200032, People's Republic of China
| | - Yun Feng
- Liver Surgery Department, Shanghai Cancer Center, Fudan University, No. 270 Dongan Rd., Shanghai, 200032, People's Republic of China
| | - Xigan He
- Shanghai Cancer Center, Fudan University, Shanghai, People's Republic of China
| | - Weiqi Xu
- Shanghai Cancer Center, Fudan University, Shanghai, People's Republic of China
| | - Lu Wang
- Liver Surgery Department, Shanghai Cancer Center, Fudan University, No. 270 Dongan Rd., Shanghai, 200032, People's Republic of China.
| |
Collapse
|
4
|
Wang D, He S, Chu L, Chao Q, Zhang Q, Shu H. A metastatic skull tumor from intrahepatic cholangiocarcinoma: A case report and literature review. Medicine (Baltimore) 2019; 98:e18291. [PMID: 31804374 PMCID: PMC6919424 DOI: 10.1097/md.0000000000018291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Intrahepatic cholangiocarcinoma (ICC) originates from the epithelial cells of the secondary branches that are distant from the intrahepatic bile duct. ICC is a rare pathological type of primary liver cancer, with a high malignancy rate and poor prognosis. However, patients with ICC metastasis to the skull are extremely rarely encountered. Herein, we present a case of a metastatic skull tumor from ICC, along with a literature review. PATIENT CONCERNS A 50-year-old right-handed man who did not smoke was diagnosed with a poorly differentiated ICC (T2aN0M0) in segment VI of the liver in February 2017. Hepatectomy was performed. The patient then presented with a painful mass in the posterior occipital region with dizziness experienced since 1 month, for which he underwent posterior occipital craniotomy. Postoperative specimens were sent for pathological examination. DIAGNOSES We diagnosed the patient with a metastatic skull tumor from ICC. INTERVENTIONS The patient underwent posterior occipital craniotomy and total resection of the tumor. OUTCOMES The patient received chemotherapy 1 month after surgery, and after 6 months of follow-up, the patient was alive. LESSONS ICC often shows metastases to the vertebrae. Therefore, physicians should consider the possibility of metastasis in patients with ICC, especially in those who show a painful skull mass of unknown origin; moreover, among patients with vertebral metastasis, physicians should be very vigilant about an occipital mass. We believe that the craniospinal venous system may be the pathway for occipital metastasis in patients with ICC.
Collapse
Affiliation(s)
| | | | - Liang Chu
- Department of General Surgery, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, People's Republic of China
| | | | | | | |
Collapse
|