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Macbeth F, Treasure T. SABR-5 Results Are Not Reliable in Assessing Improvement or Maintenance of Quality of Life Without Comparable Evaluation in Control Patients. Clin Oncol (R Coll Radiol) 2024; 36:e235-e236. [PMID: 38755074 DOI: 10.1016/j.clon.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 04/25/2024] [Indexed: 05/18/2024]
Affiliation(s)
- F Macbeth
- Centre for Trials Research, Cardiff University, Cardiff CF14 4YS, UK
| | - T Treasure
- Clinical Operational Research Unit, University College London, London UK
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2
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Ouyang Y, Zhu Y, Chen H, Li G, Hu X, Luo H, Li Z, Han S. Case Report: Long-term survival of a patient with advanced rectal cancer and multiple pelvic recurrences after seven surgeries. Front Oncol 2023; 13:1169616. [PMID: 37256170 PMCID: PMC10225707 DOI: 10.3389/fonc.2023.1169616] [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: 03/30/2023] [Accepted: 05/04/2023] [Indexed: 06/01/2023] Open
Abstract
Background Rectal cancer has a high risk of recurrence and metastasis, with median survival ranging from 24 months to 36 months. K-RAS mutation is a predictor of poor prognosis in rectal cancer. Advanced rectal cancer can be stopped in its tracks by pelvic exenteration. Case summary A 51-year-old woman was diagnosed with advanced rectal cancer (pT4bN2aM1b, stage IV) with the KRAS G12D mutation due to a change in bowel habits. The patient had experienced repeated recurrences of rectal cancer after initial radical resection, and the tumor had invaded the ovaries, sacrum, bladder, vagina and anus. Since the onset of the disease, the patient had undergone a total of seven surgeries and long-term FOLFIRI- or XELOX-based chemotherapy regimens, with the targeted agents bevacizumab and regorafenib. Fortunately, the patient was able to achieve intraoperative R0 resection in almost all surgical procedures and achieve tumor-free survival after pelvic exenteration. The patient has been alive for 86 months since her diagnosis. Conclusions Patients with advanced rectal cancer can achieve long-term survival through active multidisciplinary management and R0 surgery.
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Affiliation(s)
- Ye Ouyang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yilin Zhu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Haoyi Chen
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Guoquan Li
- Department of General Surgery, Guangdong Province Huizhou Sixth Hospital, Huizhou, China
| | - Xiongwei Hu
- Department of General Surgery, Guangdong Province Huizhou Sixth Hospital, Huizhou, China
| | - Hongyu Luo
- Department of General Surgery, Guangdong Province Huizhou Sixth Hospital, Huizhou, China
| | - Zhou Li
- Department of Gastrointestinal Surgery, General Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shuai Han
- Department of Gastrointestinal Surgery, General Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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3
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Prisciandaro E, Ceulemans LJ, Van Raemdonck DE, Decaluwé H, De Leyn P, Bertolaccini L. Impact of the extent of lung resection on postoperative outcomes of pulmonary metastasectomy for colorectal cancer metastases: an exploratory systematic review. J Thorac Dis 2022; 14:2677-2688. [PMID: 35928602 PMCID: PMC9344403 DOI: 10.21037/jtd-22-239] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/27/2022] [Indexed: 01/18/2023]
Abstract
Background Pulmonary metastasectomy (PM) with curative intent has become a widely accepted treatment for lung metastases from solid tumours in selected patients, with low perioperative morbidity and mortality. In particular, PM is strongly recommended in selected patients with secondary lesions from colorectal cancer (CRC), due to its excellent postoperative prognosis. Nevertheless, the impact of the extent of PM on recurrence and survival remains controversial. This review aimed at assessing differences in short- and long-term postoperative outcomes depending on the extent of lung resection for lung metastases. Methods A systematic literature review of studies comparing anatomical and non-anatomical resections of lung metastases was performed (Prospective Register of Systematic Reviews Registration: 254931). A literature search for articles published in English between the date of database inception and January 31, 2021 was performed in EMBASE (via Ovid), MEDLINE (via PubMed) and Cochrane CENTRAL. Retrospective studies, randomised and non-randomised controlled trials were included. The Cochrane Collaboration tool was used to determine the risk of bias for the primary outcome for included studies. Results Out of 432 papers, three retrospective non-randomised studies (1,342 patients) were selected for systematic reviewing. Although our search design did not exclude any primary tumour histology, all selected studies investigated surgical resection of lung metastases from CRC. Because of variations in the compared surgical approaches to pulmonary metastases, a meta-analysis proved unfeasible. There was a tendency to perform anatomical resections for larger metastases. Multivariate analyses revealed that anatomical resections were protective for recurrence-free survival (RFS), while the impact of such procedures on overall survival (OS) remained uncertain. A significantly higher incidence of resection-margin recurrences was observed in patients who underwent non-anatomical resections. Discussion Anatomical resections of lung metastases from CRC seem to be associated with improved RFS. However, well-constructed comparative clinical trials focusing on the extent of PM are needed.
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Affiliation(s)
- Elena Prisciandaro
- Department of Thoracic Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Laurens J. Ceulemans
- Department of Thoracic Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium;,Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Katholieke Universiteit Leuven, Leuven, Belgium
| | - Dirk E. Van Raemdonck
- Department of Thoracic Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium;,Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Katholieke Universiteit Leuven, Leuven, Belgium
| | - Herbert Decaluwé
- Department of Thoracic Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium;,Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Katholieke Universiteit Leuven, Leuven, Belgium
| | - Paul De Leyn
- Department of Thoracic Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium;,Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Katholieke Universiteit Leuven, Leuven, Belgium
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
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A Comment on the American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colon Cancer. Dis Colon Rectum 2022; 65:e662. [PMID: 35348474 DOI: 10.1097/dcr.0000000000002464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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5
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Macbeth F, Treasure T, Williams NR. Letter in Response to 'Approach to Oligometastatic Cancer in the Elderly Patient'. Curr Oncol Rep 2022; 24:1091-1093. [PMID: 35451687 DOI: 10.1007/s11912-022-01236-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK.
| | - Norman R Williams
- Surgical and Interventional Trial Unit, University College London, London, UK
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Treasure T, Macbeth F, Younes R. The Pulmonary Metastasectomy in Colorectal Cancer study calls for reconsideration of the clinical effectiveness of this widespread practice. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2022; 68:296-298. [PMID: 35442350 DOI: 10.1590/1806-9282.20211094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/24/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Tom Treasure
- University College London, Clinical Operational Research Unit - London, United Kingdom
| | - Fergus Macbeth
- Cardiff University, Centre for Trials Research - Cardiff, United Kingdom
| | - Riad Younes
- Hospital Alemão Oswaldo Cruz, Cancer Center - São Paulo (SP), Brazil
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7
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Treasure T, Dunning J, Williams NR, Macbeth F. Lung metastasectomy for colorectal cancer: The impression of benefit from uncontrolled studies was not supported in a randomized controlled trial. J Thorac Cardiovasc Surg 2022; 163:486-490. [PMID: 33840470 DOI: 10.1016/j.jtcvs.2021.01.142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/19/2020] [Accepted: 01/02/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, United Kingdom.
| | - Joel Dunning
- James Cook University Hospital, Middlesbrough, United Kingdom
| | - Norman R Williams
- Surgical and Interventional Trials Unit, University College London, London, United Kingdom
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
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8
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Treasure T, Williams NR, Macbeth F. The full cohort of 512 patients and the nested controlled trial in 93 patients in the Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) study raise doubts about the effective size at present claimed. J Cardiothorac Surg 2022; 17:9. [PMID: 35034630 PMCID: PMC8762936 DOI: 10.1186/s13019-022-01757-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 01/08/2022] [Indexed: 11/23/2022] Open
Abstract
A comparison of the relative merits of video-assisted pulmonary metastasectomy versus thoracotomy is predicated on the assumption that removal of asymptomatic lung metastases favourably influences survival and that it does so by a large degree. Recently published but long-awaited evidence from a prospective cohort study and a randomised trial of Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) challenges that assumption.
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK.
| | - Norman R Williams
- Surgical and Interventional Trials Unit, University College London, London, UK
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
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9
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The Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) trial results cast doubt upon benefit of lung and liver metastasectomy at the time colorectal resection. Langenbecks Arch Surg 2022; 407:881-883. [PMID: 34981188 DOI: 10.1007/s00423-021-02419-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
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10
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Treasure T, Farewell V, Macbeth F, Batchelor T, Milosevic M, King J, Zheng Y, Leonard P, Williams NR, Brew-Graves C, Morris E, Fallowfield L. The Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) burden of care study: Analysis of local treatments for lung metastases and systemic chemotherapy in 220 patients in the PulMiCC cohort. Colorectal Dis 2021; 23:2911-2922. [PMID: 34310835 DOI: 10.1111/codi.15833] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 02/08/2023]
Abstract
AIM The aim of this work was to examine the burden of further treatments in patients with colorectal cancer following a decision about lung metastasectomy. METHOD Five teams participating in the Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) study provided details on subsequent local treatments for lung metastases, including the use of chemotherapy. For patients in three groups (no metastasectomy, one metastasectomy or multiple local interventions), baseline factors and selection criteria for additional treatments were examined. RESULTS The five teams recruited 220 patients between October 2010 and January 2017. No lung metastasectomy was performed in 51 patients, 114 patients had one metastasectomy and 55 patients had multiple local interventions. Selection for initial metastasectomy was associated with nonelevated carcinoembryonic antigen, fewer metastases and no prior liver metastasectomy. These patients also had better Eastern Cooperative Oncology Group scores and lung function at baseline. Four sites provided information on chemotherapy in 139 patients: 79 (57%) had one to five courses of chemotherapy, to a total of 179 courses. The patterns of survival after one or multiple metastasectomy interventions showed evidence of guarantee-time bias contributing to an impression of benefit over no metastasectomy. After repeated metastasectomy, a significantly higher risk of death was observed, with no apparent reduction in chemotherapy usage. CONCLUSION Repeated metastasectomy is associated with a higher risk of death without reducing the use of chemotherapy. Continued monitoring without surgery might reassure patients with indolent disease or allow response assessment during systemic treatment. Overall, the carefully collected information from the PulMICC study provides no indication of an important survival benefit from metastasectomy.
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
| | | | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Tim Batchelor
- Bristol Royal Infirmary, University Hospitals, Bristol, UK
| | - Misel Milosevic
- Institute for Lung Diseases of Vojvodina, Thoracic Surgery Clinic, Sremska Kamenica, Serbia
| | | | - Yan Zheng
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zheng Zhou University/Henan Cancer Hospital, Zheng Zhou, Henan Province, China
| | - Pauline Leonard
- Barking, Havering and Redbridge University Hospitals, Romford, UK
| | - Norman R Williams
- Surgical and Interventional Trials Unit (SITU), University College London, London, UK
| | - Chris Brew-Graves
- Division of Medicine, National Cancer Imaging Accelerator (NCIA), University College London, London, UK
| | | | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), University of Sussex, Falmer, UK
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Surgery, selection or biology in lung metastasectomy for colorectal lung metastasectomy? PulMiCC may not provide all the answers but it does narrow down the question. Int J Colorectal Dis 2021; 36:2281. [PMID: 33782765 DOI: 10.1007/s00384-021-03916-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 02/04/2023]
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12
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Brew-Graves C, Leonard P, Treasure T. Lung Metastasectomy in the Treatment of Rectal Cancer Gives Little if Any Benefit Compared With the Importance of Control at the Primary Cancer Site. Am J Clin Oncol 2021; 44:503-504. [PMID: 34432669 DOI: 10.1097/coc.0000000000000853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Chris Brew-Graves
- National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine
| | - Pauline Leonard
- Barking, Havering and Redbridge University Hospitals, London, UK
| | - Tom Treasure
- Clinical Operational Research Unit University College London
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13
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Williams NR, Treasure T, Macbeth F, Fallowfield L. The Prospective Observational Cohort and the Nested Randomized Controlled Trial in the Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC Study) Question the Reliance on Existing Evidence for the Magnitude of Benefit From Lung Metastasectomy. Am J Clin Oncol 2021; 44:502-503. [PMID: 34432668 PMCID: PMC7611601 DOI: 10.1097/coc.0000000000000847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Norman R Williams
- Surgical and Interventional Trials Unit, University College London, UK
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, UK
| | | | - Lesley Fallowfield
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), University of Sussex, Sussex, UK
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Treasure T, Farewell V, Macbeth F, Batchelor T, Milošević M, King J, Zheng Y, Leonard P, Williams NR, Brew‐Graves C, Fallowfield L. The Pulmonary Metastasectomy in Colorectal Cancer cohort study: Analysis of case selection, risk factors and survival in a prospective observational study of 512 patients. Colorectal Dis 2021; 23:1793-1803. [PMID: 33783109 PMCID: PMC8496511 DOI: 10.1111/codi.15651] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/02/2021] [Accepted: 03/23/2021] [Indexed: 01/02/2023]
Abstract
AIM We wanted to examine survival in patients with resected colorectal cancer (CRC) whose lung metastases are or are not resected. METHODS Teams participating in the study of Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) identified potential candidates for lung metastasectomy and invited their consent to join Stage 1. Baseline data related to CRC and fitness for surgery were collected. Eligible patients were invited to consent for randomization in the PulMiCC randomized controlled trial (Stage 2). Sites were provided with case report forms for non-randomized patients to record adverse events and death at any time. They were all reviewed at 1 year. Baseline and survival data were analysed for the full cohort. RESULTS Twenty-five clinical sites recruited 512 patients from October 2010 to January 2017. Data collection closed in October 2020. Before analysis, 28 patients with non-CRC lung lesions were excluded and three had withdrawn consent leaving 481. The date of death was known for 292 patients, 136 were alive in 2020 and 53 at earlier time points. Baseline factors and 5-year survival were analysed in three strata: 128 non-randomized patients did not have metastasectomy; 263 had elective metastasectomy; 90 were from the randomized trial. The proportions of solitary metastases for electively operated and non-operated patients were 69% and 35%. Their respective 5-year survivals were 47% and 22%. CONCLUSION Survival without metastasectomy was greater than widely presumed. Difference in survival appeared to be largely related to selection. No inference can be drawn about the effect of metastasectomy on survival in this observational study.
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research UnitUniversity College LondonLondonUK
| | | | | | - Tim Batchelor
- Bristol Royal InfirmaryUniversity HospitalsBristolUK
| | - Mišel Milošević
- Institute for Lung Diseases of VojvodinaThoracic Surgery ClinicSremska KamenicaSerbia
| | - Juliet King
- Thoracic SurgeryGuy's and St Thomas'HospitalLondonUK
| | - Yan Zheng
- Department of Thoracic SurgeryAffiliated Cancer Hospital of ZhengZhou University/Henan Cancer HospitalZheng ZhouChina
| | - Pauline Leonard
- Barking, Havering and Redbridge University HospitalsRomfordUK
| | - Norman R. Williams
- Surgical and Interventional Trials Unit (SITU)University College LondonLondonUK
| | - Chris Brew‐Graves
- National Cancer Imaging Accelerator (NCIA)Division of MedicineUniversity College LondonLondonUK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE‐C)University of SussexFalmerUK
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15
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Fenton HM, Finan PJ, Milton R, Shackcloth M, Taylor JC, Treasure T, Morris EJA. National variation in pulmonary metastasectomy for colorectal cancer. Colorectal Dis 2021; 23:1306-1316. [PMID: 33368958 PMCID: PMC8614123 DOI: 10.1111/codi.15506] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/17/2020] [Accepted: 12/04/2020] [Indexed: 12/12/2022]
Abstract
AIM Evidence on patterns of use of pulmonary metastasectomy in colorectal cancer patients is limited. This population-based study aims to investigate the use of pulmonary metastasectomy in the colorectal cancer population across the English National Health Service (NHS) and quantify the extent of any variations in practice and outcome. METHODS All adults who underwent a major resection for colorectal cancer in an NHS hospital between 2005 and 2013 were identified in the COloRECTal cancer data Repository (CORECT-R). All inpatient episodes corresponding to pulmonary metastasectomy, occurring within 3 years of the initial colorectal resection, were identified. Multi-level logistic regression was used to determine patient and organizational factors associated with the use of pulmonary metastasectomy for colorectal cancer, and Kaplan-Meier and Cox models were used to assess survival following pulmonary metastasectomy. RESULTS In all, 173 354 individuals had a major colorectal resection over the study period, with 3434 (2.0%) undergoing pulmonary resection within 3 years. The frequency of pulmonary metastasectomy increased from 1.2% of patients undergoing major colorectal resection in 2005 to 2.3% in 2013. Significant variation was observed across hospital providers in the risk-adjusted rates of pulmonary metastasectomy (0.0%-6.8% of patients). Overall 5-year survival following pulmonary resection was 50.8%, with 30-day and 90-day mortality of 0.6% and 1.2% respectively. CONCLUSIONS This study shows significant variation in the rates of pulmonary metastasectomy for colorectal cancer across the English NHS.
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Affiliation(s)
- Hayley M. Fenton
- Cancer Epidemiology GroupLeeds Institute for Data AnalyticsUniversity of LeedsLeedsUK
| | - Paul J. Finan
- Cancer Epidemiology GroupLeeds Institute for Data AnalyticsUniversity of LeedsLeedsUK
| | - Richard Milton
- Department of Thoracic SurgerySt James’s University HospitalLeedsUK
| | - Michael Shackcloth
- Department of Thoracic SurgeryLiverpool Heart and Chest HospitalLiverpoolUK
| | - John C. Taylor
- Cancer Epidemiology GroupLeeds Institute for Data AnalyticsUniversity of LeedsLeedsUK
| | - Tom Treasure
- Clinical Operational Research UnitUniversity College LondonLondonUK
| | - Eva J. A. Morris
- Nuffield Department of Population HealthBig Data InstituteUniversity of OxfordOxfordUK
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Macbeth F, Williams NR, Treasure T. Pulmonary metastasectomy in colorectal cancer: a randomized controlled trial. ANZ J Surg 2021; 91:473. [PMID: 33740304 DOI: 10.1111/ans.16658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/01/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Norman R Williams
- Surgical and Interventional Trials Unit, University College London, London, UK
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
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17
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Treasure T. Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC). Assumed benefits are not confirmed by new study findings. Pathol Res Pract 2021; 222:153442. [PMID: 33862562 DOI: 10.1016/j.prp.2021.153442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 04/03/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, UK.
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18
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Treasure T, Williams NR. Lung metastasectomy for colorectal cancer in the PulMiCC randomised controlled trial. THE LANCET REGIONAL HEALTH. EUROPE 2021; 3:100080. [PMID: 34557807 PMCID: PMC8454816 DOI: 10.1016/j.lanepe.2021.100080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
| | - Norman R Williams
- Surgical and Interventional Trials Unit, University College London, London, UK
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19
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Batchelor T, Hasan J, Macbeth F, Shackcloth M, Treasure T. Randomised Controlled Trial Evidence Questions the Assumption that Pulmonary Metastasectomy Benefits Patients with Colorectal Cancer. Ann Surg Oncol 2021; 28:4066-4067. [PMID: 33590363 DOI: 10.1245/s10434-020-09521-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 11/18/2022]
Abstract
Pulmonary metastasectomy for sarcoma is surgery without proven benefit, and in the light of a randomized controlled trial examining pulmonary metastasectomy in colorectal cancer, it should be questioned.
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Affiliation(s)
| | | | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Tom Treasure
- Clinical Operational Research Unit, University College, London, UK.
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Zhao ZR, Long H. ASO Author Reflections: Pulmonary Metastasectomy in Patients with Lung Metastases from Nasopharyngeal Carcinoma. Ann Surg Oncol 2021; 28:4551-4552. [PMID: 33586071 DOI: 10.1245/s10434-021-09693-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Ze-Rui Zhao
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, and Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Lung Cancer Research Center, Sun Yat-Sen University, Guangzhou, China
| | - Hao Long
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, and Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China. .,Lung Cancer Research Center, Sun Yat-Sen University, Guangzhou, China.
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21
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Zhao ZR, Liu DH, Wang YZ, Sun XS, Long H. Pulmonary Metastasectomy in Patients with Lung Metastases from Nasopharyngeal Carcinoma. Ann Surg Oncol 2021; 28:4542-4550. [PMID: 33492543 DOI: 10.1245/s10434-021-09597-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/31/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Approximately 10% of patients with nasopharyngeal carcinoma (NPC) develop lung-only metastases. Data regarding the potential role of lung metastasectomy are limited. OBJECTIVE The aim of this case-control study was to determine whether lung metastasectomy prolongs survival in patients with NPC with lung-only metastases. METHODS The resectability of 215 consecutive patients diagnosed with lung-only metastases from 2001 to 2018 was reviewed by doctors blinded to the patient groups. The propensity score matching method was used to balance the potential probability of being assigned to treatment groups based on pretherapeutic information. Postmetastatic survival (PMS) and cumulative incidence of local failure were compared between the surgical and nonsurgical arms. RESULTS Overall, 120 potentially resectable cases were enrolled, and 45 and 22 patients who underwent and did not undergo metastasectomy, respectively, were included in the propensity-matched cohort. Patients who underwent pulmonary resection had better PMS and a lower cumulative incidence of local failure than those who did not undergo surgery. The 5-year PMS rates were 75.53% and 47.81% in the surgical and nonsurgical arms, respectively (difference 27.72%; 95% confidence interval 3.95-51.49%). Younger patients (≤ 45 years), and those with a lower primary N stage (N0-1), longer disease-free interval (> 2 years), smaller total diameter of the metastatic lesions (≤ 3 cm), unilateral distribution of metastases, no mediastinal/hilar lymph node involvement, and adjuvant chemotherapy showed a significantly longer PMS after metastasectomy by multivariable analysis. CONCLUSIONS Lung metastasectomy may improve PMS and decrease the chance of local treatment failure in NPC patients with potentially resectable lung-only metastases.
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Affiliation(s)
- Ze-Rui Zhao
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, and Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Lung Cancer Research Center, Sun Yat-Sen University, Guangzhou, China
| | - Di-Han Liu
- The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yi-Zhi Wang
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, and Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Lung Cancer Research Center, Sun Yat-Sen University, Guangzhou, China
| | - Xue-Song Sun
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, and Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Hao Long
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, and Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China. .,Lung Cancer Research Center, Sun Yat-Sen University, Guangzhou, China.
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Reply to: The course of lung oligometastatic colorectal cancer may be a reflection of selection for treatment rather than an effect of stereotactic body radiotherapy. Strahlenther Onkol 2020; 197:76-78. [PMID: 33242139 DOI: 10.1007/s00066-020-01710-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 10/22/2022]
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Is survival really better after repeated lung metastasectomy? Clin Exp Metastasis 2020; 38:73-75. [PMID: 33119884 DOI: 10.1007/s10585-020-10061-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
Abstract
Several groups have observed that average survival time after a second lung metastasectomy is longer than after a first metastasectomy. The randomised controlled trial Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) found no survival benefit from lung metastasectomy. In fact, median survival was longer, and four-year overall survival was higher, in the control group than in those randomly assigned to metastasectomy, although not significantly so. The illusion of benefit is because survival without metastasectomy has been assumed to be near zero, as stated in Society of Thoracic Surgeons' Expert Consensus Document on Pulmonary Metastasectomy 2019. It has been repeatedly found that survival is influenced by the selection of patients who have characteristics associated with better prognosis. The passage of time while monitoring and assessing patients, and observing their rate of progression, provides for immortal time bias. Reselection of the most favourable patients for repeated metastasectomy is the likely reason for any differences in survival between first and repeated metastasectomy operations.
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