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Miller SR, Chang DT. Local-Regional Therapy for Oligometastatic Colorectal Cancer. Cancer J 2024; 30:272-279. [PMID: 39042779 DOI: 10.1097/ppo.0000000000000729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
ABSTRACT Colorectal cancer is one of the most common malignancies in the United States as well as a leading cause of cancer-related death. Upward of 30% of patients ultimately develop metastatic disease, most commonly to the liver and lung. Untreated, patients have poor survival. Historically, patients with oligometastatic disease were treated with resection leading to long-term survival; however, there are many patients who are not surgical candidates. Innovations in thermal ablation, hepatic artery infusions, chemoembolization and radioembolization, and stereotactic ablative radiation have led to an expansion of patients eligible for local therapy. This review examines the evidence behind each modality for the most common locations of oligometastatic colorectal cancer.
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Affiliation(s)
- Sean R Miller
- From the Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
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Dong T, Fan H, Lyu J, Shi Y, Hu P, Wu X, Sun J. A retrospective study comparing the efficacy of microwave ablation and stereotactic body radiotherapy in colorectal cancer lung metastases. Oncol Lett 2024; 28:322. [PMID: 38807676 PMCID: PMC11130612 DOI: 10.3892/ol.2024.14455] [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: 02/08/2024] [Accepted: 04/24/2024] [Indexed: 05/30/2024] Open
Abstract
The purpose of the present study was to assess and compare the efficacy of microwave ablation (MWA) and stereotactic body radiotherapy (SBRT) in the treatment of lung metastases from patients with colorectal cancer (CRC) and to identify the preferable treatment modality based on patient and tumor characteristics. Records of 118 patients with CRC with a total of 307 lung metastases who underwent SBRT or MWA between January 2015 and December 2022 were retrospectively analyzed, including the essential clinicopathological information on patients (age, sex and underlying diseases), diagnosis and treatment information [primary tumor site, levels of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9], imaging data [diameter of lung metastasis, location of the metastasis (i.e., whether or not the tumor was adjacent to the vessel or bronchus) and internal features] and follow-up data (postoperative therapy, complications or adverse effects and survival outcomes). For statistical analysis of the local tumor progression (LTP), disease-free survival and overall survival (OS) rates, Cox regression analysis, along with the Kaplan-Meier method adjusted using inverse probability of treatment weighting (IPTW), were performed. The median follow-up duration in the present study was 31.5 months. Multivariable Cox regression analysis revealed that the CEA level, metastasis diameter and internal features were independent predictors of OS. In the IPTW-adjusted analysis, no significant difference in the 1-year OS rate was observed between the SBRT and MWA groups (92.9 vs. 93.9%; P=0.483); however, a notable discrepancy in the treatment modalities was noted, leading to significant differences in the 2- and 3-year OS rates (65.9 vs. 57.6%, P=0.001, and 44.7 vs. 36.4%, P<0.001, respectively). A significant interaction effect for the treatment modality was observed for LTP (P=0.021). In conclusion, the present study revealed that SBRT and MWA have similar therapeutic effects in terms of prolonging the survival of patients with CRC with lung metastases; however, regarding the local control of lung metastases, MWA is associated with a number of significant advantages.
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Affiliation(s)
- Tianjie Dong
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang 312000, P.R. China
| | - Hongjie Fan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Jiali Lyu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, P.R. China
| | - Yuting Shi
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang 312000, P.R. China
| | - Peng Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, P.R. China
| | - Xia Wu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, P.R. China
| | - Jihong Sun
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, P.R. China
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Yoshida C, Chang SS, Okamoto T, Inada R. Recurrence-free survival curve for pulmonary metastasectomy in colorectal cancer plateaus at 3 years. Updates Surg 2024:10.1007/s13304-024-01874-8. [PMID: 38801601 DOI: 10.1007/s13304-024-01874-8] [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: 02/29/2024] [Accepted: 05/05/2024] [Indexed: 05/29/2024]
Abstract
Pulmonary metastasectomy in colorectal cancer (CRC) has encouraging results; however, specific criteria for lung resection and the timing of resection remain undetermined. Therefore, in this study, we aimed to examine the long-term prognosis and 10-year survival rates and analyze poor prognostic factors in patients who underwent resection of pulmonary metastases from CRC. This retrospective, single-institution study included 156 patients with controlled primary CRC and metastases confined to the lungs or liver who underwent pulmonary metastasectomy between 2005 and 2022. Statistical analyses were conducted using the X2 and two-tailed Student's t test to compare variables. The receiver operating characteristic (ROC) curve was used to determine the appropriate cut-off point for tumor size as a predictive factor of survival. Recurrence-free survival (RFS) and overall survival (OS) were estimated using the Kaplan-Meier method, and non-parametric group comparisons were performed using log-rank tests. The 5- and 10-year OS rates were 67% and 59%, respectively. Further, there was no recurrence 38 months post-surgery, and the RFS curve plateaued. Moreover, by 88 months post-surgery, no deaths occurred, and the OS curve plateaued. Multivariate analysis revealed that a pulmonary metastatic tumor >14 mm and disease-free interval <2 years indicated poor prognosis. The RFS curve for pulmonary metastasectomy may plateau approximately 3 years after surgery. Pulmonary metastasectomy can achieve long-term survival in selected patients with CRC. Furthermore, surgical resection of recurrence after pulmonary metastasectomy may lead to better results. Thus, tumor size and disease-free interval may be independent prognostic factors.
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Affiliation(s)
- Chihiro Yoshida
- Department of General Thoracic Surgery, Kochi Health Sciences Center, 2125-1 Ike, Kochi City, Kochi, 781-8555, Japan.
| | - Sung Soo Chang
- Department of General Thoracic Surgery, Kochi Health Sciences Center, 2125-1 Ike, Kochi City, Kochi, 781-8555, Japan
| | - Taku Okamoto
- Department of General Thoracic Surgery, Kochi Health Sciences Center, 2125-1 Ike, Kochi City, Kochi, 781-8555, Japan
| | - Ryo Inada
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi City, Kochi, Japan
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Hashimoto S, Tominaga T, Nonaka T, Noda K, Kiya S, Shiraishi T, Oishi K, Takamura Y, Yamazaki S, Araki M, Sumida Y, Miyazaki T, Kamohara R, Morino S, Matsumoto K, Nakamura A, Nagayasu T. Long-term outcomes and early recurrence after resection for metachronous pulmonary metastases from colorectal cancer. Langenbecks Arch Surg 2023; 409:24. [PMID: 38158429 DOI: 10.1007/s00423-023-03209-4] [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: 09/30/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE Properly selecting patients for aggressive curative resection for pulmonary metastases (PMs) from colorectal cancer (CRC) is desirable. We purposed to clarify prognostic factors and risk factors for early recurrence after metachronous PM resection. METHODS Clinical data of 151 patients who underwent R0 resection for metachronous PMs from CRC at two institutions between 2008 and 2021 were reviewed. RESULTS Seventy-six patients (50.3%) were male, and the median age was 71 (42-91) years. The numbers of colon/rectal cancers were 76/75, with pStage I/II/III/IV/unknown in 15/34/86/13/3. The duration from primary surgery to PM was 19.7 (1.0-106.4) months. The follow-up period was 41.9 (0.3-156.2) months. The 1-, 3-, and 5-year recurrence-free survival (RFS) rates were 75.1%, 53.7%, and 51.1%, and the 1-, 3-, and 5-year overall survival (OS) rates were 97.7%, 87.5%, and 68.2%. On multivariate analysis, lymph node metastasis of the primary lesion (HR 1.683, 95%CI 1.003-2.824, p = 0.049) was an independent predictor of poor RFS, and history of resection for extrapulmonary metastasis (e-PM) (HR 2.328, 95%CI 1.139-4.761, p = 0.021) was an independent predictor of poor OS. Patients who experienced early recurrence (< 6 months) after PM resection showed poorer OS than others (3-year OS 50.8% vs. 90.2%, p = 0.002). On multivariate analysis, e-PM was an independent predictor of early recurrence after PM resection (OR 3.989, 95%CI 1.002-15.885, p = 0.049). CONCLUSION Since a history of e-PM was a predictor of early recurrence and poor OS after R0 resection for PM, surgical treatment of patients with a history of e-PM should be considered carefully.
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Affiliation(s)
- Shintaro Hashimoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8511, Japan
| | - Tetsuro Tominaga
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8511, Japan.
| | - Takashi Nonaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8511, Japan
| | - Keisuke Noda
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8511, Japan
| | - Soishiro Kiya
- Department of Surgery, Sasebo City General Hospital, Sasebo, Japan
| | - Toshio Shiraishi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8511, Japan
| | - Kaido Oishi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8511, Japan
| | - Yuma Takamura
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8511, Japan
| | - Shoto Yamazaki
- Department of Surgery, Sasebo City General Hospital, Sasebo, Japan
| | - Masato Araki
- Department of Surgery, Sasebo City General Hospital, Sasebo, Japan
| | - Yorihisa Sumida
- Department of Surgery, Sasebo City General Hospital, Sasebo, Japan
| | - Takuro Miyazaki
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8511, Japan
- Department of Surgery, Sasebo City General Hospital, Sasebo, Japan
| | - Ryotaro Kamohara
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8511, Japan
- Department of Surgery, Sasebo City General Hospital, Sasebo, Japan
| | - Shigeyuki Morino
- Department of Surgery, Sasebo City General Hospital, Sasebo, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8511, Japan
| | - Akihiro Nakamura
- Department of Surgery, Sasebo City General Hospital, Sasebo, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8511, Japan
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Shishido Y, Ishii M, Maeda T, Kokado Y, Masuya D, Kusama T, Fujimoto K, Higashiyama H. Survival outcomes of lung metastases from colorectal cancer treated with pulmonary metastasectomy or modern systemic chemotherapy: a single institution experience. J Cardiothorac Surg 2023; 18:327. [PMID: 37964370 PMCID: PMC10647062 DOI: 10.1186/s13019-023-02434-8] [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: 03/23/2023] [Accepted: 11/04/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Although pulmonary metastasectomy is an accepted treatment strategy for resectable lung metastases (LM) from colorectal cancer (CRC), its survival benefits are controversial. In contrast, recent advancements in chemotherapy have significantly improved metastatic CRC prognosis. This study aimed to evaluate survival outcome of LM from CRC in the age of newly developed chemotherapy. METHODS We retrospectively reviewed 50 patients who underwent complete resection and 22 patients who received chemotherapy as definitive treatment for LM from resected CRC at our hospital. The present study was limited to patients who started treatment for isolated LM after molecular targeted drugs became available in Japan. RESULTS Overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS) rates after pulmonary resection were 64.5%, 66.4%, and 32.6% at five years, respectively. OS and CSS rates of chemotherapy patients were 26.8% and 28.3% at five years, with a median progression-free survival time of 10.0 months. When compared the characteristics of surgical and chemotherapy patients, patients with pN factors of CRC (p = 0.013), smaller size (p < 0.001), larger number (p < 0.001), and bilateral (p < 0.001) LM received chemotherapy. Univariate analysis showed that multiple LM and rectal lesions were poor prognostic factors for OS (p = 0.012) and DFS (p = 0.017) in surgical patients, and rectal lesions were a poor prognostic factor for OS (p = 0.013) in chemotherapy patients. CONCLUSIONS Pulmonary metastasectomy showed a favorable survival in patients with LM from CRC. Despite the high recurrence rate after metastasectomy and recent advances in chemotherapy, surgical resection could still be considered as a valid option among multidisciplinary treatments. TRIAL REGISTRATION The research plan was approved by the Institutional Review Board of Shinko Hospital (No. 2142) on February 7, 2022.
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Affiliation(s)
- Yutaka Shishido
- Department of Gastrointestinal Surgery, Shinko Hospital, 1-4-47, Wakinohama-cho, Chuo-ku, Kobe, 6510072, Hyogo, Japan.
| | - Masayuki Ishii
- Department of Gastrointestinal Surgery, Shinko Hospital, 1-4-47, Wakinohama-cho, Chuo-ku, Kobe, 6510072, Hyogo, Japan
| | - Tetsuo Maeda
- Department of Gastrointestinal Surgery, Shinko Hospital, 1-4-47, Wakinohama-cho, Chuo-ku, Kobe, 6510072, Hyogo, Japan
| | - Yujiro Kokado
- Department of Gastrointestinal Surgery, Shinko Hospital, 1-4-47, Wakinohama-cho, Chuo-ku, Kobe, 6510072, Hyogo, Japan
| | - Daiki Masuya
- Department of Thoracic Surgery, Shinko Hospital, 1-4-47, Wakinohama-cho, Chuo-ku, Kobe, 6510072, Hyogo, Japan
| | - Toshiyuki Kusama
- Department of Medical Oncology, Shinko Hospital, 1-4-47, Wakinohama-cho, Chuo-ku, Kobe, 6510072, Hyogo, Japan
| | - Koji Fujimoto
- Department of Gastrointestinal Surgery, Shinko Hospital, 1-4-47, Wakinohama-cho, Chuo-ku, Kobe, 6510072, Hyogo, Japan
| | - Hiroshi Higashiyama
- Department of Gastrointestinal Surgery, Shinko Hospital, 1-4-47, Wakinohama-cho, Chuo-ku, Kobe, 6510072, Hyogo, 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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Liu YW, Chou A, Chou SH. Experience of Simultaneous Bilateral Open Surgery and VATS for Pulmonary Metastasectomy. Thorac Cardiovasc Surg 2023; 71:121-129. [PMID: 35279816 DOI: 10.1055/s-0042-1744476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Resection is the current treatment of choice for resectable bilateral pulmonary metastases. This study aimed to compare the differences in outcomes between simultaneous bilateral open and video-assisted thoracic surgery (VATS) for pulmonary metastasectomy. METHODS Forty-three patients underwent pulmonary metastasectomy through one-stage bilateral open thoracotomy (n = 16) and VATS (n = 27) between 2011 and 2020. Perioperative and oncological data were analyzed. RESULTS The predominant primary tumor histology in both groups was colorectal cancer. The operative time, blood loss, and pain score on postoperative day 1 (POD1) were higher in the open group (p < 0.001, 0.009, and 0.03, respectively). No significant differences in pain score on POD2 and POD3, postoperative length of stay, or complications were found. Notably, numbers of the resected metastatic lung nodules were significantly greater in the open group (median number: 9.5 vs. 3, p < 0.001). Recurrence-free survival (RFS) and overall survival (OS) were comparable. The median RFS was 15 months (interquartile range [IQR], 6-22) in the open group and 18 months (IQR, 8-47) in the VATS group. The median OS was 28 months (IQR, 14-44) and 29 months (IQR, 15-54) in the open group and VATS group, respectively. CONCLUSION One-stage bilateral pulmonary metastasectomy is safe and reduces medical expenditures in selected patients regardless of surgical approach. Although the open group harbored a greater number of metastatic foci, perioperative and oncological outcomes were similar to that of the VATS group.
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Affiliation(s)
- Yu-Wei Liu
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Andre Chou
- Poznañ University of Medical Sciences, Poznañ, Poland
| | - Shah-Hwa Chou
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Lefevre E, Bouilhol E, Chauvière A, Souleyreau W, Derieppe MA, Trotier AJ, Miraux S, Bikfalvi A, Ribot EJ, Nikolski M. Deep learning model for automatic segmentation of lungs and pulmonary metastasis in small animal MR images. FRONTIERS IN BIOINFORMATICS 2022; 2:999700. [PMID: 36304332 PMCID: PMC9580845 DOI: 10.3389/fbinf.2022.999700] [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: 07/21/2022] [Accepted: 09/26/2022] [Indexed: 12/03/2022] Open
Abstract
Lungs are the most frequent site of metastases growth. The amount and size of pulmonary metastases acquired from MRI imaging data are the important criteria to assess the efficacy of new drugs in preclinical models. While efficient solutions both for MR imaging and the downstream automatic segmentation have been proposed for human patients, both MRI lung imaging and segmentation in preclinical animal models remains challenging due to the physiological motion (respiratory and cardiac movements), to the low amount of protons in this organ and to the particular challenge of precise segmentation of metastases. As a consequence post-mortem analysis is currently required to obtain information on metastatic volume. In this work, we have developed a complete methodological pipeline for automated analysis of lungs and metastases in mice, consisting of an MR sequence for image acquisition and a deep learning method for automatic segmentation of both lungs and metastases. On one hand, we optimized an MR sequence for mouse lung imaging with high contrast for high detection sensitivity. On the other hand we developed DeepMeta, a multiclass U-Net 3+ deep learning model to automatically segment the images. To assess if the proposed deep learning pipeline is able to provide an accurate segmentation of both lungs and pulmonary metastases, we have longitudinally imaged mice with fast- and slow-growing metastasis. Fifty-five balb/c mice were injected with two different derivatives of renal carcinoma cells. Mice were imaged with a SG-bSSFP (self-gated balanced steady state free precession) sequence at different time points after the injection of cancer cells. Both lung and metastases segmentations were manually performed by experts. DeepMeta was trained to perform lung and metastases segmentation based on the resulting ground truth annotations. Volumes of lungs and of pulmonary metastases as well as the number of metastases per mouse were measured on a separate test dataset of MR images. Thanks to the SG method, the 3D bSSFP images of lungs were artifact-free, enabling the downstream detection and serial follow-up of metastases. Moreover, both lungs and metastases segmentation was accurately performed by DeepMeta as soon as they reached the volume of ∼ 0.02 m m 3 . Thus we were able to distinguish two groups of mice in terms of number and volume of pulmonary metastases as well as in terms of the slow versus fast patterns of growth of metastases. We have shown that our methodology combining SG-bSSFP with deep learning, enables processing of the whole animal lungs and is thus a viable alternative to histology alone.
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Affiliation(s)
- Edgar Lefevre
- Bordeaux Bioinformatics Center, University of Bordeaux, Bordeaux, France,*Correspondence: Edgar Lefevre, ; Macha Nikolski,
| | - Emmanuel Bouilhol
- Bordeaux Bioinformatics Center, University of Bordeaux, Bordeaux, France,IBGC, CNRS, University of Bordeaux, Bordeaux, France
| | - Antoine Chauvière
- Bordeaux Bioinformatics Center, University of Bordeaux, Bordeaux, France
| | | | | | - Aurélien J. Trotier
- Centre de Résonance Magnétique des Systèmes Biologiques, CNRS, University of Bordeaux, Bordeaux, France
| | - Sylvain Miraux
- Centre de Résonance Magnétique des Systèmes Biologiques, CNRS, University of Bordeaux, Bordeaux, France
| | | | - Emeline J. Ribot
- Centre de Résonance Magnétique des Systèmes Biologiques, CNRS, University of Bordeaux, Bordeaux, France
| | - Macha Nikolski
- Bordeaux Bioinformatics Center, University of Bordeaux, Bordeaux, France,IBGC, CNRS, University of Bordeaux, Bordeaux, France,*Correspondence: Edgar Lefevre, ; Macha Nikolski,
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9
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ÇINAR A, ALAGÖZ E, AYAN A, UÇGUN A. Kolorektal kanseri olan hastaların ameliyat sonrası klinik yönetiminde fluorine-18 fluorodeoxyglucose pozitron emisyon tomografisi/bilgisayarlı tomografi’nin tanısal önemi. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2022. [DOI: 10.17944/mkutfd.969726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Amaç: Kolorektal kanser, erken tespitinde cerrahi kür sağlanabilen yaygın bir kanser türüdür. Bu kanser tipinde tedaviye yanıtın erken belirlenmesi yaşam süresini olumlu etkilemektedir. Çalışmamızda kolorektal kanseri olan hastaların, ameliyat sonrasındaki klinik yönetimlerinde F-18 FDG PET/BT’nin tanısal önemini değerlendirmeyi amaçladık.
Gereç ve Yöntem: Haziran 2016 ve Ocak 2020 tarihleri arasında 168 hasta kolorektal kanser yönetimi amacıyla bölümümüze yönlendirilmiştir. Bu hastaların hepsi primer kolon tümörleri için ameliyat edilmişlerdi. Sistemik tedavi öncesinde ve sonrasında tedavi yanıtının değerlendirilmesi amacıyla bazal ve ardışık F-18 FDG PET/BT incelemesi yapılmıştır. F-18 FDG PET/BT taramaları sırasıyla analiz edilmiştir.
Bulgular: Hastalar primer tümör lokalizasyonlarına göre gruplandırıldı. Toplam 168 hastanın 55’inde sağ kolonda, 33’ünde sol kolonda, 14’ünde transvers kolonda, 61’inde rektosigmoid kolonda ve 5’inde çekumda primer tümör saptandı. Lokal rekürrens 57 hastada saptanmış olup 33’ü erkek (%57.9) ve 24’ü (%42.1) kadındı. Lokal rekürrense ait ortalama SUVmaks 8.97±3.42 g/ml olarak saptandı. Ek olarak çıkan kolon grubunda 2 hastada (%1.20) yeni tümöral odak gözlendi.
Sonuç: Kolorektal kanserli hastalarda, yapılabiliyorsa kolon rezeksiyonu tedavide ilk aşamadır. Küratif cerrahi sonrası ilk iki yıl içinde, hastaların yaklaşık %40’ında rekürrens görülebilmektedir. Rekürrensin erken tespiti, hastaların yaşam süresini iyileştirmektedir.
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Affiliation(s)
- Alev ÇINAR
- UNIVERSITY OF HEALTH SCIENCES, ANKARA GÜLHANE HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NUCLEAR MEDICINE
| | - Engin ALAGÖZ
- UNIVERSITY OF HEALTH SCIENCES, ANKARA GÜLHANE HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NUCLEAR MEDICINE
| | - Aslı AYAN
- UNIVERSITY OF HEALTH SCIENCES, ANKARA GÜLHANE HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NUCLEAR MEDICINE
| | - Aybüke UÇGUN
- University of Health Sciences, Gulhane Training & Research Hospital
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10
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Matsuguma H, Mun M, Sano A, Yoshino I, Hashimoto H, Shintani Y, Iida T, Shiono S, Chida M, Kuroda H, Nakayama M, Shiraishi Y, Funai K, Kawamura M. Time to Incurable Recurrence for Patients Treated With Pulmonary Metastasectomy for Colorectal Cancer. Ann Surg Oncol 2022; 29:6909-6917. [PMID: 35717520 DOI: 10.1245/s10434-022-11904-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 03/12/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Probability of cure is important for patients with lung metastasis who must decide whether to undergo metastasectomy. Although progression-free survival (PFS) is thought to reflect this, it does not include curative effects by repeat metastasectomy. Thus, the authors developed a new indicator, time to incurable recurrence (TTIR), in which only incurable recurrence was set as an event that included death, with incurable recurrence defined as recurrence not treated by definitive local therapy (DLT), recurrence treated by DLT but with PFS maintained less than 2 years, or recurrence followed by re-recurrence. METHODS This multi-institutional study included 339 patients who underwent lung metastasectomy for colorectal cancer between 1990 and 2008. RESULTS Among the 339 patients, 191 experienced recurrence, 77 received DLT for recurrence, 38 had a PFS of 2 years or longer after the treatment, and 33 had maintained a PFS at the last follow-up date. The patients had PFS ranging from 39 to 212 months (median, 101 months). The 5-year OS, PFS, and TTIR rates were respectively 63.4%, 42.2%, and 51.9%. The TTIR curve was similar to the OS curve 7 years after the initial metastasectomy. The difference between TTIR and PFS at 7 years was 9.7%, indicating probability of cure by repeat DLT. Multivariable analysis showed different prognostic factors among OS, PFS, and TTIR. CONCLUSION At the initial metastasectomy, TTIR may reflect probability of a cure, including cure by repeat DLT, and can be used to analyze prognostic factors associated with cure.
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Affiliation(s)
| | - Mingyon Mun
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Atsushi Sano
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hiroshi Hashimoto
- Department of Thoracic Surgery, National Defense Medical College, Saitama, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomohiko Iida
- Department of Thoracic Surgery, Kimitsu Central Hospital, Chiba, Japan
| | - Satoshi Shiono
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Aichi, Japan
| | - Mitsuo Nakayama
- Department of General Thoracic Surgery, Saitama Medical Center, Saitama, Japan
| | - Yuji Shiraishi
- Section of Chest Surgery, Fukujuji Hospital, Tokyo, Japan
| | - Kazuhito Funai
- First Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Masafumi Kawamura
- Division of General Thoracic Surgery, Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
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11
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Chiappetta M, Salvatore L, Congedo MT, Bensi M, De Luca V, Petracca Ciavarella L, Camarda F, Evangelista J, Valentini V, Tortora G, Margaritora S, Lococo F. Management of single pulmonary metastases from colorectal cancer: State of the art. World J Gastrointest Oncol 2022; 14:820-832. [PMID: 35582100 PMCID: PMC9048528 DOI: 10.4251/wjgo.v14.i4.820] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/26/2021] [Accepted: 03/04/2022] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most common causes of death from cancer. Lung seeding occurs in approximately 10% of patients surgically treated for primary CRC with radical intent: the lung is the most common site of metastases after the liver. While surgical treatment of liver metastases is widely accepted to affect long-term outcomes, more controversial and not standardized is the therapy for CRC patients developing lung metastases. Experience suggests the potential curative role of pulmonary metastasectomy, especially in oligometastatic disease. However, the optimal strategy of care and the definition of prognostic factors after treatment still need to be defined. This review focused on the uncommon scenario of single pulmonary metastases from CRC. We explored pertinent literature and provide an overview of the epidemiology, clinical characteristics and imaging of single pulmonary metastases from CRC. Additionally, we identified the best available evidence for overall management. In particular, we analyzed the role and results of locoregional approaches (surgery, radiotherapy or ablative procedures) and their integration with systemic therapy.
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Affiliation(s)
- Marco Chiappetta
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Lisa Salvatore
- Oncologia Medica Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Maria Teresa Congedo
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Maria Bensi
- Oncologia Medica Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Viola De Luca
- Department of Radiation Therapy, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Leonardo Petracca Ciavarella
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Floriana Camarda
- Oncologia Medica Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Jessica Evangelista
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Vincenzo Valentini
- Department of Radiation Therapy, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Giampaolo Tortora
- Oncologia Medica Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Stefano Margaritora
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Filippo Lococo
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
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12
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Liu T, Chang W, Wang H, Lin Q, Wei Y, Tang W, Liu Y, Chen Y, Niu Z, Jiang Y, Ren L, Xu J. Anatomical Resection Improves Disease-Free Survival After Lung Metastasectomy of Colorectal Cancer. Cancer Manag Res 2022; 13:9429-9437. [PMID: 35002321 PMCID: PMC8722571 DOI: 10.2147/cmar.s341543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/10/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose This study aimed to evaluate the role of anatomical resection (AR) in lung metastasectomy (LM) of colorectal cancer (CRC) and to investigate clinically relevant prognostic factors. Patients and Methods The medical records of 350 consecutive patients who underwent LM of CRC from 2011 to 2019 were reviewed. The patients were designated into AR group (lobectomy and segmentectomy), and non-anatomical resection (NAR) group (wedge resection), respectively. Kaplan–Meier method was used to analyze disease-free survival (DFS), pulmonary-specific disease-free survival (PDFS) and overall survival (OS). Cox proportional hazards regression model was performed to analyze the factors associated with DFS, PDFS and OS. Results A total of 92 (31.2%) patients were enrolled in AR group and 203 (68.8%) in non-anatomical resection (NAR) group. AR significantly improved the 3-year DFS (64.1% vs 46.8%, HR 0.587, 95% CI 0.397–0.867, P = 0.007) and PDFS (75.0% vs 60.1%, HR 0.565, 95% CI 0.356–0.899, P = 0.016) compared with NAR. However, the extent of resection did not significantly impact the 3-year OS (AR 92.4% vs NAR 85.7%, HR 0.511, 95% CI 0.224–1.165, P = 0.110). In multivariate analysis, AR was identified as a protective factor for DFS (HR 0.576, 95% CI 0.356–0.934, P = 0.025) and PDFS (HR 0.631, 95% CI 0.409–0.973, P = 0.037). Preoperative abnormal CA19-9 was identified as the only prognostic factor for OS. Conclusion AR was superior to NAR for DFS and PDFS after LM from CRC.
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Affiliation(s)
- Tianyu Liu
- Colorectal Cancer Center, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Wenju Chang
- Colorectal Cancer Center, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Technology, Shanghai, People's Republic of China
| | - Hao Wang
- Department of Thoracic Surgery; Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Qi Lin
- Colorectal Cancer Center, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Technology, Shanghai, People's Republic of China
| | - Ye Wei
- Colorectal Cancer Center, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Technology, Shanghai, People's Republic of China
| | - Wentao Tang
- Colorectal Cancer Center, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yu Liu
- Colorectal Cancer Center, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yijiao Chen
- Colorectal Cancer Center, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Zhengchuan Niu
- Colorectal Cancer Center, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yudong Jiang
- Colorectal Cancer Center, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Li Ren
- Colorectal Cancer Center, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Technology, Shanghai, People's Republic of China
| | - Jianmin Xu
- Colorectal Cancer Center, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Technology, Shanghai, People's Republic of China
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13
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Forster C, Ojanguren A, Perentes JY, Zellweger M, Krueger T, Abdelnour-Berchtold E, Gonzalez M. Survival prognostic and recurrence risk factors after single pulmonary metastasectomy. J Cardiothorac Surg 2021; 16:357. [PMID: 34961544 PMCID: PMC8713404 DOI: 10.1186/s13019-021-01740-3] [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: 12/22/2020] [Accepted: 12/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Identification of the prognostic factors of recurrence and survival after single pulmonary metastasectomy (PM). Methods Retrospective analysis of all consecutive patients who underwent PM for a single lung metastasis between 2003 and 2018. Results A total of 162 patients with a median age of 64 years underwent single PM. Video-Assisted Thoracic Surgery (VATS) was performed in 83.9% of cases. Surgical resection was achieved by wedge in 73.5%, segmentectomy in 7.4%, lobectomy in 17.9% and pneumonectomy in 1.2% of cases. The median durations of hospital stay and of drainage were 4 days (IQR 3–7) and 1 day (IQR 1–2), respectively. During the follow-up (median 31 months; IQR 15–58), 93 patients (57.4%) presented recurrences and repeated PM could be realized in 35 patients (21.6%) achieved by VATS in 77.1%. Non-colorectal tumour (HR 1.84), age < 70 years (HR 1.77) and previous extra-thoracic metastases (HR 1.61) were identified as prognostic factors of recurrence. Overall survival at 5-year was estimated at 67%. Non-colorectal tumour (HR 2.40) and mediastinal lymph nodes involvement (HR 3.42) were significantly associated with an increased risk of death. Conclusions Despite high recurrence rates after PM, surgical resection shows low morbidity rate and acceptable long-term survival, thus should remain the standard treatment for single pulmonary metastases. Trial registration: The Local Ethics Committee approved the study (No. 2019–02,474) and individual consent was waived.
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Affiliation(s)
- Céline Forster
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Amaya Ojanguren
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Jean Yannis Perentes
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Rue du Bugnon 21, 1011, Lausanne, Switzerland
| | - Matthieu Zellweger
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Thorsten Krueger
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Rue du Bugnon 21, 1011, Lausanne, Switzerland
| | - Etienne Abdelnour-Berchtold
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland. .,Faculty of Biology and Medicine, University of Lausanne (UNIL), Rue du Bugnon 21, 1011, Lausanne, Switzerland.
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14
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Ma Y, Zhang Y, Li H, Li J, Chen H, Wang P, Xiao R, Li X, Wang S, Qiu M. Spread through air spaces is a common phenomenon of pulmonary metastasized tumours regardless of origins. Eur J Cardiothorac Surg 2021; 61:1242-1248. [PMID: 34894137 DOI: 10.1093/ejcts/ezab530] [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: 06/29/2021] [Revised: 10/24/2021] [Accepted: 11/09/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Spread through air spaces (STAS) is a unique pattern of invasion in primary lung cancers. However, little is known about STAS in pulmonary metastases (PMs). This study was to investigate the incidence of STAS among PMs and the association between STAS and clinicopathological characteristics of PMs. METHODS A total of 127 patients who underwent metastasectomy at our institution from June 2009 to December 2019 were retrospectively analysed. Survival analysis was performed in 40 patients with PM from colorectal cancer (CRC). RESULTS STAS was identified in 33.1% of patients (42 of 127) with PMs. STAS was found in PMs of various primary cancers, including CRC, breast cancer, renal cell carcinoma, cholangiocarcinoma and osteogenic and soft tissue sarcoma, but the incidence varies. PMs originating from epithelial tissue showed higher incidence of STAS than those from mesenchymal tissue (45% vs 11%, P < 0.001). Elder age (P = 0.006) and primary sites (P < 0.001) were significantly correlated with STAS. In patients with PMs from CRC, the presence of STAS was an independent predictor of shorter recurrence-free survival (hazard ratio = 10.25, P = 0.002) and poor overall survival (hazard ratio = 4.75, P = 0.047) by multivariable analysis. CONCLUSIONS STAS might be a lung-specific tumour invasion pattern and STAS is commonly observed in PMs of different origins. The incidence of STAS was significantly higher in PMs originating from epithelial tissues than those from mesenchymal tissues. Presence of STAS was an independent predictor of poor prognosis in patients with PM from CRC.
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Affiliation(s)
- Yi Ma
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Yuanyuan Zhang
- Department of Pathology, Peking University People's Hospital, Beijing, China
| | - Haoran Li
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Jiawei Li
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Haiming Chen
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Peiyu Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Rongxin Xiao
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Xiao Li
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Shaodong Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Mantang Qiu
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
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15
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Ogawa H, Yajima T, Sohda M, Shirabe K, Saeki H. Role of surgical resection and its alternative local therapy for pulmonary metastasis of colorectal cancer. Ann Gastroenterol Surg 2021; 5:747-753. [PMID: 34755006 PMCID: PMC8560592 DOI: 10.1002/ags3.12472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/20/2021] [Accepted: 05/01/2021] [Indexed: 12/23/2022] Open
Abstract
We reviewed surgical and alternative treatments for pulmonary metastasis of colorectal cancer, focusing on recent reports. The standard treatment for pulmonary metastasis of colorectal cancer is pulmonary resection, if resectable, despite the fact that the metastasis is hematogenous to distant organs. Guidelines in several countries, including Japan, have described pulmonary resection as a useful option because of the favorable long-term prognosis reported in various studies pertaining to pulmonary resection. The indications for pulmonary resection have been reviewed in several studies; additionally, the number of metastases, pretreatment carcinoembryonic antigen value, and disease-free interval from the primary resection to pulmonary recurrence have been proposed. However, no consensus has been reached to date. Contrastingly, recent advances in chemotherapy have remarkably improved the outcome of distant metastases, indicating that it is time to reconsider the significance of local treatment, including pulmonary resection. In addition to surgical resection, minimally invasive therapies, such as stereotactic body radiation therapy and radiofrequency ablation have been developed as local treatments for pulmonary metastases, and their long-term results have been reported. Prospective controlled trials and large-scale data analyses are needed to determine the best local treatment for pulmonary metastases and to find the appropriate indication for each treatment.
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Affiliation(s)
- Hiroomi Ogawa
- Department of General Surgical ScienceGraduate School of MedicineGunma UniversityMaebashiJapan
| | - Toshiki Yajima
- Department of General Surgical ScienceGraduate School of MedicineGunma UniversityMaebashiJapan
- Department of Innovative Cancer ImmunotherapyGraduate School of MedicineGunma UniversityMaebashiJapan
| | - Makoto Sohda
- Department of General Surgical ScienceGraduate School of MedicineGunma UniversityMaebashiJapan
| | - Ken Shirabe
- Department of General Surgical ScienceGraduate School of MedicineGunma UniversityMaebashiJapan
| | - Hiroshi Saeki
- Department of General Surgical ScienceGraduate School of MedicineGunma UniversityMaebashiJapan
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16
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Alabraba E, Gomez D. Systematic Review of Treatments for Colorectal Metastases in Elderly Patients to Guide Surveillance Cessation Following Hepatic Resection for Colorectal Liver Metastases. Am J Clin Oncol 2021; 44:210-223. [PMID: 33710135 DOI: 10.1097/coc.0000000000000803] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although included in surveillance programmes for colorectal cancer (CRC) metastases, elderly patients are susceptible to declines in health and quality of life that may render them unsuitable for further surveillance. Deciding when to cease surveillance is challenging. METHODS There are no publications focused on surveillance of elderly patients for CRC metastases. A systematic review of studies reporting treatment outcomes for CRC metastases in elderly patients was performed to assess the risk-benefit balance of the key objectives of surveillance; detecting and treating CRC metastases. RESULTS Sixty-eight eligible studies reported outcomes for surgery and chemotherapy in the elderly. Liver resections and use of chemotherapy, including biologics, are more conservative and have poorer outcomes in the elderly compared with younger patients. Selected studies demonstrated poorer quality-of-life (QoL) following surgery and chemotherapy. Studies of ablation in elderly patients are limited. DISCUSSION The survival benefit of treating CRC metastases with surgery or chemotherapy decreases with advancing age and QoL may decline in the elderly. The relatively lower efficacy and detrimental QoL impact of multimodal therapy options for detected CRC metastases in the elderly questions the benefit of surveillance in some elderly patients. Care of elderly patients should thus be customized based on their preference, formal geriatric assessment, natural life-expectancy, and the perceived risk-benefit balance of treating recurrent CRC metastases. Clinicians may consider surveillance cessation in patients aged 75 years and above if geriatric assessment is unsatisfactory, patients decline surveillance, or patient fitness deteriorates catastrophically.
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Affiliation(s)
- Edward Alabraba
- Department of Hepatobiliary Surgery and Pancreatic Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust
| | - Dhanny Gomez
- Department of Hepatobiliary Surgery and Pancreatic Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust
- NIHR Nottingham Digestive Disease Biomedical Research Unit, University of Nottingham, Nottingham, UK
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17
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Markowiak T, Dakkak B, Loch E, Großer C, Klinkhammer-Schalke M, Hofmann HS, Ried M. Video-assisted pulmonary metastectomy is equivalent to thoracotomy regarding resection status and survival. J Cardiothorac Surg 2021; 16:84. [PMID: 33858453 PMCID: PMC8048191 DOI: 10.1186/s13019-021-01460-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 04/05/2021] [Indexed: 12/29/2022] Open
Abstract
Background Surgical resection of pulmonary metastases leads to prolonged survival if strictly indicated. Usually, thoracotomy with manual palpation of the entire lung with lymph node dissection or sampling is performed. The aim of this study was to evaluate the role of video-assisted thoracoscopic surgery (VATS) in pulmonary metastectomy with curative intent. Methods In this study, all patients with suspected pulmonary metastasis (n = 483) who visited the Center for Thoracic Surgery in Regensburg, between January 2009 and December 2017 were analysed retrospectively. Results A total of 251 patients underwent metastectomy with curative intent. VATS was performed in 63 (25.1%) patients, 54 (85.7%) of whom had a solitary metastasis. Wedge resection was the most performed procedure in patients treated with VATS (82.5%, n = 52) and thoracotomy (72.3%, n = 136). Postoperative revisions were necessary in nine patients (4.8%), and one patient died of pulmonary embolism after thoracotomy (0.5%). Patients were discharged significantly faster after VATS than after thoracotomy (p < 0.001). Complete (R0) resection was achieved in 89% of patients. The median recurrence-free survival was 11 months (95% confidence interval 7.9–14.1). During follow-up, eight (12.7%) patients in the VATS group and 42 (22.3%) patients in the thoracotomy group experienced recurrence (p = 0.98). The median overall survival was 61 months (95% confidence interval 46.1–75.9), and there was no significant difference with regard to the surgical method used (p = 0.34). Conclusions VATS metastasectomy can be considered in patients with a solitary lung metastasis. An open surgical approach with palpation of the lung showed no advantage in terms of surgical outcome or survival.
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Affiliation(s)
- Till Markowiak
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Beshir Dakkak
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Elena Loch
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Christian Großer
- Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Tumor Center, University Institute of Quality Assurance and Health Services Research, Regensburg, Germany
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.,Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Michael Ried
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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18
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Abstract
Lymph node (LN) removal during pulmonary metastasectomy is a prerequisite to achieve complete resection or at least collect prognostic information, but is not yet generally accepted. On average, the rate of unexpected lymph node involvement (LNI) is less than 10% in sarcoma, 20% in colorectal cancer (CRC) and 30% in renal cell carcinoma (RCC) when radical LN dissection is performed. LNI is a negative prognostic factor and presence of preoperative mediastinal disease usually leads to exclusion of the patient from metastasis surgery. Nonetheless, some authors found excellent prognoses even with mediastinal LNI in colorectal and RCC metastases when radical LN dissection was performed (median survival of 37 and 36 months, respectively). Multiple metastases, central location of the lesion followed by anatomical resections are associated with a higher LNI rate. The real prognostic influence of systematic LN dissection remains unclear. Two positive effects were described after radical lymphadenectomy: a trend for improved survival in RCC patients and a reduction of mediastinal recurrences from 23% to 0% in CRC patients. Unfortunately, there is a great number of studies that do not demonstrate any positive effect of lymphadenectomy during pulmonary metastasectomy except a pseudo stage migration effect. Future studies should not only focus on survival, but also on local and LN recurrence.
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Affiliation(s)
- Stefan Welter
- Department of Thoracic Surgery, Lung Clinic Hemer, Theo-Funccius-Str. 1, 58675 Hemer, Germany
| | - Varun Gupta
- Department of Thoracic Surgery, Lung Clinic Hemer, Theo-Funccius-Str. 1, 58675 Hemer, Germany
| | - Ioannis Kyritsis
- Department of Thoracic Surgery, Lung Clinic Hemer, Theo-Funccius-Str. 1, 58675 Hemer, Germany
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19
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Huang J, Zang Q, Wen Y, Pan Z, Yao Z, Huang M, Huang J, Chen J, Wang R. Prognostic value of KRAS mutation in patients undergoing pulmonary metastasectomy for colorectal cancer: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2021; 160:103308. [PMID: 33753248 DOI: 10.1016/j.critrevonc.2021.103308] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/26/2021] [Accepted: 03/03/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The purpose of the study was to evaluate whether KRAS mutation could be an independent prognostic biomarker in patients undergoing pulmonary metastasectomy (PM) for colorectal cancer (CRC). METHODS A systemic review was performed by searching online databases to identify studies reporting overall survival (OS) and recurrence free survival (RFS) of CRC patients undergoing PM. Pooled HRs were calculated for OS and RFS. RESULTS A total of 15233 patients from 60 studies were included. Pooled analysis showed that KRAS mutation was associated with worse OS (HR: 1.86, 95 % Cl: 1.35-2.57) and RFS (HR: 1.68, 95 % Cl: 1.38-2.04). A significant effect on OS and/or RFS was also shown by other 18 factors. CONCLUSIONS This meta-analysis found that KRAS mutation is an important prognostic predictor for OS and RFS in CRC patients undergoing PM, supporting a comprehensive model including clinicopathological and biological factors for optimal patients selection and prognosis for surgical treatment.
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Affiliation(s)
- Junfeng Huang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China; Nanshan School of Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Qing Zang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China; Nanshan School of Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yaokai Wen
- Nanshan School of Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhe Pan
- Nanshan School of Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhiyuan Yao
- Nanshan School of Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Mingkai Huang
- Nanshan School of Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jiongqiang Huang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jingsong Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
| | - Rongchang Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
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20
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Fukada M, Matsuhashi N, Takahashi T, Tanaka Y, Okumura N, Yamamoto H, Shirahashi K, Iwata H, Doi K, Yoshida K. Prognostic factors in pulmonary metastasectomy and efficacy of repeat pulmonary metastasectomy from colorectal cancer. World J Surg Oncol 2020; 18:314. [PMID: 33256771 PMCID: PMC7708109 DOI: 10.1186/s12957-020-02076-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/05/2020] [Indexed: 12/24/2022] Open
Abstract
Background The rate of pulmonary metastasectomy from colorectal cancer (CRC) has increased with recent advances in chemotherapy, diagnostic techniques, and surgical procedures. The purpose of this study was to investigate the prognostic factors for response to pulmonary metastasectomy and the efficacy of repeat pulmonary metastasectomy. Methods This study was a retrospective, single-institution study of 126 CRC patients who underwent pulmonary metastasectomy between 2000 and 2019 at the Gifu University Hospital. Results The 3- and 5-year survival rates were 84.9% and 60.8%, respectively. Among the 126 patients, 26 (20.6%) underwent a second pulmonary metastasectomy for pulmonary recurrence after initial pulmonary metastasectomy. Univariate analysis of survival identified seven significant factors: (1) gender (p = 0.04), (2) past history of extra-thoracic metastasis (p = 0.04), (3) maximum tumor size (p = 0.002), (4) mediastinal lymph node metastasis (p = 0.02), (5) preoperative carcinoembryonic antigen (CEA) level (p = 0.01), (6) preoperative carbohydrate antigen 19-9 (CA19-9) level (p = 0.03), and (7) repeat pulmonary metastasectomy for pulmonary recurrence (p < 0.001). On multivariate analysis, only mediastinal lymph node metastasis (p = 0.02, risk ratio 8.206, 95% confidence interval (CI) 1.566–34.962) and repeat pulmonary metastasectomy for pulmonary recurrence (p < 0.001, risk ratio 0.054, 95% CI 0.010–0.202) were significant. Furthermore, in the evaluation of surgical outcomes, the safety of second pulmonary metastasectomy was almost the same as that of initial pulmonary metastasectomy. Conclusions Repeat pulmonary metastasectomy is likely to be safe and effective for recurrent cases that meet the surgical criteria. However, mediastinal lymph node metastasis was a significant independent prognostic factor for worse overall survival.
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Affiliation(s)
- Masahiro Fukada
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Nobuhisa Matsuhashi
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Takao Takahashi
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Yoshihiro Tanaka
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Naoki Okumura
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Hirotaka Yamamoto
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Koyo Shirahashi
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Hisashi Iwata
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Kiyoshi Doi
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan.
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21
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Lung metastasectomy after colorectal cancer: prognostic impact of resection margin on long term survival, a retrospective cohort study. Int J Colorectal Dis 2020; 35:9-18. [PMID: 31686201 DOI: 10.1007/s00384-019-03386-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pulmonary metastasectomy is considered a potentially curative treatment for selected patients with metastatic colorectal cancer (CRC). Several prognostic factors have been analysed, but to date, it is still not well defined which is the optimal resection margin during lung metastasectomy (LM). This study analyses the long-term results and prognostic factors after LM in CRC patients with particular attention to the resection margins. Primary endpoint of this study is to assess the correlation between resection margins and long-term outcomes. METHODS Observational cohort study on all proven cases of CRC lung metastases (2000-2016) resected with curative intent in a single centre. RESULTS The series included 210 consecutive patients (M/F 133/77) with a mean age of 65.4 (± 9.96) years, 75% (159/210) of them with a solitary metastasis. Mean size of metastasis was 2.57 cm (± 1.45). One hundred sixty-eight patients underwent wedge resections (80%) and lymphadenectomy was carried out in 90 cases (42.9%). With a mean follow-up of 56 months (range 5-192), we observed a 1-, 3- and 5-year overall survival (OS) of 95%, 74% and 54%, respectively. The patients were divided into three groups according to the resection margin distance from the tumour: (a) ≥ 2 cm (145 cases); (b) < 2, ≥ 1 cm (37 cases); and (c) < 1 cm (12 cases). The OS was significantly different between the three groups (p = 0,020); univariate and multivariate analyses showed that a narrow resection margin was an independent prognostic factor of worse survival (p = 0.006 and HR 3.4 p = 0.009). CONCLUSIONS Long-term survival of patients after LM is strongly associated with a greater distance between the lesion and the resection margin.
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22
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Zhang C, Tan Y, Xu H. Does adjuvant chemotherapy improve the prognosis of patients after resection of pulmonary metastasis from colorectal cancer? A systematic review and meta-analysis. Int J Colorectal Dis 2019; 34:1661-1671. [PMID: 31446479 DOI: 10.1007/s00384-019-03362-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND It remains controversial whether patients benefit from adjuvant chemotherapy (ACT) after resection of pulmonary metastasis (PM) from colorectal cancer (CRC). This meta-analysis was intended to evaluate the efficacy of ACT in patients after resection of PM from CRC. METHODS We systematically retrieved articles from PMC, PubMed, Cochrane Library, and Embase (up to March 5, 2019). Survival data, including overall survival (OS) and disease-free survival (DFS), were tested by hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS We included 18 cohort studies with a total of 3885 patients. The meta-analysis showed that ACT had no significant effect on OS (HR = 0.78; 95% CI = 0.60-1.03; P = 0.077) and DFS (HR = 0.91; 95% CI = 0.74-1.11; P = 0.339) in patients after resection of PM from CRC. There was no significant difference in OS (HR = 0.79; 95% CI = 0.42-1.50; P = 0.474) in patients after resection of PM from CRC treated with bevacizumab (BV). Subgroup analysis showed that ACT did not improve OS (HR = 0.86; 95% CI = 0.57-1.29; P = 0.461) in patients who had undergone previous resection of extra PM. ACT did not improve OS in patients who had positive hilar/mediastinal lymph node metastasis (HR = 0.80; 95% CI = 0.57-1.14; P = 0.22). CONCLUSION In conclusion, ACT does not provide survival benefits for patients after resection of PM from CRC. ACT and targeted agents (BV) are not suggested for these patients.
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Affiliation(s)
- Chao Zhang
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China.,Key Laboratory of Gastric Cancer Molecular Pathology of Liaoning Province, 155 Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Yuen Tan
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China.,Key Laboratory of Gastric Cancer Molecular Pathology of Liaoning Province, 155 Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Huimian Xu
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China. .,Key Laboratory of Gastric Cancer Molecular Pathology of Liaoning Province, 155 Nanjing North Street, Heping District, Shenyang, 110001, China.
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23
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Rapicetta C, Lococo F, Davini F, Carleo F, Kauppi J, Di Stefano TS, Ricciardi S, Di Martino M, Räsänen J, Paci M, Melfi F, Cardillo G. Is Adjuvant Chemotherapy Worthwhile After Radical Resection for Single Lung Metastasis From Colorectal Cancer? A Multicentric Analysis Evaluating the Risk of Recurrence. Front Oncol 2019; 9:763. [PMID: 31482063 PMCID: PMC6710451 DOI: 10.3389/fonc.2019.00763] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/29/2019] [Indexed: 12/24/2022] Open
Abstract
Background: Adjuvant chemotherapy after resection of colorectal cancer (CRC) lung metastases may reduce recurrences and improve survival. The choice of best candidates for adjuvant chemotherapy in this setting is controversial, especially when a single lung metastases (SLM) is resected. The aim of this study is to evaluate the risk of recurrence after radical resection for single lung metastasis from CRC. Patients and methods: Demographic, clinical, and pathological data were retrospectively collected for patients radically operated on for single pulmonary metastasis from CRC in 4 centers. Survival was computed by Kaplan-Meyer methods. Chi-square, log-rank test, and for multivariate analysis, Cox-regression and binary logistic regression were used when indicated. Results: The sample consisted of 344 patients, mean age 65 yrs. Overall 5 yrs survival was 61.9%. Recurrence occurred in 113 pts (32.8%). At univariate analysis, age > 70 (p = 0.046) and tumor size > 2 cm (p = 0.038) were predictive of the worst survival chance, while synchronous lung metastasis (p = 0.039), previous resection of extrathoracic metastasis (p = 0.017), uptake at FDG-PET scan (p = 0.006) and short (<12 months) disease-free interval (DFI) prior to lung metastasectomy (p = 0.048) were risk factors for recurrence. At multivariate analysis, only high CEA (>4 ng/mL) was associated with worst survival (HR: 4.3, p = 0.014), while prior abdominal surgery (HR: 3, p = 0.033), PET positivity (HR: 2.7, p = 0.041), and DFI > 12 months (HR: 0.14, p < 0.001) confirmed to predict recurrence of disease. Conclusions: Surgical resection of solitary lung metastases from CRC is associated with prolonged survival. High value of CEA, PET positivity, previous extrathoracic resected metastasis, and short (<12 months) DFI were found to be predictive of death or disease recurrence and might identify in this scenario patients at higher risk which could potential benefit of chemotherapy.
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Affiliation(s)
- Cristian Rapicetta
- Thoracic Surgery Unit, Azienda USL di Reggio Emilia - IRCCS, Reggio Emilia, Italy
| | - Filippo Lococo
- Thoracic Surgery Unit, Azienda USL di Reggio Emilia - IRCCS, Reggio Emilia, Italy
| | - Federico Davini
- Unit of Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispeciality Center for Surgery, University Hospital of Pisa, Pisa, Italy
| | - Francesco Carleo
- Unit of Thoracic Surgery, San Camillo Forlanini Hospital, Rome, Italy
| | - Juha Kauppi
- Unit of Thoracic Surgery, Helsinki University Central Hospital, Heart and Lung Center, Helsinki, Finland
| | | | - Sara Ricciardi
- Unit of Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispeciality Center for Surgery, University Hospital of Pisa, Pisa, Italy
| | - Marco Di Martino
- Unit of Thoracic Surgery, San Camillo Forlanini Hospital, Rome, Italy
| | - Jari Räsänen
- Unit of Thoracic Surgery, Helsinki University Central Hospital, Heart and Lung Center, Helsinki, Finland
| | - Massimiliano Paci
- Thoracic Surgery Unit, Azienda USL di Reggio Emilia - IRCCS, Reggio Emilia, Italy
| | - Franca Melfi
- Unit of Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispeciality Center for Surgery, University Hospital of Pisa, Pisa, Italy
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, San Camillo Forlanini Hospital, Rome, Italy
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24
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Chung JH, Lee SH, Yi E, Lim JY, Jung JS, Son HS, Sun K. Impact of resection margin length and tumor depth on the local recurrence after thoracoscopic pulmonary wedge resection of a single colorectal metastasis. J Thorac Dis 2019; 11:1879-1887. [PMID: 31285880 DOI: 10.21037/jtd.2019.05.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background To evaluate the influence of tumor depth on preoperative computed tomography (CT) image, and resection margin length on local recurrence after pulmonary metastasectomy of colorectal cancer. Methods Patients undergoing thoracoscopic pulmonary wedge resection for single pulmonary metastasis of colorectal cancer origin from 2007 to 2017 were analyzed. Factors such as resection margin, tumor size and depth were analyzed. The local recurrences of two subgroups based on the pulmonary resection margin (Group 1: resection margin 1-10 mm or shorter than the tumor size, Group 2: resection margin >10 mm or at least greater than the tumor size) were analyzed. Results Sixty-five patients were included in this study. The local recurrence rate was 12/65 (18.5%). Median follow up period was 33 months. Median tumor size and depth on preoperative CT were 1.1 and 1.6 cm. Median length of resection margin was 0.5 cm (group 1: 0.4 cm, group 2: 1.0 cm, P<0.001). No difference was noted in 3-year local recurrence-free survival (80.8% vs. 76.7%, P=0.756) between the two subgroups. No significant correlation was noted between the length of resection margin and the tumor size and depth. However, tumor depth was an independent factor related to higher local recurrence on multivariate analysis. Conclusions Extent of resection margin in pulmonary metastasectomy does not seem to affect significantly on the local recurrence if complete resection is accomplished. However, preoperative tumor depth on CT image and postoperative distant metastasis seem to affect on local recurrence after pulmonary metastasectomy.
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Affiliation(s)
- Jae Ho Chung
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Anam Hospital, Seoul, South Korea
| | - Sung Ho Lee
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Anam Hospital, Seoul, South Korea
| | - Eunjue Yi
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Anam Hospital, Seoul, South Korea
| | - Ju Yong Lim
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Anam Hospital, Seoul, South Korea
| | - Jae Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Anam Hospital, Seoul, South Korea
| | - Ho Sung Son
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Anam Hospital, Seoul, South Korea
| | - Kyung Sun
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Anam Hospital, Seoul, South Korea
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25
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Nozawa H, Takiyama H, Hasegawa K, Kawai K, Hata K, Tanaka T, Nishikawa T, Sasaki K, Kaneko M, Murono K, Emoto S, Sonoda H, Nakajima J. Adjuvant chemotherapy improves prognosis of resectable stage IV colorectal cancer: a comparative study using inverse probability of treatment weighting. Ther Adv Med Oncol 2019; 11:1758835919838960. [PMID: 31019569 PMCID: PMC6469283 DOI: 10.1177/1758835919838960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 02/11/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Adjuvant chemotherapy (AC) is known to be beneficial for stage III colorectal cancer (CRC). In contrast, only a few studies have reported the survival benefits of AC for stage IV CRC after curative surgery. METHODS We identified 155 CRC patients with various organ metastases who underwent curative surgery in our hospital between 2003 and 2017. Clinicopathological parameters and postoperative AC were reviewed. Multivariate analyses were performed to identify prognostic factors. Moreover, the effects of AC on recurrence-free survival (RFS) and overall survival (OS) were analyzed using inverse probability of treatment weighting. RESULTS The cohort comprised 94 males and 61 females, with a mean age of 63 years. AC was administered to 57% of patients who underwent surgery between 2003 and 2010 and 76% between 2011 and 2017 (p = 0.015). AC was more likely administered to patients with a good performance status, high preoperative albumin level, regional node and peritoneal metastases, and no intraoperative blood transfusion. Multivariate analyses identified AC as a significant prognostic factors for RFS and OS [hazard ratio (HR): 1.86, p = 0.003, and 2.66, p = 0.002, respectively]. After adjusting for different backgrounds, 5-year RFS and OS rates were higher in patients receiving AC (27% and 67%) than in those without AC (14% and 46%, p < 0.0001 and p = 0.0005). Subgroup analyses showed that AC significantly improved RFS in node-negative patients (HR: 2.16, p = 0.029), and RFS and OS in node-positive patients (HR: 2.03, p < 0.0001, and 2.02, p = 0.001, respectively). CONCLUSION AC can be discussed with resectable stage IV CRC patients because of its significant survival-improving effects.
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Affiliation(s)
- Hiroaki Nozawa
- Department of Surgical Oncology, The University
of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | | | - Kiyoshi Hasegawa
- Department of Hepatobiliary and Pancreatic
Surgery, The University of Tokyo, Tokyo, Japan
| | - Kazushige Kawai
- Department of Surgical Oncology, The University
of Tokyo, Tokyo, Japan
| | - Keisuke Hata
- Department of Surgical Oncology, The University
of Tokyo, Tokyo, Japan
| | - Toshiaki Tanaka
- Department of Surgical Oncology, The University
of Tokyo, Tokyo, Japan
| | - Takeshi Nishikawa
- Department of Surgical Oncology, The University
of Tokyo, Tokyo, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, The University
of Tokyo, Tokyo, Japan
| | - Manabu Kaneko
- Department of Surgical Oncology, The University
of Tokyo, Tokyo, Japan
| | - Koji Murono
- Department of Surgical Oncology, The University
of Tokyo, Tokyo, Japan
| | - Shigenobu Emoto
- Department of Surgical Oncology, The University
of Tokyo, Tokyo, Japan
| | - Hirofumi Sonoda
- Department of Surgical Oncology, The University
of Tokyo, Tokyo, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, The University
of Tokyo, Tokyo, Japan
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26
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Cheung FPY, Alam NZ, Wright GM. The Past, Present and Future of Pulmonary Metastasectomy: A Review Article. Ann Thorac Cardiovasc Surg 2019; 25:129-141. [PMID: 30971647 PMCID: PMC6587129 DOI: 10.5761/atcs.ra.18-00229] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pulmonary metastases are a sign of advanced malignancy and an omen of poor prognosis. Once primary tumors metastasize, they become notoriously difficult to treat and interdisciplinary management often involves a combination of chemotherapy, radiotherapy, and surgery. Over the last 25 years, the emerging body of evidence has recognized the curative potential of pulmonary metastasectomy. Surgical resection of pulmonary metastases is now commonly considered for patients with controlled primary disease, absence of widely disseminated extrapulmonary disease, completely resectable lung metastases, sufficient cardiopulmonary reserve, and lack of a better alternative systemic therapy. Since the development of these selection criteria, other prognostic factors have been proposed to better predict survival and optimize the selection of surgical candidates. Disease-free interval (DFI), completeness of resection, surgical approach, number and laterality of lung metastases, and lymph node metastases all play a dynamic role in determining patient outcomes. There is a definite need to continue reviewing these prognosticators to identify patients who will benefit most from pulmonary metastasectomy and those who should avoid unnecessary loss of lung parenchyma. This literature review aims to explore and synthesize the last 25 years of evidence on the long-term survival, prognostic factors, and patient selection process for pulmonary metastasectomy.
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Affiliation(s)
| | - Naveed Zeb Alam
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Gavin Michael Wright
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia
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27
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Li J, Yuan Y, Yang F, Wang Y, Zhu X, Wang Z, Zheng S, Wan D, He J, Wang J, Ba Y, Bai C, Bai L, Bai W, Bi F, Cai K, Cai M, Cai S, Chen G, Chen K, Chen L, Chen P, Chi P, Dai G, Deng Y, Ding K, Fan Q, Fang W, Fang X, Feng F, Fu C, Fu Q, Gu Y, He Y, Jia B, Jiang K, Lai M, Lan P, Li E, Li D, Li J, Li L, Li M, Li S, Li Y, Li Y, Li Z, Liang X, Liang Z, Lin F, Lin G, Liu H, Liu J, Liu T, Liu Y, Pan H, Pan Z, Pei H, Qiu M, Qu X, Ren L, Shen Z, Sheng W, Song C, Song L, Sun J, Sun L, Sun Y, Tang Y, Tao M, Wang C, Wang H, Wang J, Wang S, Wang X, Wang X, Wang Z, Wu A, Wu N, Xia L, Xiao Y, Xing B, Xiong B, Xu J, Xu J, Xu N, Xu R, Xu Z, Yang Y, Yao H, Ye Y, Yu Y, Yu Y, Yue J, Zhang J, Zhang J, Zhang S, Zhang W, Zhang Y, Zhang Z, Zhang Z, Zhao L, Zhao R, Zhou F, Zhou J, Jin J, Gu J, Shen L. Expert consensus on multidisciplinary therapy of colorectal cancer with lung metastases (2019 edition). J Hematol Oncol 2019; 12:16. [PMID: 30764882 PMCID: PMC6376656 DOI: 10.1186/s13045-019-0702-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 01/28/2019] [Indexed: 02/08/2023] Open
Abstract
The lungs are the second most common site of metastasis for colorectal cancer (CRC) after the liver. Rectal cancer is associated with a higher incidence of lung metastases compared to colon cancer. In China, the proportion of rectal cancer cases is around 50%, much higher than that in Western countries (nearly 30%). However, there is no available consensus or guideline focusing on CRC with lung metastases. We conducted an extensive discussion and reached a consensus of management for lung metastases in CRC based on current research reports and the experts' clinical experiences and knowledge. This consensus provided detailed approaches of diagnosis and differential diagnosis and provided general guidelines for multidisciplinary therapy (MDT) of lung metastases. We also focused on recommendations of MDT management of synchronous lung metastases and initial metachronous lung metastases. This consensus might improve clinical practice of CRC with lung metastases in China and will encourage oncologists to conduct more clinical trials to obtain high-level evidences about managing lung metastases.
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Affiliation(s)
- Jian Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52, Fucheng Road, Haidian District, Beijing, 100142, China
| | - Ying Yuan
- The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88, Jiefang Road, Hangzhou, Zhejiang, China
| | - Fan Yang
- Peking University People's Hospital, No. 11, Xizhimen Nandajie, Beijing, China
| | - Yi Wang
- Peking University People's Hospital, No. 11, Xizhimen Nandajie, Beijing, China
| | - Xu Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52, Fucheng Road, Haidian District, Beijing, 100142, China
| | - Zhenghang Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52, Fucheng Road, Haidian District, Beijing, 100142, China
| | - Shu Zheng
- The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88, Jiefang Road, Hangzhou, Zhejiang, China
| | - Desen Wan
- Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Jie He
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, China
| | - Jianping Wang
- The Sixth Hospital Affiliated of Sun Yat-sen University, No. 19, Erheng Road, Yuancun, Tianhe District, Guangzhou, Guangdong, China
| | - Yi Ba
- Tianjin Medical University Cancer Institute & Hospital, Huanhu West Road, Tiyuanbei, Hexi District, Tianjin, China
| | - Chunmei Bai
- Peking Union Medical College Hospital, No. 1, Shuaifuyuan, Dongcheng District, Beijing, China
| | - Li Bai
- Chinese People's Liberation Army General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, China
| | - Wei Bai
- Shanxi Provincial Cancer Hospital, No. 3, Zhigong Xincun, Xinghualing District, Taiyuan, Shanxi, China
| | - Feng Bi
- Huaxi Hospital of Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, Sichuan, China
| | - Kaican Cai
- Nanfang Hospital of Southern Medical University, No. 1838, Guangzhou North Road, Guangzhou, Guangdong, China
| | - Muyan Cai
- Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Sanjun Cai
- Fudan University Shanghai Cancer Center, No. 270, Dongan Road, Xuhui District, Shanghai, China
| | - Gong Chen
- Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Keneng Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52, Fucheng Road, Haidian District, Beijing, 100142, China
| | - Lin Chen
- Chinese People's Liberation Army General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, China
| | - Pengju Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52, Fucheng Road, Haidian District, Beijing, 100142, China
| | - Pan Chi
- Fujian Medical University Union Hospital, No. 29, Xinquan Road, Gulou District, Fuzhou, Fujian, China
| | - Guanghai Dai
- Chinese People's Liberation Army General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, China
| | - Yanhong Deng
- The Sixth Hospital Affiliated of Sun Yat-sen University, No. 19, Erheng Road, Yuancun, Tianhe District, Guangzhou, Guangdong, China
| | - Kefeng Ding
- The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88, Jiefang Road, Hangzhou, Zhejiang, China
| | - Qingxia Fan
- The First Affiliated Hospital of Zhengzhou University, No. 1, Jianhe East Road, Zhengzhou, Henan, China
| | - Weijia Fang
- The First Affiliated Hospital of Zhejiang University School of Medicine, No. 79, Qingchun Road, Zhejiang, Hangzhou, China
| | - Xuedong Fang
- China-Japan Union Hospital of Jilin University, No. 126, Sendai Street, Changchun, Jilin, China
| | - Fengyi Feng
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, China
| | - Chuangang Fu
- Tongji University Shanghai East Hospital, No. 150, Jimo Road, Pudong New Area, Shanghai, China
| | - Qihan Fu
- The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88, Jiefang Road, Hangzhou, Zhejiang, China
| | - Yanhong Gu
- Jiangsu Provincial People's Hospital, No. 300, Guangzhou Road, Nanjing, Jiangsu, China
| | - Yulong He
- The Seventh Affiliated Hospital of Sun Yat-sen University, No. 628, Zhenyuan Road, Shenzhen, Guangdong, China
| | - Baoqing Jia
- Chinese People's Liberation Army General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, China
| | - Kewei Jiang
- Peking University People's Hospital, No. 11, Xizhimen Nandajie, Beijing, China
| | - Maode Lai
- Zhejiang University School of Medicine, No. 866, Yuhangtang Road, Zhejiang, Hangzhou, China
| | - Ping Lan
- The Sixth Hospital Affiliated of Sun Yat-sen University, No. 19, Erheng Road, Yuancun, Tianhe District, Guangzhou, Guangdong, China
| | - Enxiao Li
- The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shaanxi, China
| | - Dechuan Li
- Zhejiang Cancer Hospital, No. 38, Guangji Road, Banshanqiao, Gongshu District, Zhejiang, Hangzhou, China
| | - Jin Li
- Tongji University Shanghai East Hospital, No. 150, Jimo Road, Pudong New Area, Shanghai, China
| | - Leping Li
- Shandong Provincial Hospital, No. 324, Jingwuweiqi Road, Ji'nan, Shangdong, China
| | - Ming Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52, Fucheng Road, Haidian District, Beijing, 100142, China
| | - Shaolei Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52, Fucheng Road, Haidian District, Beijing, 100142, China
| | - Yexiong Li
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, China
| | - Yongheng Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52, Fucheng Road, Haidian District, Beijing, 100142, China
| | - Zhongwu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52, Fucheng Road, Haidian District, Beijing, 100142, China
| | - Xiaobo Liang
- Shanxi Provincial Cancer Hospital, No. 3, Zhigong Xincun, Xinghualing District, Taiyuan, Shanxi, China
| | - Zhiyong Liang
- Peking Union Medical College Hospital, No. 1, Shuaifuyuan, Dongcheng District, Beijing, China
| | - Feng Lin
- The Sixth Hospital Affiliated of Sun Yat-sen University, No. 19, Erheng Road, Yuancun, Tianhe District, Guangzhou, Guangdong, China
| | - Guole Lin
- Peking Union Medical College Hospital, No. 1, Shuaifuyuan, Dongcheng District, Beijing, China
| | - Hongjun Liu
- Shandong Provincial Hospital, No. 324, Jingwuweiqi Road, Ji'nan, Shangdong, China
| | - Jianzhong Liu
- Tianjin Medical University Cancer Institute & Hospital, Huanhu West Road, Tiyuanbei, Hexi District, Tianjin, China
| | - Tianshu Liu
- Zhongshan Hospital of Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, China
| | - Yunpeng Liu
- The First Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, Liaoning, China
| | - Hongming Pan
- Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, No. 3, Qingchun East Road, Zhejiang, Hangzhou, China
| | - Zhizhong Pan
- Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Haiping Pei
- Xiangya Hospital of Central South University, No. 87, Xiangya Road, Changsha, Hunan, China
| | - Meng Qiu
- Huaxi Hospital of Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, Sichuan, China
| | - Xiujuan Qu
- The First Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, Liaoning, China
| | - Li Ren
- Zhongshan Hospital of Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, China
| | - Zhanlong Shen
- Peking University People's Hospital, No. 11, Xizhimen Nandajie, Beijing, China
| | - Weiqi Sheng
- Fudan University Shanghai Cancer Center, No. 270, Dongan Road, Xuhui District, Shanghai, China
| | - Chun Song
- Tongji University Shanghai East Hospital, No. 150, Jimo Road, Pudong New Area, Shanghai, China
| | - Lijie Song
- The First Affiliated Hospital of Zhejiang University School of Medicine, No. 79, Qingchun Road, Zhejiang, Hangzhou, China
| | - Jianguo Sun
- Xinqiao Hospital of Army Medical University, No. 83, Xinqiaozheng Street, Shapingba District, Chongqing, China
| | - Lingyu Sun
- The Fourth Affiliated Hospital of Harbin Medical University, No. 37, Yiyuan Street, Nangang District, Harbin, Heilongjiang, China
| | - Yingshi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52, Fucheng Road, Haidian District, Beijing, 100142, China
| | - Yuan Tang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, China
| | - Min Tao
- The First Affiliated Hospital of Soochow University, No. 188, Shizi Street, Canglang District, Suzhou, Jiangsu, China
| | - Chang Wang
- The First Affiliated Hospital of Jilin University, No. 71, Xinmin Road, Changchun, Jilin, China
| | - Haijiang Wang
- The Third People's Hospital of Shenzhen, No. 29, Bulan Road, Longgang District, Shenzhen, Guangdong, China
| | - Jun Wang
- Peking University People's Hospital, No. 11, Xizhimen Nandajie, Beijing, China
| | - Shubin Wang
- Peking University Shenzhen Hospital, No. 1120, Lianhua Road, Futian District, Shenzhen, Guangdong, China
| | - Xicheng Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52, Fucheng Road, Haidian District, Beijing, 100142, China
| | - Xishan Wang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, China
| | - Ziqiang Wang
- Huaxi Hospital of Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, Sichuan, China
| | - Aiwen Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52, Fucheng Road, Haidian District, Beijing, 100142, China
| | - Nan Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52, Fucheng Road, Haidian District, Beijing, 100142, China
| | - Lijian Xia
- Shandong Qianfoshan Hospital, No. 16766, Jingshi Road, Lixia District, Ji'nan, Shandong, China
| | - Yi Xiao
- Peking Union Medical College Hospital, No. 1, Shuaifuyuan, Dongcheng District, Beijing, China
| | - Baocai Xing
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52, Fucheng Road, Haidian District, Beijing, 100142, China
| | - Bin Xiong
- Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, Hubei, China
| | - Jianmin Xu
- Zhongshan Hospital of Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, China
| | - Jianming Xu
- 307 Hospital of the Chinese People's Liberation Army, Road 8, Dong Street, Fengtai Distinct, Beijing, China
| | - Nong Xu
- The First Affiliated Hospital of Zhejiang University School of Medicine, No. 79, Qingchun Road, Zhejiang, Hangzhou, China
| | - Ruihua Xu
- Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Zhongfa Xu
- Affiliated Hospital of Shandong Academy of Medical Sciences, No. 38, Wuyingshan Road, Tianqiao District, Ji'nan, Shandong, China
| | - Yue Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52, Fucheng Road, Haidian District, Beijing, 100142, China
| | - Hongwei Yao
- Beijing Friendship Hospital, No. 95, Yong'an Road, Xicheng District, Beijing, China
| | - Yingjiang Ye
- Peking University People's Hospital, No. 11, Xizhimen Nandajie, Beijing, China
| | - Yonghua Yu
- Shandong Cancer Hospital, No. 440, Jiyan Road, Ji'nan, Shandong, China
| | - Yueming Yu
- The Fourth Hospital of Hebei Medical University, No. 12, Jiankang Road, Shijiazhuang, Hebei, China
| | - Jinbo Yue
- Shandong Cancer Hospital, No. 440, Jiyan Road, Ji'nan, Shandong, China
| | - Jingdong Zhang
- Liaoning Cancer Hospital & Institute, No. 44, Xiaoheyan Road, Dadong District, Shenyang, Liaoning, China
| | - Jun Zhang
- Ruijin Hospital of Shanghai Jiaotong University School of Medicine, No. 197, Ruijin 2nd Road, Shanghai, China
| | - Suzhan Zhang
- The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88, Jiefang Road, Hangzhou, Zhejiang, China
| | - Wei Zhang
- Changhai Hospital, No. 168, Changhai Road, Yangpu District, Shanghai, China
| | - Yanqiao Zhang
- Harbin Medical University Cancer Hospital, No. 150, Haping Road, Nangang District, Harbin, Heilongjiang, China
| | - Zhen Zhang
- Fudan University Shanghai Cancer Center, No. 270, Dongan Road, Xuhui District, Shanghai, China
| | - Zhongtao Zhang
- Beijing Friendship Hospital, No. 95, Yong'an Road, Xicheng District, Beijing, China
| | - Lin Zhao
- Peking Union Medical College Hospital, No. 1, Shuaifuyuan, Dongcheng District, Beijing, China
| | - Ren Zhao
- Ruijin Hospital of Shanghai Jiaotong University School of Medicine, No. 197, Ruijin 2nd Road, Shanghai, China
| | - Fuxiang Zhou
- Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, Hubei, China
| | - Jian Zhou
- Zhongshan Hospital of Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, China
| | - Jing Jin
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, China.
| | - Jin Gu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52, Fucheng Road, Haidian District, Beijing, 100142, China.
| | - Lin Shen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52, Fucheng Road, Haidian District, Beijing, 100142, China.
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Lai HW, Wei JCC, Hung HC, Lin CC. Impact of treatment modality on clinical outcome in metastatic colorectal cancer patients stratified by metastatic sites. Postgrad Med 2019; 131:163-170. [DOI: 10.1080/00325481.2019.1568016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Hsin-Wu Lai
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Nantou Hospital, Ministry of Health and Welfare, Nantou City, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taichung, Taiwan
| | - Hung-Chang Hung
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Nantou Hospital, Ministry of Health and Welfare, Nantou City, Taiwan
- Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Chun-Che Lin
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taichung, Taiwan
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Yu J, Li N, Tang Y, Wang X, Tang Y, Wang SL, Song YW, Liu YP, Li YX, Jin J. Outcomes after hypofractionated stereotactic radiotherapy for colorectal cancer oligometastases. J Surg Oncol 2019; 119:532-538. [PMID: 30609038 DOI: 10.1002/jso.25361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 12/18/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND OBJECTIVES To assess the efficacy and the effect of biologic effective dose (BED) on outcomes treated by hypofractionated stereotactic radiotherapy for colorectal cancer (CRC) oligometastases. METHODS Patients with CRC oligometastases treated at our hospital between 2009 and 2016 were included. The relationship between BED and risk of local recurrence was assessed. Recursive partitioning analysis (RPA) was used to evaluate the effect of BED on outcomes. RESULTS A total of 48 patients were included in this study. Median follow-up time of surviving patient was 15 months (range, 3-82 months). The 1-year local control rate was 85%. The risk of local recurrence decreased sharply when BED was >90 Gy10 . RPA showed BED of 100 Gy 10 was the appropriate dose for recurrence risk stratification. BED ≥ 100 Gy 10 was significantly better than BED < 100 Gy 10 for achieving 1-year local control (94.4% vs 63.2%; P = 0.022) and 1-year OS (100% vs 73.4%; P = 0.028). One patient who received long-term antiangiogenic treatment died of massive intestinal hemorrhage; no other grade 3 or above early or late events were observed. CONCLUSIONS Hypofractionated stereotactic radiotherapy provides favorable outcomes with acceptable toxicities in CRC oligometastases. BED ≥ 100 Gy is associated with better outcomes.
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Affiliation(s)
- Jing Yu
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ning Li
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yu Tang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xin Wang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yuan Tang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shu-Lian Wang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yong-Wen Song
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yue-Ping Liu
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ye-Xiong Li
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jing Jin
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Radiotherapy for oligometastatic cancer: a survey among radiation oncologists of Lombardy (AIRO-Lombardy), Italy. Radiol Med 2018; 124:315-322. [PMID: 30554376 DOI: 10.1007/s11547-018-0972-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 12/05/2018] [Indexed: 02/06/2023]
Abstract
AIMS To evaluate the use of radiotherapy (RT) for oligometastatic cancer (OMC) among radiation oncologists in Lombardy, Italy. METHODS AND STUDY DESIGN A survey with 12 items regarding data of 2016 was sent to all 34 Lombardy RT centers. The survey included six general items and six specific items regarding patient/disease/treatment characteristics. RESULTS Thirteen centers answered the survey (38%). All centers responded to general items and 12 centers submitted patient/disease/treatment data. General items The majority of centers (8/13) consider OMC if metastases number is less than 5. The most commonly prescribed dose/fraction is 5-10 Gy (8/13) using schedules of 3-5 fractions (11/13). Patient data items A total of 15.681 patients were treated in 2016 with external beam RT in 12 responding centers, and 1.087 patients were treated for OMC (7%). Primary tumor included lung, prostate, breast, colorectal and other malignancies in 33%, 21%, 12%, 9% and 25% of all OMC patients, respectively. Brain, lymph node, lung, bone, liver and others were the most common treated sites (24%, 24%, 22%, 17%, 8% and 5%, respectively). One and more than one metastasis were treated in 75 and 25% of patients, respectively. The vast majority of patients (95%) were treated with image-guided intensity-modulated RT or stereotactic RT. CONCLUSIONS Seven percent of all RT patients in Lombardy are treated for OMC. Extreme hypofractionation and high-precision RT are commonly employed. The initiative of multicenter and multidisciplinary collaboration has been undertaken in order to prepare the platform for prospective and/or observational studies in OMC.
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The influence of tumour site on prognosis in metastatic colorectal carcinomas with primary tumour resection. Int J Colorectal Dis 2018; 33:1215-1223. [PMID: 29915904 DOI: 10.1007/s00384-018-3098-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of our study was to compare the characteristics and prognosis between right- and left-sided metastatic colorectal carcinomas. METHODS Data from 937 patients with stage IV colorectal carcinomas (synchronous distant metastasis) who had a resection of the primary tumour between 1985 and 2014 were analysed. Carcinomas in the caecum to transverse colon were defined as right-sided (n = 250; 26.7%). They were compared to tumours located from the splenic flexure to the rectum categorised as left-sided (n = 687; 73.3%). RESULTS In right-sided carcinomas, we observed significantly more female patients (50.8 vs 36.2%; p < 0.001), more unfavourable histological types (24.0 vs 8.6%; p < 0.001), more M1c carcinomas (metastases to the peritoneum ± others; 32.0 vs 14.4%; p < 0.001) and more emergencies (11.6 vs 7.1%; p = 0.029), while multimodal treatment was utilised in fewer patients (51.6 vs 63.8%; p = 0.001) and curative resections were less frequently (24.1 vs 35.4%; p = 0.002). Prognosis was significantly worse in patients with right-sided carcinomas (2-year-survival 27.2 vs 44.6%, p < 0.01). This difference was more pronounced after R2 resection (15.3 vs 29.7%; p < 0.001), than after macroscopic curative resection (2-year-survival 63.9 vs 71.9%; p = 0.106). In multivariate Cox regression analysis, tumour site was found to be an independent prognostic factor for overall survival (HR 1.2; 95% CI 1.0-1.5; p = 0.012). During the three 10-year periods, the prognosis improved equally in patients with right- and left-sided carcinomas, while the differences in survival remained identical. CONCLUSIONS In a surgical patient cohort undergoing primary tumour resection, significant differences in prognosis were observed between patients with metastatic right- and left-sided colorectal carcinomas.
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Al-Ameri M, Persson M, Bergman P, Franco-Cereceda A, Sartipy U. Long-term survival after surgery for pulmonary metastases from colorectal cancer: an observational cohort study. J Thorac Dis 2017; 9:4358-4365. [PMID: 29268505 DOI: 10.21037/jtd.2017.10.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Evidence for pulmonary metastasectomy following colorectal cancer (CRC) is scarce. The aim of the study was to investigate long-term survival and identify prognostic factors to aid patient selection. Methods We included all patients who underwent pulmonary resections for CRC metastases between January 01, 2004 and December 31, 2015 in a population-based cohort study. The primary outcome measure was all-cause mortality and was ascertained from Swedish national registers. The Kaplan-Meier estimator was used to calculate cumulative survival. We used Cox regression for estimation of hazard ratios (HR) and 95% confidence intervals (CI) for the association between patient characteristics and survival. Results We included 184 patients. The number of procedures per year increased from 1 in 2004 to 34 in 2015. During a median follow-up time of 3.2 years, 36% (66/184) patients died. Overall survival at 5 years was 60% (95% CI: 50-68%) and was significantly lower compared to an age- and gender-matched Swedish population. Carcinoembryonic antigen (CEA) level was identified as a prognostic factor for mortality in the age and sex-adjusted analysis (HR, 2.46; 95% CI: 1.15-5.26, P=0.020). Conclusions We found a steady increase in the number of pulmonary metastasectomies after CRC during the study period. We identified prethoracotomy CEA level as a prognostic factor for long-term survival, which was consistent with prior reports. The 5-year overall survival rate in our study was 60%, which was high in comparison with prior reports. Although our results indicated that current patient selection criteria were reasonable, definitive evidence of efficacy is pending.
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Affiliation(s)
- Mamdoh Al-Ameri
- Section of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Michael Persson
- Section of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Per Bergman
- Section of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anders Franco-Cereceda
- Section of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Ulrik Sartipy
- Section of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Karim S, Nanji S, Brennan K, Pramesh CS, Booth CM. Chemotherapy for resected colorectal cancer pulmonary metastases: Utilization and outcomes in routine clinical practice. Eur J Surg Oncol 2017. [PMID: 28634014 DOI: 10.1016/j.ejso.2017.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The role of chemotherapy in the setting of resected colorectal cancer pulmonary metastases (CRCPM) is not well defined. Here we describe utilization of peri-operative chemotherapy and outcomes among patients with resected CRCPM in the general population. METHODS All cases of CRCPM who underwent resection from 2002 to 2009 were identified using the Ontario Cancer Registry (OCR). Electronic treatment records identified peri-operative chemotherapy delivered within 16 weeks before or after pulmonary metastasectomy (PM). Modified Poisson regression was used to evaluate factors associated with chemotherapy delivery. Cox proportional models were used to explore the association between post-operative chemotherapy and cancer-specific (CSS) and overall survival (OS). RESULTS The study population included 420 patients. Thirty-six percent of patients (151/420) received peri-operative chemotherapy. Among these patients, 75% (113/151) received post-operative chemotherapy. Factors that were independently associated with use of post-operative chemotherapy included higher socioeconomic status (SES) and no prior adjuvant chemotherapy (p < 0.01). In adjusted analyses post-operative chemotherapy was not associated with improved CSS (HR 0.99, 95% CI 0.67-1.47) or OS (HR 0.93 95% CI 0.66-1.31). In exploratory analyses, among those patients who did not receive previous adjuvant therapy for the primary colorectal cancer, post-operative chemotherapy following lung metastasectomy was associated with HR 0.50 (95% CI 0.27-0.95) for OS and HR 0.59 (95% CI 0.27-1.27) for CSS. CONCLUSION One third of patients with resected CRCPM in routine practice receive peri-operative chemotherapy. A randomized controlled trial is warranted to evaluate whether chemotherapy following resection of CRCPM is associated with improved survival.
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Affiliation(s)
- S Karim
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Canada; Department of Oncology, Queen's University, Kingston, Canada
| | - S Nanji
- Department of Oncology, Queen's University, Kingston, Canada; Department of Surgery, Queen's University, Kingston, Canada
| | - K Brennan
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Canada
| | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - C M Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Canada; Department of Oncology, Queen's University, Kingston, Canada; Department of Public Health Sciences, Queen's University, Kingston, Canada.
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Cao G, Cheng D, Ye L, Pan Y, Yang F, Lyu S. Surgical resection of pulmonary metastases from colorectal cancer: 11 years of experiences. PLoS One 2017; 12:e0175284. [PMID: 28394911 PMCID: PMC5386242 DOI: 10.1371/journal.pone.0175284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/23/2017] [Indexed: 01/26/2023] Open
Abstract
Objective To analyze the benefits and prognostic factors after surgical resection of pulmonary metastases from colorectal cancer (CRC). Methods From Jan. 2004 to Jan. 2015, continuous 88 cases diagnosed with pulmonary metastases from CRC, including 15 cases of synchronous metastases and 73 metachronous metastases, were analyzed in the retrospective study. Results All of these 88 cases underwent curative pulmonary resection including 8 cases of simultaneous surgery. The one-year, three-year and five-year survival of the 88 cases were 93.4%, 60.2% and 35.7%, respectively. 63 patients just have one metastasis, and 25 patients have more than one metastasis. Additionally, the one-year, three-year and five-year survival was 98.1%, 70.2% and 40.3% respectively in one metastasis group, while 80.1%, 37.9% and 22.5% respectively in more than one metastasis group (p = 0.003). DFS of 37 metachronous metastases were equal or greater than 18 months, and DFS of 36 metachronous metastases were less than 18 months. The one-year, three-year and five-year survival was 97.8%, 77.9% and 41.4% respectively in the DFS≥18 month group, while 88.2%, 44.6% and 28.1% respectively in the DFS<18 month group (p = 0.01). Conclusion Surgical resection of pulmonary metastases from colorectal cancer can improve survival rate in selected patients. It seems that the number of metastases is an independence prognostic factor in surgical treatment. Furthermore, longer DFI implies longer survival for resectable CRC pulmonary metastases.
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Affiliation(s)
- Guoquan Cao
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dezhi Cheng
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lechi Ye
- Department of surgical oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yiyuan Pan
- Department of surgical oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Fan Yang
- Department of surgical oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shixu Lyu
- Department of surgical oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- * E-mail:
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Mihai A, Mu Y, Armstrong J, Dunne M, Beriwal S, Rock L, Thirion P, Heron DE, Bird BH, Westrup J, Murphy CG, Huq MS, McDermott R. Patients with colorectal lung oligometastases (L-OMD) treated by dose adapted SABR at diagnosis of oligometastatic disease have better outcomes than patients previously treated for their metastatic disease. JOURNAL OF RADIOSURGERY AND SBRT 2017; 5:43-53. [PMID: 29296462 PMCID: PMC5675507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/06/2016] [Indexed: 06/07/2023]
Abstract
AIM To evaluate the clinical outcomes of patients with OMD from a CRC primary, who underwent SABR either as first treatment at diagnosis of metachronous oligometastatic disease to lung or at progression in lung after prior treatments for metastatic disease. METHODS This is a retrospective review of 60 patients with 85 lung oligometastases treated by SABR at two institutions, between May 2009 and September 2014. Local control (LC), overall survival (OS), progression - free survival (PFS), and toxicity were evaluated. RESULTS Median follow-up was 22.9±15.5 months (range: 2.6-68.6). For the entire cohort, LC was observed for 76.6% of the target lesions; the 2- year OS and PFS were 77% and 28 % respectively. After a median of 7.9 months from SABR, 39 patients presented a first progression. In univariate analysis, patients with multiple recurrences prior to SABR (p=0.001) and those who received chemotherapy for metastatic progression (p=0.014) had poorer PFS from time of SABR. Median PFS for patients with no prior treatment for L-OMD vs. prior chemotherapy +/- local treatment vs. local treatment only was: not reached vs. 8.83 (± 2) vs. 32.5 (±2.75) months. The main pattern of first progression was out of field progression: in-field progression alone occurred in 7 patients (12%) and with synchronous regional/distant progression in 10 patients (17%. In all patients, chemotherapy was withheld until progression post-SABR. Treatment was well tolerated; only one patient experienced grade 3 bronchial toxicity, three months after completion of SABR. CONCLUSIONS SABR achieves high rates of local control with limited toxicities in patients with lung oligometastatic disease from a colorectal primary. This retrospective data indicates that patients with newly diagnosed lung oligometastatic disease may be safely treated with SABR as first treatment, with chemotherapy held in reserve. In heavily pretreated patients, SABR may allow patients a treatment break from systemic therapy, which may be beneficial both psychologically and physically. Future randomized SABR studies should evaluate sequencing of chemotherapy, the role of immunotherapies, and the quality of life of patients undergoing SABR.
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Affiliation(s)
- Alina Mihai
- Beacon Hospital, Radiotherapy Department, Dublin 18, Ireland
| | - Yijia Mu
- University of Pittsburgh Cancer Institute, Pittsburgh, PA 15232, USA
| | - John Armstrong
- Beacon Hospital, Radiotherapy Department, Dublin 18, Ireland
| | - Mary Dunne
- St Luke's Radiation Oncology Network, St Luke's Hospital, Dublin 6, Ireland
| | - Sushil Beriwal
- University of Pittsburgh Cancer Institute, Pittsburgh, PA 15232, USA
| | - Luke Rock
- Beacon Hospital, Radiotherapy Department, Dublin 18, Ireland
| | - Pierre Thirion
- Beacon Hospital, Radiotherapy Department, Dublin 18, Ireland
| | - Dwight E Heron
- University of Pittsburgh Cancer Institute, Pittsburgh, PA 15232, USA
| | | | | | | | - M Saiful Huq
- University of Pittsburgh Cancer Institute, Pittsburgh, PA 15232, USA
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Tsitsias T, Toufektzian L, Routledge T, Pilling J. Are there recognized prognostic factors for patients undergoing pulmonary metastasectomy for colorectal carcinoma?: Table 1:. Interact Cardiovasc Thorac Surg 2016; 23:962-969. [DOI: 10.1093/icvts/ivw273] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 07/13/2016] [Accepted: 07/25/2016] [Indexed: 12/11/2022] Open
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Rentsch M, Schiergens T, Khandoga A, Werner J. Surgery for Colorectal Cancer - Trends, Developments, and Future Perspectives. Visc Med 2016; 32:184-91. [PMID: 27493946 DOI: 10.1159/000446490] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although colorectal surgery is long established as the mainstay treatment for colon cancer, certain topics regarding technical fine-tuning to increase postsurgical recurrence-free survival have remained a matter of debate throughout the past years. These include complete mesocolic excision (CME), treatment strategies for metastatic disease, significance of hyperthermic intraperitoneal chemotherapy (HIPEC), and surgical techniques for the treatment of colorectal cancer recurrence. In addition, new surgical techniques have been introduced in oncologic colorectal surgery, and their potential to provide sufficiently radical resection has yet to be proven. METHODS A structured review of the literature was performed to identify the current state of the art with regard to the mentioned key issues in colorectal surgery. RESULTS This article provides a comprehensive review of the current literature addressing the above-mentioned current challenges in colorectal surgery. The focus lies on the impact of CME and, in relation to this, on lymph node dissection, as well as on treatment of metastatic disease including peritoneal spread, and finally on the treatment of recurrent disease. CONCLUSION Uniformly, the current literature reveals that surgery aiming at complete malignancy elimination within multimodal treatment approaches represents the fundamental quantum leap for the achievement of long-term tumor-free survival.
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Affiliation(s)
- Markus Rentsch
- Department of General, Visceral, Transplantation Surgery, University of Munich, Campus Großhadern, Munich, Germany
| | - Tobias Schiergens
- Department of General, Visceral, Transplantation Surgery, University of Munich, Campus Großhadern, Munich, Germany
| | - Andrej Khandoga
- Department of General, Visceral, Transplantation Surgery, University of Munich, Campus Großhadern, Munich, Germany
| | - Jens Werner
- Department of General, Visceral, Transplantation Surgery, University of Munich, Campus Großhadern, Munich, Germany
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