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Antonoff MB, Kui N, Sun R, Deboever N, Hofstetter W, Mehran RJ, Morris VK, Rice DC, Swisher SG, Vaporciyan AA, Walsh GL, Rajaram R. Factors associated with receipt of pulmonary metastasectomy in patients with lung-limited metastatic colorectal cancer: Disparities in care and impact on overall survival. J Thorac Cardiovasc Surg 2024; 168:263-271. [PMID: 37690624 DOI: 10.1016/j.jtcvs.2023.08.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES Pulmonary metastasectomy (PM) for colorectal cancer may provide respite from systemic therapy and prolonged disease-free intervals. We sought to identify factors associated with PM and to characterize the differential impact on overall survival for those offered lung resection. METHODS The National Cancer Database was queried for stage IV colorectal cancer patients with lung-limited metastatic disease between 2010 and 2016. Among patients who underwent primary tumor resection, those who underwent PM were compared with those who did not. Penalized regression with the least absolute selection and shrinkage operator was used to determine factors associated with receiving metastasectomy as well as overall survival. RESULTS In total, 867 (15.1%) patients underwent resection of both primary tumor and pulmonary metastases whereas 4864 (84.8%) had primary tumor resection alone. In unadjusted analyses, metastasectomy patents were younger, more often privately insured, more educated, and traveled farther to receive care (all P < .001). In multivariable analyses, younger age, traveling >25 miles, and care at high-volume hospitals were associated with PM (P < .01). In addition, primary site surgery without PM was associated with worse overall survival (hazard ratio, 1.35; confidence interval, 1.23-1.49), even after adjusting for patient, tumor, and hospital-related factors. CONCLUSIONS Patients who were older, who received care closer to home, and who were treated at low-volume hospitals were less likely to receive metastasectomy for lung-limited colorectal cancer after definitive resection of their primary tumor. Failure to receive PM resulted in worse overall survival, emphasizing the strong need for efforts to provide uniform, equitable care to all patients.
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Affiliation(s)
- Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex.
| | - Naishu Kui
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Ryan Sun
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Nathaniel Deboever
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Wayne Hofstetter
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Van K Morris
- Department of GI Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Garrett L Walsh
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Ravi Rajaram
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
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2
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Zhang Z, Wang J, Dai D, Xia F, Sun Y, Li G, Wan J, Shen L, Zhang H, Wang Y, Zhong J, Bao J, Zhang Z. Radiomic score for lung nodules as a prognostic biomarker in locally advanced rectal cancer patients: A bi-institutional study. Cancer Med 2024; 13:e7240. [PMID: 38923236 PMCID: PMC11196379 DOI: 10.1002/cam4.7240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/31/2024] [Accepted: 04/23/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Undetermined lung nodules are common in locally advanced rectal cancer (LARC) and lack precise risk stratification. This study aimed to develop a radiomic-based score (Rad-score) to distinguish metastasis and predict overall survival (OS) in patients with LARC and lung nodules. METHODS Retrospective data from two institutions (July 10, 2006-September 24, 2015) was used to develop and validate the Rad-score for distinguishing lung nodule malignancy. The prognostic value of the Rad-score was investigated in LARC cohorts, leading to the construction and validation of a clinical and radiomic score (Cli-Rad-score) that incorporates both clinical and radiomic information for the purpose of improving personalized clinical prognosis prediction. Descriptive statistics, survival analysis, and model comparison were performed to assess the results. RESULTS The Rad-score demonstrated great performance in distinguishing malignancy, with C-index values of 0.793 [95% CI: 0.729-0.856] in the training set and 0.730 [95% CI: 0.666-0.874] in the validation set. In independent LARC cohorts, Rad-score validation achieved C-index values of 0.794 [95% CI: 0.737-0.851] and 0.747 [95% CI: 0.615-0.879]. Regarding prognostic prediction, Rad-score effectively stratified patients. Cli-Rad-score outperformed the clinicopathological information alone in risk stratification, as evidenced by significantly higher C-index values (0.735 vs. 0.695 in the internal set and 0.618 vs. 0.595 in the external set). CONCLUSIONS CT-based radiomics could serve as a reliable and powerful tool for lung nodule malignancy distinction and prognostic prediction in LARC patients. Rad-score predicts prognosis independently. Incorporation of Cli-Rad-score significantly enhances the persionalized clinical prognostic capacity in LARC patients with lung nodules.
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Affiliation(s)
- Zhiyuan Zhang
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Clinical Research Center for Radiation OncologyShanghaiChina
- Shanghai Key Laboratory of Radiation OncologyShanghaiChina
| | - Jiazhou Wang
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Clinical Research Center for Radiation OncologyShanghaiChina
- Shanghai Key Laboratory of Radiation OncologyShanghaiChina
| | - Di Dai
- Department of RadiologyNanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer ResearchNanjingChina
| | - Fan Xia
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Clinical Research Center for Radiation OncologyShanghaiChina
- Shanghai Key Laboratory of Radiation OncologyShanghaiChina
| | - Yiqun Sun
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Institute of Medical ImagingFudan UniversityShanghaiChina
- Department of RadiologyFudan University Shanghai Cancer CenterShanghaiChina
| | - Guichao Li
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Clinical Research Center for Radiation OncologyShanghaiChina
- Shanghai Key Laboratory of Radiation OncologyShanghaiChina
| | - Juefeng Wan
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Clinical Research Center for Radiation OncologyShanghaiChina
- Shanghai Key Laboratory of Radiation OncologyShanghaiChina
| | - Lijun Shen
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Clinical Research Center for Radiation OncologyShanghaiChina
- Shanghai Key Laboratory of Radiation OncologyShanghaiChina
| | - Hui Zhang
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Clinical Research Center for Radiation OncologyShanghaiChina
- Shanghai Key Laboratory of Radiation OncologyShanghaiChina
| | - Yan Wang
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Clinical Research Center for Radiation OncologyShanghaiChina
- Shanghai Key Laboratory of Radiation OncologyShanghaiChina
| | - Jie Zhong
- Department of OncologyNanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer ResearchNanjingChina
| | - Jun Bao
- Department of OncologyNanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer ResearchNanjingChina
| | - Zhen Zhang
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Clinical Research Center for Radiation OncologyShanghaiChina
- Shanghai Key Laboratory of Radiation OncologyShanghaiChina
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Scanagatta P, Ancona G, Cagnetti S, Giorgetta CE, Inzirillo F, Ravalli E, Maiolani M, Naldi G. The Case for Pulmonary Metastasectomy-Clinical Practice Narrative Review and Commentary. Life (Basel) 2024; 14:702. [PMID: 38929685 PMCID: PMC11204682 DOI: 10.3390/life14060702] [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: 04/19/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
Pulmonary metastasectomy has become a well-established procedure for patients with certain types of solid tumors. Patients are usually scheduled for staged lung metastasectomy in case of primary tumor control, the absence of distant non-lung metastases, and when complete resection is achievable. Nodules are removed with precision resection in order to ensure radical resection with minimal margins; this technique permits good oncological results, preserving the surrounding pulmonary parenchyma and causing minimal distortion compared to staplers. When possible, anatomical resections should be avoided since they are not justified by real oncological advantages and, in the majority of cases, sacrifice too much healthy tissue, possibly leading to inoperability in the case of metachronous relapses. Thus, preserving the maximum amount of pulmonary parenchyma is crucial because repeated metastasectomies are possible and frequent, with no theoretical limits to the number of reinterventions. In our multidisciplinary board team, we support the role of pulmonary metastasectomy as a useful curative therapy, with acceptable morbidity and mortality, with indications to be discussed case-by-case.
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Affiliation(s)
- Paolo Scanagatta
- Division of Thoracic Surgery, ASST Valtellina e Alto Lario, “Eugenio Morelli” Hospital, 23035 Sondalo, Italy
| | - Gianluca Ancona
- Division of Thoracic Surgery, ASST Valtellina e Alto Lario, “Eugenio Morelli” Hospital, 23035 Sondalo, Italy
| | - Sara Cagnetti
- Division of Thoracic Surgery, ASST Valtellina e Alto Lario, “Eugenio Morelli” Hospital, 23035 Sondalo, Italy
| | - Casimiro Eugenio Giorgetta
- Division of Thoracic Surgery, ASST Valtellina e Alto Lario, “Eugenio Morelli” Hospital, 23035 Sondalo, Italy
| | - Francesco Inzirillo
- Division of Thoracic Surgery, ASST Valtellina e Alto Lario, “Eugenio Morelli” Hospital, 23035 Sondalo, Italy
| | - Eugenio Ravalli
- Division of Thoracic Surgery, ASST Valtellina e Alto Lario, “Eugenio Morelli” Hospital, 23035 Sondalo, Italy
| | - Martina Maiolani
- Division of Oncology, ASST Valtellina e Alto Lario, “Ospedale Civile” Sondrio, 23100 Sondalo, Italy
| | - Giuseppe Naldi
- Division of Thoracic Surgery, ASST Valtellina e Alto Lario, “Eugenio Morelli” Hospital, 23035 Sondalo, Italy
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4
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Kanzaki R, Watari H, Omura A, Kawagishi S, Tanaka R, Maniwa T, Okami J. Outcomes and prognostic factors of repeat pulmonary metastasectomy. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae028. [PMID: 38426364 PMCID: PMC10927334 DOI: 10.1093/icvts/ivae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/16/2023] [Accepted: 02/27/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES Information on prognostic factors after repeat pulmonary metastasectomy (PM) is limited, and outcomes after a third PM are not well documented. METHODS A single-institute retrospective study was conducted. Between 2000 and 2020, 68 patients underwent repeat PM for pulmonary metastases from various cancers. Outcomes and prognostic factors for the second PM and outcomes after the third PM were analysed. RESULTS This study included 39 men and 29 women. The mean age at second PM was 53.2 years old. The primary tumours were soft tissue sarcoma in 24 patients, colorectal cancer in 19 and osteosarcoma in 10. The interval between the first PM procedure and detection of pulmonary metastasis after the first PM (months) was ≤12 in 37 patients and >12 in 31 patients. At the second PM, 20 patients underwent lobectomy or bilobectomy, and 48 underwent sublobar resection. Complete resection was achieved in 60 patients, and 52 patients experienced recurrence after the second PM. The 5-year relapse-free survival and overall survival rates after the second PM were 27% and 48%, respectively. Multivariable analysis revealed that the interval between the first PM and the subsequent detection of pulmonary metastasis (≤12 months) was a poor prognostic factor for both relapse-free survival and overall survival after the second PM. Seventeen patients underwent a third PM, 3 of whom achieved a 3-year disease-free survival. CONCLUSIONS Patients with a period of >12 months between the first PM and the subsequent detection of pulmonary metastases showed favourable outcomes and are thus considered good candidates for second PM. A third PM may be beneficial for selected patients.
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Affiliation(s)
- Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hirokazu Watari
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Akiisa Omura
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Sachi Kawagishi
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Ryo Tanaka
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Tomohiro Maniwa
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Jiro Okami
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
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5
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Deboever N, Bayley EM, Eisenberg MA, Hofstetter WL, Mehran RJ, Rice DC, Rajaram R, Roth JA, Sepesi B, Swisher SG, Vaporciyan AA, Walsh GL, Bednarski BK, Morris VK, Antonoff MB. Lung surveillance following colorectal cancer pulmonary metastasectomy: Utilization of clinicopathologic risk factors to guide strategy. J Thorac Cardiovasc Surg 2024; 167:814-819.e2. [PMID: 37495170 DOI: 10.1016/j.jtcvs.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/03/2023] [Accepted: 07/08/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Appropriately selected patients clearly benefit from resection of colorectal cancer (CRC) pulmonary metastases (PMs). However, there remains equipoise surrounding optimal chest surveillance strategies following pulmonary metastasectomy. We aimed to identify risk factors that may inform chest surveillance in this population. METHODS Patients who underwent CRC pulmonary metastasectomy were identified from a single institution's prospectively maintained surgical database. Clinicopathologic and genomic characteristics were collected. Patients were stratified by diagnosis of subsequent PM within 6 months of the index lung resection. Multivariate modeling was used to evaluate risk factors. RESULTS A total of 197 patients met the study's inclusion criteria, of whom 52.3% (n = 103) developed subsequent PM, at a median of 9.51 months following the index metastasectomy. Patients with KRAS alterations (odds ratio [OR], 3.073; 95% confidence interval [CI], 1.363-6.926; P = .007), TP53 alterations (OR, 3.109; 95% CI, 1.318-7.341; P = .010) were found to be at risk of PM diagnosis within 6 months of the index metastasectomy, while those with an APC alteration (OR, .218; 95% CI, 0.080-0.598; P = .003) were protected. Moreover, patients who received systemic therapy within 3 months of the initial PM diagnosis also were more likely to develop early lung recurrence (OR, 2.105; 95% CI, 0.971-4.563; P = .059). CONCLUSIONS Patients with KRAS alterations, TP53 alterations, and no APC alterations developed early recurrence in the lung following pulmonary metastasectomy, as did those who received chemotherapy after their initial PM diagnosis. As such, these groups benefit from early lung imaging after metastasectomy, as chest surveillance protocols should be based on patient-centered clinicopathologic and genomic risk factors.
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Affiliation(s)
- Nathaniel Deboever
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Erin M Bayley
- Department of General Surgery, Baylor University, Houston, Tex
| | - Michael A Eisenberg
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Ravi Rajaram
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Jack A Roth
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Garrett L Walsh
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Brian K Bednarski
- Department of Colon and Rectal Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Van K Morris
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex.
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Song M, Zhou X, Hou R, Sigdel M, Liu Y, Zhang C, Xu K, Han X, Jiao D. CT-guided radioactive 125I seeds brachytherapy for lung oligometastases from colorectal cancer: initial results. BMC Cancer 2024; 24:265. [PMID: 38403626 PMCID: PMC10895717 DOI: 10.1186/s12885-024-12013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/16/2024] [Indexed: 02/27/2024] Open
Abstract
OBJECTIVES To evaluate the safety and effectiveness of computed tomography (CT)-guided radioactive 125I seeds brachytherapy (RISB) for lung oligometastases (LO) from colorectal cancer (CRC). METHODS Data for 144 LOs from 70 CRC patients who underwent CT-guided RISB were retrospectively analyzed. The primary endpoints were progression-free survival (PFS) and overall survival (OS), and the secondary endpoints were technical success, local control rate (LCR), and complications. Kaplan-Meier method was used for survival analysis. Cox model was used to identify the independent predictors of poor prognosis. RESULTS The RISB procedures were successfully performed in all patients, and the success rate was 100%. The median follow-up was 27.8 months. The median PFS was 10.0 months (95% CI: 8.9-11.1) and the 1- and 2-year PFS rates were 32.9% and 5.9%, respectively. On multivariate analysis, serum carcinoembryonic antigen (CEA) ≤ 15 ng/ml (P = 0.048), middle-high differentiated pathological classification (P = 0.015), primary TNM stages I-III (P = 0.001), LO number ≤ 2 (P < 0.001) and cumulative gross tumor volume (GTV) ≤ 40 cm3 (P < 0.001) showed superior PFS. The median OS was 30.8 months (95% CI: 27.1-34.4) and the 1-, 2-, and 3-year OS rates were 95.7%, 67.4%, and 42.5%, respectively. On multivariate analysis, serum CEA ≤ 15 ng/ml (P = 0.004), middle-high differentiated pathological classification (P < 0.001), primary TNM stages I-III (P < 0.001), LO number ≤ 2 (P < 0.001), cumulative GTV ≤ 40 cm3 (P < 0.001) and system treatments combined with chemotherapy and target therapy (P < 0.001) showed superior OS. The LCR for 3, 6, and 12 months was 97.9%, 91.0%, and 83.6%, respectively. There were 4 cases of pneumothorax at 5.7% that required drainage. CONCLUSIONS RISB for LO from CRC is safe and effective, and serum CEA, TNM stage, LO number, cumulative GTV, and system treatments should be emphasized for long OS.
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Affiliation(s)
- Mengyao Song
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Xueliang Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Rongna Hou
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Milan Sigdel
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Yiming Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Chengzhi Zhang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Kaihao Xu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Dechao Jiao
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China.
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Yokoi R, Tajima JY, Fukada M, Hayashi H, Kuno M, Asai R, Sato Y, Yasufuku I, Kiyama S, Tanaka Y, Murase K, Matsuhashi N. Optimizing Treatment Strategy for Oligometastases/Oligo-Recurrence of Colorectal Cancer. Cancers (Basel) 2023; 16:142. [PMID: 38201569 PMCID: PMC10777959 DOI: 10.3390/cancers16010142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/25/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer, and nearly half of CRC patients experience metastases. Oligometastatic CRC represents a distinct clinical state characterized by limited metastatic involvement, demonstrating a less aggressive nature and potentially improved survival with multidisciplinary treatment. However, the varied clinical scenarios giving rise to oligometastases necessitate a precise definition, considering primary tumor status and oncological factors, to optimize treatment strategies. This review delineates the concepts of oligometastatic CRC, encompassing oligo-recurrence, where the primary tumor is under control, resulting in a more favorable prognosis. A comprehensive examination of multidisciplinary treatment with local treatments and systemic therapy is provided. The overarching objective in managing oligometastatic CRC is the complete eradication of metastases, offering prospects of a cure. Essential to this management approach are local treatments, with surgical resection serving as the standard of care. Percutaneous ablation and stereotactic body radiotherapy present less invasive alternatives for lesions unsuitable for surgery, demonstrating efficacy in select cases. Perioperative systemic therapy, aiming to control micrometastatic disease and enhance local treatment effectiveness, has shown improvements in progression-free survival through clinical trials. However, the extension of overall survival remains variable. The review emphasizes the need for further prospective trials to establish a cohesive definition and an optimized treatment strategy for oligometastatic CRC.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Nobuhisa Matsuhashi
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City 501-1194, Gifu, Japan; (R.Y.); (K.M.)
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8
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van Dorp M, Wolfhagen N, Torensma B, Dickhoff C, Kazemier G, Heineman DJ, Schreurs WH. Pulmonary metastasectomy and repeat metastasectomy for colorectal pulmonary metastases: outcomes from the Dutch Lung Cancer Audit for Surgery. BJS Open 2023; 7:7153159. [PMID: 37146204 PMCID: PMC10162679 DOI: 10.1093/bjsopen/zrad009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Surgical resection of recurrent pulmonary metastases in patients with colorectal cancer is an established treatment option; however, the evidence for repeat resection is limited. The aim of this study was to analyse long-term outcomes from the Dutch Lung Cancer Audit for Surgery. METHODS Data from the mandatory Dutch Lung Cancer Audit for Surgery were used to analyse all patients after metastasectomy or repeat metastasectomy for colorectal pulmonary metastases from January 2012 to December 2019 in the Netherlands. Kaplan-Meier survival analysis was performed to determine the difference in survival. Multivariable Cox regression analyses were performed to identify predictors of survival. RESULTS A total of 1237 patients met the inclusion criteria, of which 127 patients underwent repeat metastasectomy. Five-year overall survival was 53 per cent after pulmonary metastasectomy for colorectal pulmonary metastases and 52 per cent after repeat metastasectomy (P = 0.852). The median follow-up was 42 (range 0-285) months. More patients experienced postoperative complications after repeat metastasectomy compared with the first metastasectomy (18.1 per cent versus 11.6 per cent respectively; P = 0.033). Eastern Cooperative Oncology Group performance status greater than or equal to 1 (HR 1.33, 95 per cent c.i. 1.08 to 1.65; P = 0.008), multiple metastases (HR 1.30, 95 per cent c.i. 1.01 to 1.67; P = 0.038), and bilateral metastases (HR 1.50, 95 per cent c.i. 1.01 to 2.22; P = 0.045) were prognostic factors on multivariable analysis for pulmonary metastasectomy. Diffusing capacity of the lungs for carbon monoxide less than 80 per cent (HR 1.04, 95 per cent c.i. 1.01 to 1.06; P = 0.004) was the only prognostic factor on multivariable analysis for repeat metastasectomy. CONCLUSION This study demonstrates that patients with colorectal pulmonary metastases have comparable median and 5-year overall survival rates after primary or recurrent pulmonary metastasectomy. However, repeat metastasectomy has a higher risk of postoperative complications.
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Affiliation(s)
- Martijn van Dorp
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | | | - Bart Torensma
- Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Chris Dickhoff
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Geert Kazemier
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - David J Heineman
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
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9
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Mills AC, Hofstetter WL, Mehran RJ, Rajaram R, Rice DC, Sepesi B, Swisher SG, Vaporciyan AA, Walsh GL, Antonoff MB. Repeated Pulmonary Metastasectomy: Third Operations and Beyond. Ann Thorac Surg 2023; 115:679-685. [PMID: 35926641 DOI: 10.1016/j.athoracsur.2022.07.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/11/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND For extrathoracic malignant neoplasms that have metastasized to the lungs, previous investigations have demonstrated both oncologic and survival benefits after pulmonary and repeated metastasectomy. Little is known about the feasibility of incrementally increasing numbers of subsequent metastasectomy procedures. METHODS We conducted a retrospective review of patients who underwent ≥3 pulmonary resection procedures for recurrent, metachronous metastatic disease of nonlung primary malignant neoplasms at a single institution between 1992 and 2020. Primary outcomes collected pertained to safety and feasibility, including estimated blood loss (EBL), hospital length of stay, and details of postoperative complications. RESULTS There were 117 patients who met inclusion criteria, having undergone at least 3 metastasectomy operations, with 55 (47.1%) undergoing a fourth operation and 20 (17.1%) undergoing a fifth operation. EBL did not differ between first and second operations (106.6 mL vs 102.5 mL; P = .76). It was, however, significantly greater at third operations (102.5 mL vs 238.7 mL; P = .000016). We noted an increase in wound complications between the second and third operations (0.9% vs 6.8%; P = .02) and incremental increases in likelihood of prolonged air leak with each subsequent operation. The need for reoperation was low for all and similar between operations. Importantly, hospital length of stay was similar for all procedures, as were the frequencies of hospital readmission. CONCLUSIONS Third-time redo pulmonary metastasectomy can be performed safely and feasibly in select patients. Further repeated resection should remain a therapeutic option for patients, although risks for potentially longer operating time, greater EBL, and prolonged air leaks may be anticipated.
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Affiliation(s)
- Alexander C Mills
- Department of General Surgery, Memorial Hermann Hospital, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ravi Rajaram
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Garrett L Walsh
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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10
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Hassan M, Ehle B, Le UT, Titze L, Passlick B, Grapatsas K. Outcome of Repeated Resection of Pulmonary Metastases for Renal Cell Cancer. Thorac Cardiovasc Surg 2023; 71:130-137. [PMID: 35987192 DOI: 10.1055/s-0042-1755555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND To date, many studies investigated results and prognostic factors of pulmonary metastasectomy (PM) in renal cell cancer (RCC). However, reports concerning repeated resection for patients with recurrent pulmonary metastases (RPM) are limited. In this study, we analyzed safety, efficacy, and prognostic factors for survival after PM focusing on RPM for RCC. PATIENTS AND METHODS Clinical, operative, and follow-up data of patients who underwent PM or RPM for RCC in our institution were retrospectively collected and correlated with each other from January 2005 to December 2019. RESULTS Altogether 154 oncological pulmonary resections in curative intention as PM or RPM were performed in 82 and 26 patients. Postoperative complications were similar in both groups (n = 22 [26.8%] vs. 4 [15.4%], p = 0.2). Zero mortality was documented up to the 30th postoperative day. RPM was not associated with decreased 5-year-survival compared with PM (66.2 vs. 57,9%, p = 0.5). Patients who underwent RPM for recurrent lung metastases had a better overall survival in comparison with the other treatments including chemotherapy, radiotherapy, immunotherapy, and best supportive care (p = 0.04). In the multivariate analysis, disease-free survival was identified as an independent prognostic factor for survival (hazard ratio: 0.969, 0.941-0.999, p = 0.04). CONCLUSION RPM is a safe and feasible procedure. The resection of recurrent lung metastases shows to prolong survival in comparison with the other therapeutic options for selected patients with RCC.
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Affiliation(s)
- Mohamed Hassan
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Benjamin Ehle
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Uyen-Thao Le
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Laurin Titze
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernward Passlick
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Konstantinos Grapatsas
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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11
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Horie T, Kanemitsu Y, Takamizawa Y, Moritani K, Tsukamoto S, Shida D. Prognostic differences between oligometastatic and polymetastatic disease after resection in patients with colorectal cancer and hepatic or lung metastases: Retrospective analysis of a large cohort at a single institution. Surgery 2023; 173:328-334. [PMID: 36400583 DOI: 10.1016/j.surg.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/30/2022] [Accepted: 10/11/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Long-term survival data are lacking, and prognostic factors are not well-defined for patients with colorectal cancer and hepatic or lung metastases. This study evaluated the outcomes after resection of oligometastatic hepatic or lung metastases from colorectal cancer and sought to identify prognostic factors. METHODS We retrospectively investigated 1,123 patients with colorectal cancer and hepatic or pulmonary metastases who underwent curative surgery between January 1991 and December 2016. RESULTS Of the 1,123 patients, 719 had hepatic metastases, 287 had pulmonary metastases, and 117 had both. The 5-year overall survival rate was 52.3% in the hepatic metastases group, 70.4% in the pulmonary metastases group, and 71.4% in the hepatic and pulmonary metastases group (P < .001). In total, 1,045 patients had oligometastases (1-5 metastatic lesions in 1 or 2 organs) and 78 had polymetastases (≥6 metastases in 1 or 2 organs). Prognosis was significantly better in patients with oligometastases than in those with polymetastases. The 5-year overall survival rate was 59.0% in the oligometastases group and 35.3% in the polymetastases group (P < .001); the respective 5-year relapse-free survival rates were 37.5% and 11.6% (P < .001). Multivariable analysis identified predictors of both poor overall survival and relapse-free survival to be a high carcinoembryonic antigen level before the first metastasectomy, largest metastasis measuring ≥2 cm, polymetastases, and synchronous metastases. CONCLUSION Prognosis after curative resection was better in patients with oligometastatic colorectal cancer in the liver or lung than in those with polymetastases. Multidisciplinary decision-making strategies, including about surgery, should be based on number of metastases rather than their site.
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Affiliation(s)
- Tomoko Horie
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan.
| | - Yasuyuki Takamizawa
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Konosuke Moritani
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Shunsuke Tsukamoto
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Dai Shida
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan; Division of Frontier Surgery, Institute of Medical Science, University of Tokyo, Japan
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12
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Mistretta FA, Luzzago S, Conti A, Verri E, Marvaso G, Collà Ruvolo C, Catellani M, Di Trapani E, Cozzi G, Bianchi R, Ferro M, Cordima G, Brescia A, Cossu Rocca M, Mirone V, Jereczek-Fossa BA, Nolè F, de Cobelli O, Musi G. Oligometastatic Prostate Cancer: A Comparison between Multimodality Treatment vs. Androgen Deprivation Therapy Alone. Cancers (Basel) 2022; 14:cancers14092313. [PMID: 35565441 PMCID: PMC9100905 DOI: 10.3390/cancers14092313] [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: 11/30/2021] [Revised: 02/06/2022] [Accepted: 02/23/2022] [Indexed: 02/04/2023] Open
Abstract
Background: We compared multimodality treatment (MMT, defined as robot-assisted radical prostatectomy (RARP) with androgen deprivation therapy (ADT), with or without adjuvant radiotherapy (RT)) vs. ADT alone in oligometastatic prostate cancer (OPC) patients. Methods: From 2010 to 2018, we identified 74 patients affected by cM1a-b OPC (≤5 metastases). Kaplan−Meier (KM) plots depicted cancer-specific mortality (CSM), disease progression, metastatic castration-resistant PC (mCRPC), and time to second-line systemic therapy rates. Multivariable Cox regression models (MCRMs) focused on disease progression and mCRPC. Results: Forty (54.0%) MMT and thirty-four (46.0%) ADT patients were identified. On KM plots, higher CSM (5.9 vs. 37.1%; p = 0.02), mCRPC (24.0 vs. 62.5%; p < 0.01), and second-line systemic therapy (33.3 vs. 62.5%; p < 0.01) rates were recorded in the ADT group. No statistically significant difference was recorded for disease progression. ForMCRMs adjusted for the metastatic site and PSA, a higher mCRPC rate was recorded in the ADT group. No statistically significant difference was recorded for disease progression. Treatment-related adverse events occurred in 5 (12.5%) MMT vs. 15 (44.1%) ADT patients (p < 0.01). Conclusions: MMT was associated with lower CSM, mCRPC, and second-line therapy rates. A lower rate of treatment-related adverse events was recorded for the MMT group.
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Affiliation(s)
- Francesco A. Mistretta
- Department of Urology, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy; (F.A.M.); (A.C.); (C.C.R.); (M.C.); (E.D.T.); (G.C.); (R.B.); (M.F.); (G.C.); (A.B.); (O.d.C.); (G.M.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy; (G.M.); (B.A.J.-F.)
| | - Stefano Luzzago
- Department of Urology, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy; (F.A.M.); (A.C.); (C.C.R.); (M.C.); (E.D.T.); (G.C.); (R.B.); (M.F.); (G.C.); (A.B.); (O.d.C.); (G.M.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy; (G.M.); (B.A.J.-F.)
- Correspondence:
| | - Andrea Conti
- Department of Urology, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy; (F.A.M.); (A.C.); (C.C.R.); (M.C.); (E.D.T.); (G.C.); (R.B.); (M.F.); (G.C.); (A.B.); (O.d.C.); (G.M.)
| | - Elena Verri
- Department of Oncology, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy; (E.V.); (M.C.R.); (F.N.)
| | - Giulia Marvaso
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy; (G.M.); (B.A.J.-F.)
- Department of Radiotherapy, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy
| | - Claudia Collà Ruvolo
- Department of Urology, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy; (F.A.M.); (A.C.); (C.C.R.); (M.C.); (E.D.T.); (G.C.); (R.B.); (M.F.); (G.C.); (A.B.); (O.d.C.); (G.M.)
- Department of Urology, University of Naples Federico II, 80100 Naples, Italy;
| | - Michele Catellani
- Department of Urology, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy; (F.A.M.); (A.C.); (C.C.R.); (M.C.); (E.D.T.); (G.C.); (R.B.); (M.F.); (G.C.); (A.B.); (O.d.C.); (G.M.)
| | - Ettore Di Trapani
- Department of Urology, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy; (F.A.M.); (A.C.); (C.C.R.); (M.C.); (E.D.T.); (G.C.); (R.B.); (M.F.); (G.C.); (A.B.); (O.d.C.); (G.M.)
| | - Gabriele Cozzi
- Department of Urology, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy; (F.A.M.); (A.C.); (C.C.R.); (M.C.); (E.D.T.); (G.C.); (R.B.); (M.F.); (G.C.); (A.B.); (O.d.C.); (G.M.)
| | - Roberto Bianchi
- Department of Urology, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy; (F.A.M.); (A.C.); (C.C.R.); (M.C.); (E.D.T.); (G.C.); (R.B.); (M.F.); (G.C.); (A.B.); (O.d.C.); (G.M.)
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy; (F.A.M.); (A.C.); (C.C.R.); (M.C.); (E.D.T.); (G.C.); (R.B.); (M.F.); (G.C.); (A.B.); (O.d.C.); (G.M.)
| | - Giovanni Cordima
- Department of Urology, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy; (F.A.M.); (A.C.); (C.C.R.); (M.C.); (E.D.T.); (G.C.); (R.B.); (M.F.); (G.C.); (A.B.); (O.d.C.); (G.M.)
| | - Antonio Brescia
- Department of Urology, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy; (F.A.M.); (A.C.); (C.C.R.); (M.C.); (E.D.T.); (G.C.); (R.B.); (M.F.); (G.C.); (A.B.); (O.d.C.); (G.M.)
| | - Maria Cossu Rocca
- Department of Oncology, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy; (E.V.); (M.C.R.); (F.N.)
| | - Vincenzo Mirone
- Department of Urology, University of Naples Federico II, 80100 Naples, Italy;
| | - Barbara A. Jereczek-Fossa
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy; (G.M.); (B.A.J.-F.)
- Department of Radiotherapy, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy
| | - Franco Nolè
- Department of Oncology, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy; (E.V.); (M.C.R.); (F.N.)
| | - Ottavio de Cobelli
- Department of Urology, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy; (F.A.M.); (A.C.); (C.C.R.); (M.C.); (E.D.T.); (G.C.); (R.B.); (M.F.); (G.C.); (A.B.); (O.d.C.); (G.M.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy; (G.M.); (B.A.J.-F.)
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy; (F.A.M.); (A.C.); (C.C.R.); (M.C.); (E.D.T.); (G.C.); (R.B.); (M.F.); (G.C.); (A.B.); (O.d.C.); (G.M.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy; (G.M.); (B.A.J.-F.)
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Outcome of Repeat Pulmonary Metastasectomy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1335:37-44. [PMID: 33890245 DOI: 10.1007/5584_2021_635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Pulmonary metastasectomy is a well-established contribution to the cure of oligometastatic cancers, but its exact effectiveness is poorly understood. Here we report the outcomes of repeat pulmonary metastasectomy from a multicenter trial. This retrospective study included patients who underwent re-do metastasectomies between January 2010 and December 2014. The exclusion criterion was metastasectomy without curative intent. We reviewed medical files of 621 consecutive patients who underwent initial pulmonary metastasectomy. Of those, 64 patients underwent repeat metastasectomies, and these patients were included in the analysis. All the 64 patients underwent a second metastasectomy, later 35 of them underwent a third metastasectomy, 12 underwent a fourth metastasectomy, and 6 underwent a fifth metastasectomy. The total number of re-do metastasectomies was 181. The median overall survival among the patients undergoing re-do metastasectomy was 66.0 ± 3.8 months. Three and 5-year survival rates were 82.3% and 63.3%, respectively. The 5-year survival rates were 63.3% after the first, 50.9% after the second, 74.4% after the third, 83.3% after the fourth, and 60.0% after the fifth metastasectomy. We conclude that at the current stage of knowledge, there is an indication for repeat re-do metastasectomy with curative intent.
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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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Pellini B, Pejovic N, Feng W, Earland N, Harris PK, Usmani A, Szymanski JJ, Qaium F, Mudd J, Petty M, Jiang Y, Singh A, Maher CA, Henke LE, Park H, Ciorba MA, Kim H, Mutch MG, Pedersen KS, Tan BR, Hawkins WG, Fields RC, Chaudhuri AA. ctDNA MRD Detection and Personalized Oncogenomic Analysis in Oligometastatic Colorectal Cancer From Plasma and Urine. JCO Precis Oncol 2021; 5:PO.20.00276. [PMID: 34250420 PMCID: PMC8232837 DOI: 10.1200/po.20.00276] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/14/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023] Open
Abstract
We hypothesized that circulating tumor DNA (ctDNA) molecular residual disease (MRD) analysis without prior mutational knowledge could be performed after neoadjuvant chemotherapy to assess oligometastatic colorectal cancer (CRC) treated surgically with curative intent. We also investigated urine as an alternative analyte for ctDNA MRD detection in this nongenitourinary setting. PATIENTS AND METHODS We applied AVENIO targeted next-generation sequencing to plasma, tumor, and urine samples acquired on the day of curative-intent surgery from 24 prospectively enrolled patients with oligometastatic CRC. Age-related clonal hematopoiesis was accounted for by removing variants also present in white blood cells. Plasma and urine ctDNA MRD were correlated with tumor cells detected in the surgical specimen, and adjuvant treatment strategies were proposed based on ctDNA-inferred tumor mutational burden (iTMB) and targetable alterations. RESULTS Seventy-one percent of patients were treated with neoadjuvant chemotherapy. Tumor-naive plasma ctDNA analysis detected MRD at a median level of 0.62% with 95% sensitivity and 100% specificity, and 94% and 77% sensitivity when only considering patients treated with neoadjuvant chemotherapy and putative driver mutations, respectively. In urine, ctDNA MRD detection specificity remained high at 100%, but sensitivity decreased to 64% with median levels being 11-fold lower than in plasma (P < .0001). Personalized ctDNA MRD oncogenomic analysis revealed 81% of patients might have been candidates for adjuvant immunotherapy based on high iTMB or targeted therapy based on actionable PIK3CA mutations. CONCLUSION Tumor-naive plasma ctDNA analysis can sensitively and specifically detect MRD in patients with oligometastatic CRC after neoadjuvant chemotherapy. Urine-based ctDNA MRD detection is also feasible; however, it is less sensitive than plasma because of significantly lower levels. Oligometastatic patients with detectable MRD may benefit from additional personalized treatment based on ctDNA-derived oncogenomic profiling.
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Affiliation(s)
- Bruna Pellini
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Nadja Pejovic
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Wenjia Feng
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Noah Earland
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Peter K. Harris
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Abul Usmani
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Jeffrey J. Szymanski
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Faridi Qaium
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Jacqueline Mudd
- Section of Surgical Oncology, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Marvin Petty
- Section of Surgical Oncology, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | | | | | - Christopher A. Maher
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
- Department of Biomedical Engineering, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
- McDonnell Genome Institute, Washington University School of Medicine, St Louis, MO
| | - Lauren E. Henke
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Haeseong Park
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Matthew A. Ciorba
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Hyun Kim
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Matthew G. Mutch
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
- Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Katrina S. Pedersen
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Benjamin R. Tan
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - William G. Hawkins
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
- Section of Hepatobiliary-Pancreatic and Gastrointestinal Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Ryan C. Fields
- Section of Surgical Oncology, Department of Surgery, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Aadel A. Chaudhuri
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
- Department of Biomedical Engineering, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
- Department of Genetics, Washington University School of Medicine, St Louis, MO
- Department of Computer Science and Engineering, Washington University in St Louis, St Louis, MO
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Forster C, Ojanguren A, Perentes JY, Zellweger M, Federici S, Krueger T, Abdelnour-Berchtold E, Gonzalez M. Is repeated pulmonary metastasectomy justified? Clin Exp Metastasis 2020; 37:675-682. [PMID: 32920725 PMCID: PMC7665970 DOI: 10.1007/s10585-020-10056-w] [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: 06/08/2020] [Accepted: 09/06/2020] [Indexed: 02/07/2023]
Abstract
Recurrence after pulmonary metastasectomy (PM) is frequent, but it is unclear to whom repeated pulmonary metastasectomy (RPM) offers highest benefits. Retrospective analysis of oncological and post-operative outcomes of consecutive patients who underwent PM from 2003 to 2018. Overall survival (OS) and disease-free interval (DFI) were calculated. Cox regression was used to identify variables influencing OS and DFI. In total, 264 patients (female/male: 114/150; median age: 62 years) underwent PM for colorectal cancer (32%), sarcoma (19%), melanoma (16%) and other primary tumors (33%). Pulmonary metastasectomy was approached by video-assisted thoracic surgery (VATS) in 73% and pulmonary resection was realized by non-anatomical resection in 76% of cases. The overall median follow-up time was 33 months (IQR 16–56 months) and overall 5-year survival rate was 62%. Local or distant recurrences were observed in 172 patients (65%) and RPM could be performed in 66 patients (25%) for a total of 116 procedures. RPM was realized by VATS in 49% and pulmonary resection by wedge in 77% of cases. In RPM patients, the 5-year survival rate after first PM was 79%. Post-operative cardio-pulmonary complication rate (13% vs. 12%; p = 0.8) and median length of stay (4 vs. 5 days; p = 0.2) were not statistically different between first PM and RPM. Colorectal cancer (HR 0.56), metachronous metastasis (HR 0.48) and RPM (HR 0.5) were associated with better survival. In conclusion, our results suggest that RPM offers favorable survival rates without increasing post-operative morbidity.
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Affiliation(s)
- Céline Forster
- Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Amaya Ojanguren
- Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Jean Yannis Perentes
- 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
- Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Sara Federici
- Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Thorsten Krueger
- 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
| | | | - Michel Gonzalez
- 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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17
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Sakamaki Y, Ishida D, Tanaka R. Prognosis of patients with recurrence after pulmonary metastasectomy for colorectal cancer. Gen Thorac Cardiovasc Surg 2020; 68:1172-1178. [PMID: 32323124 DOI: 10.1007/s11748-020-01368-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/11/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We investigated the prognosis of patients with recurrence of pulmonary metastases (PM) from colorectal cancer (CRC) after resection. METHODS We reviewed our surgical series of 101 CRC patients with PM who underwent R0 resection with curative intent. The overall survival (OS) and disease-free survival (DFS) rates after metastasectomy as well as the prognostic factors of survival were analyzed. RESULTS Fifty-five patients (54%) experienced recurrence, of whom 21 had developed extrapulmonary metastasis (EPM) before lung resection. Multivariate analysis restricted to patients with recurrence identified a disease-free interval (DFI) shorter than a year as an adverse prognosticator of OS (HR, 2.68; 95% CI 1.40-5.51; P < 0.01) and DFS (HR, 8.54; 95% CI 3.0-24.6; P < 0.001). EPM was also identified as an adverse prognosticator of OS for patients with recurrence (HR, 3.16; 95% CI 1.64-5.88; P < 0.001). There was a significant difference in the 5-year OS rate between patients with and without EPM (27.9% vs 64.9%, P < 0.001), and between those with a DFI shorter and longer than a year (40.0% vs 75.0%, P < 0.01). Among these, 31 patients (56%) bore lung-limited recurrence after their first lung resection, of whom 20 (36%) underwent a total of 29 repeat pulmonary metastasectomies, which resulted in a 5-year OS rate of 71.3% after the second lung resection. CONCLUSIONS Our findings indicate that CRC patients with PM whose DFI is shorter than a year after lung resection or those with prior EPM more frequently experience multisite recurrence.
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Affiliation(s)
- Yasushi Sakamaki
- Department of Chest Surgery, Osaka Police Hospital, Kitayamacho 10-31, Tennoji, Osaka, 543-8502, Japan.
| | - Daisuke Ishida
- Department of Chest Surgery, Osaka Police Hospital, Kitayamacho 10-31, Tennoji, Osaka, 543-8502, Japan
| | - Ryo Tanaka
- Department of Chest Surgery, Osaka Police Hospital, Kitayamacho 10-31, Tennoji, Osaka, 543-8502, Japan
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18
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Gonzalez M, Zellweger M, Nardini M, Migliore M. Precision surgery in lung metastasectomy. Future Oncol 2019; 16:7-13. [PMID: 31858825 DOI: 10.2217/fon-2018-0713] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The value of pulmonary metastasis (PM) resection in the context of controlled primary tumor sites was shown to improve survival of patients if complete resection could be achieved. The surgeon's approach can be modulated by various parameters pertaining to safety margins including local growth properties, size, spread and location of PMs. Lymph node dissection and assessment is recommended although its impact on survival remains unclear. Thoracoscopic surgery combined to thin slice chest CT scans has shown results comparable to thoracotomy in patients with few PMs. The management of PMs should therefore be discussed on an individual, interdisciplinary basis to offer the best possible oncological and surgical results as well as to maximize long term patient survival rates.
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Affiliation(s)
- Michel Gonzalez
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Matthieu Zellweger
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Marco Nardini
- Service of Thoracic Surgery, University Hospital of Catania, Italy
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19
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Procaccio L, Bergamo F, Manai C, Di Antonio V, Fassan M, Zagonel V, Lonardi S, Loupakis F. An overview on clinical, pathological and molecular features of lung metastases from colorectal cancer. Expert Rev Respir Med 2019; 13:635-644. [PMID: 31119959 DOI: 10.1080/17476348.2019.1620605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Lung metastases occur in 10-20% of patients with colorectal cancer (CRC). Most of them are treated with palliative intent and have a poor prognosis. Pulmonary metastasectomy may be a curative option for carefully selected patients with 5-year survival rates ranging from 25% to 60%. However, up to 70% of patients develop recurrence after pulmonary metastasectomy. Therefore, the identification of prognostic factors is essential in CRC patients with resectable lung metastases. Areas covered: This review aims at summarizing the actual body of knowledge available on lung metastases from CRC focusing on their clinical, pathological and molecular profile. Moreover, we provide an update on experts' attitudes towards lung metastasectomy, adjuvant or perioperative chemotherapy. Expert opinion: Traditional clinical prognosticators such as the total number of pulmonary metastases, carcinoembryonic antigen (CEA) serum levels before surgery, and presence of lymph node metastases cannot provide reliable criteria to predict survival after lung metastasectomy. Indeed, research efforts have been directed in recent years toward studying the biological characteristics of lung lesions to better define prognosis and response to treatment, and ultimately shed new light on their proper local and systemic management.
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Affiliation(s)
- Letizia Procaccio
- a Unit of Medical Oncology 1, Department of Clinical and Experimental Oncology , Istituto Oncologico Veneto IOV - IRCCS , Padova , Italia.,b Department of Surgery, Oncology and Gastroenterology , University of Padova , Padova , Italia
| | - Francesca Bergamo
- a Unit of Medical Oncology 1, Department of Clinical and Experimental Oncology , Istituto Oncologico Veneto IOV - IRCCS , Padova , Italia
| | - Chiara Manai
- a Unit of Medical Oncology 1, Department of Clinical and Experimental Oncology , Istituto Oncologico Veneto IOV - IRCCS , Padova , Italia
| | - Veronica Di Antonio
- a Unit of Medical Oncology 1, Department of Clinical and Experimental Oncology , Istituto Oncologico Veneto IOV - IRCCS , Padova , Italia
| | - Matteo Fassan
- c Department of Medicine, Surgical Pathology and Cytopathology Unit , University of Padova , Padova , Italy
| | - Vittorina Zagonel
- a Unit of Medical Oncology 1, Department of Clinical and Experimental Oncology , Istituto Oncologico Veneto IOV - IRCCS , Padova , Italia
| | - Sara Lonardi
- a Unit of Medical Oncology 1, Department of Clinical and Experimental Oncology , Istituto Oncologico Veneto IOV - IRCCS , Padova , Italia
| | - Fotios Loupakis
- a Unit of Medical Oncology 1, Department of Clinical and Experimental Oncology , Istituto Oncologico Veneto IOV - IRCCS , Padova , Italia
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20
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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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21
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Li W, Jiang H, Yu Y, Wang Y, Wang Z, Cui Y, Shen K, Shen Z, Fang Y, Liu T. Outcomes of gastrectomy following upfront chemotherapy in advanced gastric cancer patients with a single noncurable factor: a cohort study. Cancer Manag Res 2019; 11:2007-2013. [PMID: 30881125 PMCID: PMC6407509 DOI: 10.2147/cmar.s192570] [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] [Indexed: 12/24/2022] Open
Abstract
Purpose Chemotherapy is the standard care for patients with incurable advanced gastric cancer. Whether or when the addition of gastrectomy to chemotherapy improves survival of advanced gastric cancer patients with a single noncurable factor remains controversial. We aimed to evaluate the superiority of gastrectomy following chemotherapy vs chemotherapy alone regarding overall survival (OS) in these patients. Patients and methods Patients with advanced gastric cancer from January 2008 to December 2014 were retrieved from our prospectively acquired database and retrospectively analyzed. The patients with a single noncurable factor were grouped in terms of cancer treatment: chemotherapy alone or gastrectomy following chemotherapy. Results Four hundred and fourteen patients (333 chemotherapy alone and 81 gastrectomy following chemotherapy) were included in this study. Kaplan–Meier survival curve showed a significant difference on median OS between chemotherapy-alone group and the gastrectomy plus chemotherapy group (10.9 vs 15.9 months, P<0.01). After propensity score analysis (n=126), chemotherapy plus surgery (81 patients) also showed survival benefit over chemotherapy alone (35 patients) (15.9 vs 10.0 months, P<0.01). Furthermore, stratified analyses indicated that patients with liver metastasis, <65 years of age, male, having normal level of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA199) upon diagnosis, or having nongastro-esophageal junction tumor benefited from surgery. Conclusion This study suggests that gastrectomy after chemotherapy could lead to survival benefit over chemotherapy alone in advanced gastric cancer patients with a single nonresectable factor if the disease was controllable by chemotherapy.
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Affiliation(s)
- Wei Li
- Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China,
| | - Huiqin Jiang
- Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China,
| | - Yiyi Yu
- Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China,
| | - Yan Wang
- Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China,
| | - Zhiming Wang
- Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China,
| | - Yuehong Cui
- Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China,
| | - Kuntang Shen
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhenbin Shen
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yong Fang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tianshu Liu
- Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China, .,Center of Evidence-Based Medicine, Fudan University, Shanghai, China,
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22
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Aujla KS, Katz AW, Singh DP, Okunieff P, Milano MT. Hypofractionated Stereotactic Radiotherapy for Non-breast or Prostate Cancer Oligometastases: A Tail of Survival Beyond 10 Years. Front Oncol 2019; 9:111. [PMID: 30873385 PMCID: PMC6400963 DOI: 10.3389/fonc.2019.00111] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/06/2019] [Indexed: 12/27/2022] Open
Abstract
Purpose and Objective(s): We sought to analyze the long-term follow-up of patients treated with hypofractionated, stereotactic radiotherapy (HSRT) for oligometastases from malignancies other than breast or prostate cancer. Materials and Methods: From 2001 to 2006, 82 cancer patients with 1-5 radiographically apparent metastatic lesions (in 1-3 organs) from primary sites other than breast or prostate cancer, were enrolled on a prospective study of HSRT. Freedom from widespread metastasis (FFWM) was defined from date of enrollment until death, an event (i.e., widespread distant metastasis not amenable to local therapy), or last radiographic study. Local recurrence was scored as an event if pathologically confirmed or if a treated lesion increased by ≥20% using RECIST criteria. Prognostic variables were assessed using Cox regression analysis. Results: The mean age was 61 ± 11 years, with a male to female ratio of 46:36. The most common metastatic sites were liver (50%), lung (48%), thoracic lymph nodes (18%), and bone (5%). Sixty-one patients (74%) had 1 involved organ and 18 (22%) had 1 lesion treated. The preferred dose-fractionation scheduled was 50 Gy in 10 fractions (52 patients). The median follow-up was 1.7 years. Eleven patients lived >5 years, and 6 lived >10 years. The 5-year OS, PFS, FFWM, and LC rates were 13.4, 7.3, 18.3, and 63.4%, and the 10-years OS, PFS, FFWM, and patient LC rates were 7.3, 6.1, 13.4, and 62.2%, respectively. A greater net gross tumor volume (GTV) was significantly adverse for OS (p < 0.01) and LC (p < 0.01). For FFWM, net GTV was not a significant factor (p = 0.14). Four patients remain alive at >13 years from enrollment and treatment, without evidence of active disease. Conclusion: A small subset of select non-breast, non-prostate cancer patients with limited metastasis treated with HSRT are long-term survivors. Net GTV is a significant factor for tumor control and survival. Further research is needed to help better select patients most likely to benefit from local therapy for metastatic disease.
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Affiliation(s)
- Khush S. Aujla
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, United States
| | - Alan W. Katz
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, United States
| | - Deepinder P. Singh
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, United States
| | - Paul Okunieff
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Michael T. Milano
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, United States
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23
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Kwon J, Han HS, Kim HK, Baek SW, Yang Y, Lee KH, Son SM, Kim WD, Kim DH, Yun HY. Long-term Survival after Repeated Local Therapy and Salvage Chemotherapy for Recurrent Metastases from Gastric Cancer: a Case Report and Literature Review. J Gastric Cancer 2018; 18:305-312. [PMID: 30276007 PMCID: PMC6160522 DOI: 10.5230/jgc.2018.18.e26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/09/2018] [Accepted: 08/14/2018] [Indexed: 11/20/2022] Open
Abstract
We report a rare case of long-term survival in a patient who received local therapy and salvage chemotherapy for recurrent metastases, along with a literature review. A 65-year-old male patient underwent subtotal gastrectomy for advanced gastric adenocarcinoma. Six months after gastrectomy, 2 metastatic intra-abdominal lymph node enlargements were detected, which were treated with radiotherapy. At 55 months after gastrectomy, an abdominal wall mass was detected, which was treated by surgical resection. The patient received 5-fluorouracil/leucovorin/irinotecan chemotherapy for 27 months before and after radiotherapy and docetaxel chemotherapy for 6 months after surgical resection of the abdominal wall metastasis. At the last visit, 7.8 years since the initial resection of the primary gastric cancer and 6.2 years since detection of the first metastases, the patient was disease-free and required no further chemotherapy. This case suggests that repeated local therapy offers potential for long-term survival in a carefully selected subset of patients with recurrent metastases.
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Affiliation(s)
- Jihyun Kwon
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Hye Sook Han
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.,Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hee Kyung Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Seung-Woo Baek
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yaewon Yang
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Ki Hyeong Lee
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.,Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seung-Myoung Son
- Department of Pathology, Chungbuk National University Hospital, Cheongju, Korea
| | - Won-Dong Kim
- Department of Radiation Oncology, Chungbuk National University Hospital, Cheongju, Korea.,Department of Radiation Oncology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Dae Hoon Kim
- Department of Surgery, Chungbuk National University Hospital, Cheongju, Korea
| | - Hyo Yung Yun
- Department of Surgery, Chungbuk National University Hospital, Cheongju, Korea.,Department of Surgery, Chungbuk National University College of Medicine, Cheongju, Korea
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24
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Zellweger M, Abdelnour-Berchtold E, Krueger T, Ris HB, Perentes JY, Gonzalez M. Surgical treatment of pulmonary metastasis in colorectal cancer patients: Current practice and results. Crit Rev Oncol Hematol 2018; 127:105-116. [PMID: 29891107 DOI: 10.1016/j.critrevonc.2018.05.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/12/2018] [Accepted: 05/07/2018] [Indexed: 12/13/2022] Open
Abstract
Colorectal cancer (CRC) is a frequently occurring disease, yet diagnosed at a local stage in only 40% of cases. Lung metastases (LM) appear in 5-15% of patients and, left untreated, carry a very poor prognosis. Some CRC patients may benefit from a potentially curative LM resection, but success and benefit are difficult to predict. We discuss prognostic factors of survival after lung metastasectomy in CRC patients under several scenarios (with/ without prior liver metastases; repetitive pulmonary resections). We reviewed all studies (2005-2015) about pulmonary metastases surgical management with curative intent in CRC patients, with a minimum threshold on the number of patients reported (without prior liver metastases: n ≥ 100; with prior resection of liver metastases: n ≥ 50; repetitive thoracic surgery: n ≥ 30). The picture of the prognostic factors of survival is nuanced: surgical management demonstrates clear successes and steady progress, yet there is no single success criterion; stratification of patients and selection bias impact the conclusions. Surgical management of liver and lung metastases may prolong life or cure CRC patients, provided the lesions are fully resected and patients carefully selected. Repeat lung metastasectomy is a safe approach to treat patients in selected cases. In conclusion, there is no standard for surgical management in CRC patients with pulmonary metastases. Patients with isolated unilateral lung metastasis with normal CEA level and no lymph node involvement benefit the most from surgery. Most series report good results in highly selected patients, but instances of long-term disease-free survival remain exceptional.
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Affiliation(s)
- Matthieu Zellweger
- Division of Thoracic Surgery, Centre Hospitalier Vaudois (CHUV), Lausanne, Switzerland.
| | | | - Thorsten Krueger
- Division of Thoracic Surgery, Centre Hospitalier Vaudois (CHUV), Lausanne, Switzerland.
| | - Hans-Beat Ris
- Division of Thoracic Surgery, Centre Hospitalier Vaudois (CHUV), Lausanne, Switzerland.
| | - Jean Yannis Perentes
- Division of Thoracic Surgery, Centre Hospitalier Vaudois (CHUV), Lausanne, Switzerland.
| | - Michel Gonzalez
- Division of Thoracic Surgery, Centre Hospitalier Vaudois (CHUV), Lausanne, Switzerland.
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25
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Nanji S, Karim S, Tang E, Brennan K, McGuire A, Pramesh C, Booth CM. Pulmonary Metastasectomy for Colorectal Cancer: Predictors of Survival in Routine Surgical Practice. Ann Thorac Surg 2018. [DOI: 10.1016/j.athoracsur.2018.02.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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26
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Kim JY, Park IJ, Kim HR, Kim DK, Lee JL, Yoon YS, Kim CW, Lim SB, Lee JB, Yu CS, Kim JC. Post-pulmonary metastasectomy prognosis after curative resection for colorectal cancer. Oncotarget 2018; 8:36566-36577. [PMID: 28402263 PMCID: PMC5482677 DOI: 10.18632/oncotarget.16616] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/12/2017] [Indexed: 12/23/2022] Open
Abstract
Purpose We aimed to compare disease-free survival after pulmonary metastasectomy to that after hepatic metastasectomy, and to identify prognostic factors after pulmonary metastasectomy. Results Between 2005 and 2015, 129 patients underwent resection of isolated metachronous lung metastases from colorectal cancer. Three-year DFS after pulmonary metastasectomy was similar to that after hepatic metastasectomy (50.7% vs. 45.5%, respectively; p=0.58). Rectal cancer (hazard ratio [HR]: 2.04, 95% confidence interval [CI]: 1.09–3.79; p=0.03) and ≥2 metastases (HR: 2.17, 95% CI: 1.28–3.68; p=0.004) were independent adverse risk factors associated with disease-free survival after pulmonary metastasectomy on multivariate analysis. Three-year DFS for colon vs. rectal cancer patients was 72.5% vs. 42.6%, respectively (p=0.04). The number of lung metastases was an independent risk factor for DFS after pulmonary metastasectomy in rectal cancer patients. Patients and Methods Patients who underwent lung metastasectomy after curative resection of colorectal cancers were investigated. Disease-free survival (DFS) after pulmonary metastasectomy was compared to that after hepatic metastasectomy, which has a relatively well-known prognosis. Multivariate Cox proportional hazards analysis was performed to identify clinical variables predictive of survival after pulmonary metastasectomy. Conclusions Disease-free survival rates after resection of lung vs. liver metastases arising from colorectal cancers are similar. However, lung metastases specifically from rectal cancers produce poorer DFS rates. Primary tumor location must be considered for pulmonary metastasis treatment and follow-up in colorectal cancer patients.
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Affiliation(s)
- Jee Yeon Kim
- Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - In Ja Park
- Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Jong Lyul Lee
- Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Yong Sik Yoon
- Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Chan Wook Kim
- Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Seok-Byung Lim
- Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Jung Bok Lee
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Chang Sik Yu
- Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Jin Cheon Kim
- Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
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27
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Swaid F, Tsung A. Current Management of Liver Metastasis From Colorectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2018. [DOI: 10.1007/s11888-018-0397-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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28
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Role of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Diagnosis of Newly Found Suspected Malignant Solitary Pulmonary Lesions in Patients Who Have Received Curative Treatment for Colorectal Cancer. Gastroenterol Res Pract 2017; 2017:3458739. [PMID: 28487728 PMCID: PMC5405602 DOI: 10.1155/2017/3458739] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/28/2017] [Accepted: 03/09/2017] [Indexed: 12/13/2022] Open
Abstract
Background. Positron emission tomography/computed tomography (PET/CT) is recommended for colorectal cancer (CRC) patients with suspected malignant pulmonary lesions. This study aims to systematically discuss the 18F-FDG-PET/CT diagnosis of solitary pulmonary lesions that are strongly suspected to be malignant in CRC patients who have previously undergone curative therapy. Methods. This retrospective study involved 49 consecutive CRC patients who had previously undergone curative therapy and then underwent PET/CT for the investigation of solitary pulmonary lesions that were strongly suspected to be malignant. Results. Pathological examination confirmed the presence of pulmonary metastases (29 patients, 59.2%), primary lung cancer (15 patients, 30.6%), and benign pulmonary disease (5 patients, 10.2%). Small lung lesions, advanced pathological stage, adjuvant chemotherapy after CRC surgery, solitary pulmonary lesions with lower border irregularity, higher carcinoembryonic antigen level, and the lack of concomitant mediastinal lymph node metastasis were more likely to be associated with pulmonary metastasis than with primary lung cancer. None of these factors was independently significant in the multivariate analysis. Conclusion. Clinicopathological characteristics help to differentiate metastasis and primary lung cancer to some extent during the diagnosis of solitary pulmonary lesions suspected to be malignant in this group of patients. This may provide valuable information to clinicians.
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Pagès PB, Serayssol C, Brioude G, Falcoz PE, Brouchet L, Le Pimpec-Barthes F, Thomas PA, Bernard A. Risk factors for survival and recurrence after lung metastasectomy. J Surg Res 2016; 203:293-300. [DOI: 10.1016/j.jss.2016.01.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/08/2016] [Accepted: 01/20/2016] [Indexed: 12/27/2022]
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Ihn MH, Kim DW, Cho S, Oh HK, Jheon S, Kim K, Shin E, Lee HS, Chung JH, Kang SB. Curative Resection for Metachronous Pulmonary Metastases from Colorectal Cancer: Analysis of Survival Rates and Prognostic Factors. Cancer Res Treat 2016; 49:104-115. [PMID: 27188203 PMCID: PMC5266407 DOI: 10.4143/crt.2015.367] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 04/18/2016] [Indexed: 12/25/2022] Open
Abstract
Purpose Prognostic factors in patients with pulmonary metastases (PM) from colorectal cancer (CRC) are still controversial. This study assessed oncologic outcomes and prognostic factors in patients with metachronous PM from CRC. Materials and Methods Between June 2003 and December 2011, 122 patients with CRC underwent curative resection of PM detected at least 4 months after CRC resection. Clinico-pathological factors selected from the prospectively maintained database were analyzed retrospectively. Results The median disease-free interval (DFI) between resection of the primary tumor and detection of PM was 22.0 months (range, 4 to 85 months). Solitary PM were detected in 77 patients (63.1%), with a median maximal tumor diameter of 12.0 mm (range, 2 to 70 mm). Of 52 patients who underwent mediastinal lymph node (LN) dissection, eight patients had LN involvement. Five-year overall survival and disease-free survival (DFS) rates after initial pulmonary metastasectomy were 66.4% and 50.9%, respectively. DFI, mediastinal LN involvement, and the number and distribution of PM were significantly prognostic factors for DFS. In multivariable analysis DFI ≥ 12 months, solitary lesion, and absence of mediastinal LN involvement were independently prognostic for DFS. Of the 122 patients, 48 patients (39.3%) developed recurrent PM a median 13.0 months after initial pulmonary metastasectomy. Recurrent DFI was independently prognostic of DFS in patients who underwent repeated pulmonary metastasectomy. Conclusion There is a potential survival benefit for patients with metachronous PM from CRC who undergo pulmonary metastasectomy, even those with recurrent PM. Pulmonary metastasectomy should be considered in selected patients, particularly those with longer DFI, solitary lesions, and absence of mediastinal LN involvement.
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Affiliation(s)
- Myong Hoon Ihn
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sukki Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sanghoon Jheon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eun Shin
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jin-Haeng Chung
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Pagès PB, Le Pimpec-Barthes F, Bernard A. [Surgery for pulmonary metastases from colorectal cancer: Predictive factors for survival]. Rev Mal Respir 2016; 33:838-852. [PMID: 27133381 DOI: 10.1016/j.rmr.2016.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 02/11/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Colorectal cancer is the 3rd commonest cause of death from cancer: 5% of patients will develop lung metastases. The management of oligometastatic disease is based on the objective of optimal local control. STATE OF THE ART To date, no results from randomized control trials support the resection of pulmonary metastases in oligometastastic colorectal cancer patients. However, numerous series, mainly retrospective, report long-term survival for highly selected patients, with 5-year survival ranging from 45 to 65% in the most recent series. The consensual predictive factors of a good prognosis are: a disease free-interval>36 months, a number of metastases≤3, a normal level of carcino-embryonic antigen and the absence of hilar or mediastinal lymph node involvement. PERSPECTIVES Around 20 to 40% of patients will develop recurrence, probably linked to the presence of undetectable micrometastases. Therefore, experimental work is being undertaken to develop new treatment techniques such as isolated lung perfusion, radiofrequency ablation and stereotactic radiation therapy. CONCLUSION Highly selected patients suffering from colorectal cancer lung metastases could benefit from resection with improved survival and disease-control.
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Affiliation(s)
- P-B Pagès
- Service de chirurgie cardiovasculaire et thoracique, CHU Bocage central, université de Bourgogne, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France.
| | - F Le Pimpec-Barthes
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - A Bernard
- Service de chirurgie cardiovasculaire et thoracique, CHU Bocage central, université de Bourgogne, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France
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Systemic Versus Local Therapies for Colorectal Cancer Pulmonary Metastasis: What to Choose and When? J Gastrointest Cancer 2016; 47:223-31. [DOI: 10.1007/s12029-016-9818-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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You YN, Skibber JM, Hu CY, Crane CH, Das P, Kopetz ES, Eng C, Feig BW, Rodriguez-Bigas MA, Chang GJ. Impact of multimodal therapy in locally recurrent rectal cancer. Br J Surg 2016; 103:753-762. [PMID: 26933792 DOI: 10.1002/bjs.10079] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/14/2015] [Accepted: 11/16/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND The practice of salvaging recurrent rectal cancer has evolved. The aim of this study was to define the evolving salvage potential over time among patients with locally recurrent disease, and to identify durable determinants of long-term success. METHODS The study included consecutive patients with recurrent rectal cancer undergoing multimodal salvage with curative intent between 1988 and 2012. Predictors of long-term survival were defined by Cox regression analysis and compared over time. Re-recurrence and subsequent treatments were evaluated. RESULTS After multidisciplinary evaluation of 229 patients, salvage therapy with curative intent included preoperative chemotherapy and/or radiotherapy (73·4 per cent; with 41·3 per cent undergoing repeat pelvic irradiation), surgical salvage resection with or without intraoperative irradiation (36·2 per cent), followed by postoperative adjuvant chemotherapy (38·0 per cent). Multivisceral resection was undertaken in 47·2 per cent and bone resection in 29·7 per cent. The R0 resection rate was 80·3 per cent. After a median follow-up of 56·5 months, the 5-year overall survival rate was 50 per cent in 2005-2012, markedly increased from 32 per cent in 1988-1996 (P = 0·044). Long-term success was associated with R0 resection (P = 0·017) and lack of secondary failure (P = 0·003). Some 125 patients (54·6 per cent) developed further recurrence at a median of 19·4 months after salvage surgery. Repeat operative rescue was feasible in 21 of 48 patients with local re-recurrence alone and in 17 of 77 with distant re-recurrence, with a median survival of 19·8 months after further recurrence. CONCLUSION The long-term salvage potential for recurrent rectal cancer improved significantly over time, with the introduction of an individualized treatment algorithm of multimodal treatments and surgical salvage. Durable predictors of long-term success were R0 resection at salvage operation, avoidance of secondary failure, and feasibility of repeat rescue after re-recurrence.
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Affiliation(s)
- Y N You
- Departments of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - J M Skibber
- Departments of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - C-Y Hu
- Departments of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - C H Crane
- Departments of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - P Das
- Departments of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - E S Kopetz
- Departments of Gastrointestinal Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - C Eng
- Departments of Gastrointestinal Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - B W Feig
- Departments of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - M A Rodriguez-Bigas
- Departments of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - G J Chang
- Departments of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
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Management of resectable colorectal lung metastases. Clin Exp Metastasis 2015; 33:285-96. [DOI: 10.1007/s10585-015-9774-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 12/07/2015] [Indexed: 02/07/2023]
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Abstract
In this study, we investigated role and results of multi-reoperations for lung metastases. From 1986 to 2010, 113 consecutive patients (61 men and 52 women; mean age: 53.2 ± 12.8 years) underwent repeated lung metastasectomy with curative intent in our institution. Two procedures were performed in 113 patients, three in 54, four in 31, five in eight and six in three. There was no perioperative mortality. Cumulative 5-year survival was 65% and this was significantly higher than the value recorded for patients undergoing only one metastasectomy (42%; p = 0.021). Size, number of resections and probability of recurrence increased by number of operation whereas disease free interval reduced. At any metastasectomy both short disease-free interval and multiple metastases resulted in the most significant negative prognosticators. In conclusion, redo metastasectomy is worthwhile for the initial procedures, afterwards both disease-free and overall survivals decrease and surgery lose its efficacy.
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Affiliation(s)
- Tommaso Claudio Mineo
- Thoracic Surgery Division, Tor Vergata University, Viale Oxford 81, 00133 Roma, Italy
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Phase II multicenter clinical trial of pulmonary metastasectomy and isolated lung perfusion with melphalan in patients with resectable lung metastases. J Thorac Oncol 2015; 9:1547-53. [PMID: 25105436 DOI: 10.1097/jto.0000000000000279] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The 5-year overall survival rate of patients undergoing complete surgical resection of pulmonary metastases (PM) from colorectal cancer (CRC) and sarcoma remains low (20-50%). Local recurrence rate is high (48-66%). Isolated lung perfusion (ILuP) allows the delivery of high-dose locoregional chemotherapy with minimal systemic leakage to improve local control. METHODS From 2006 to 2011, 50 patients, 28 male, median age 57 years (15-76), with PM from CRC (n = 30) or sarcoma (n = 20) were included in a phase II clinical trial conducted in four cardiothoracic surgical centers. In total, 62 ILuP procedures were performed, 12 bilaterally, with 45 mg of melphalan at 37°C, followed by resection of all palpable PM. Survival was calculated according to the Kaplan-Meier method. RESULTS Operative mortality was 0%, and 90-day morbidity was mainly respiratory (grade 3: 42%, grade 4: 2%). After a median follow-up of 24 months (3-63 mo), 18 patients died, two without recurrence. Thirty patients had recurrent disease. Median time to local pulmonary progression was not reached. The 3-year overall survival and disease-free survival were 57% ± 9% and 36% ± 8%, respectively. Lung function data showed a decrease in forced expiratory volume in 1 second and diffusing capacity of the alveolocapillary membrane of 21.6% and 25.8% after 1 month, and 10.4% and 11.3% after 12 months, compared with preoperative values. CONCLUSION Compared with historical series of PM resection without ILuP, favorable results are obtained in terms of local control without long-term adverse effects. These data support the further investigation of ILuP as additional treatment in patients with resectable PM from CRC or sarcoma.
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Reyes DK, Pienta KJ. The biology and treatment of oligometastatic cancer. Oncotarget 2015; 6:8491-524. [PMID: 25940699 PMCID: PMC4496163 DOI: 10.18632/oncotarget.3455] [Citation(s) in RCA: 215] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 02/24/2015] [Indexed: 12/15/2022] Open
Abstract
Clinical reports of limited and treatable cancer metastases, a disease state that exists in a transitional zone between localized and widespread systemic disease, were noted on occasion historically and are now termed oligometastasis. The ramification of a diagnosis of oligometastasis is a change in treatment paradigm, i.e. if the primary cancer site (if still present) is controlled, or resected, and the metastatic sites are ablated (surgically or with radiation), a prolonged disease-free interval, and perhaps even cure, may be achieved. Contemporary molecular diagnostics are edging closer to being able to determine where an individual metastatic deposit is within the continuum of malignancy. Preclinical models are on the outset of laying the groundwork for understanding the oligometastatic state. Meanwhile, in the clinic, patients are increasingly being designated as having oligometastatic disease and being treated owing to improved diagnostic imaging, novel treatment options with the potential to provide either direct or bridging therapy, and progressively broad definitions of oligometastasis.
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Affiliation(s)
- Diane K. Reyes
- Departments of Urology and Brady Urological Institute, and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
| | - Kenneth J. Pienta
- Departments of Urology and Brady Urological Institute, and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
- Departments of Pharmacology and Molecular Sciences, and Chemical and Biomolecular Engineering, The Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
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Pulmonary metastasectomy: outcomes and issues according to the type of surgical resection. Gen Thorac Cardiovasc Surg 2015; 63:320-30. [PMID: 25836329 DOI: 10.1007/s11748-015-0544-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Indexed: 12/16/2022]
Abstract
According to a recent report by the Committee for Scientific Affairs of the Japanese Association for Thoracic Surgery, pulmonary metastasectomy accounted for as many as 10.2 % of all entry cases of general thoracic surgery, and its use is increasing year by year. Accordingly, many studies have examined the surgical procedures used during pulmonary metastasectomy for metastases from primary tumors affecting various organs as well as the outcomes of and indications for such procedures, but some problems remain. In this article, the following questions related to the surgical approach and the type of resection used during pulmonary metastasectomy are reviewed: (1) Wedge resection--what is a safe margin for preventing local recurrence? (2) What is the clinical significance of node sampling/dissection during pulmonary metastasectomy? and (3) When is segmentectomy necessary? In addition, we discuss: (4) open thoracotomy vs. video-assisted thoracoscopic surgery (VATS), (5) repeated metastasectomy for pulmonary metastases, (6) the surgical approach for bilateral pulmonary metastasectomy, (7) pneumonectomy, and (8) pulmonary metastasectomy combined with resection of the neighboring organs.
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Jung EJ, Kim SR, Ryu CG, Paik JH, Yi JG, Hwang DY. Indeterminate pulmonary nodules in colorectal cancer. World J Gastroenterol 2015; 21:2967-2972. [PMID: 25780294 PMCID: PMC4356916 DOI: 10.3748/wjg.v21.i10.2967] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/11/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinicopathologic parameters of pulmonary metastasis in colorectal cancer (CRC) patients after lung operation of indeterminate pulmonary nodules (IPNs).
METHODS: From a prospective database of CRC patients, 40 cases that underwent lung operation between November 2008 and December 2012 for suspicious metastatic pulmonary nodules on chest computed tomography (CT) were enrolled. The decision to perform a lung operation was made if the patient met the following criteria: (1) completely resected or resectable primary CRC; (2) completely resectable IPNs; (3) controlled or controllable extrapulmonary metastasis; and (4) adequate general condition and pulmonary function to tolerate pulmonary operation. Lung operation was performed by a thoracic surgeon without CT-guided biopsy for pathologic confirmation.
RESULTS: A total of 40 cases of lung resection was performed in 29 patients. Five patients underwent repeated lung resection. The final pathology result showed metastasis from the CRC in 30 cases (75%) and benign pathology in 10 cases (25%). The primary tumor site was the rectum in 26/30 (86.6%) cases with pulmonary metastasis, but only 3/10 (30%) cases in the benign group had a primary rectal cancer (P = 0.001). Positron emission tomography (PET)-CT was performed for 22/30 (73.4%) patients in the lung metastasis group and for 6/10 (60.0%) patients in the benign group. PET-CT revealed hot uptake of 18fluorine 2-fluoro-2-deoxy-D-glucose with all IPNs in both groups. The group with pulmonary metastasis had a higher incidence of primary rectal cancer (P = 0.001), a more advanced tumor stage (P = 0.011), and more frequent lymphatic invasion of tumor cells (P = 0.005). Six cases with previous liver metastasectomy were present in the lung metastasis group. Serum carcinoembryonic antigen levels before lung operation were not elevated in any of the patients.
CONCLUSION: The stage and location of the primary tumor and tumor cell infiltration of lymphatics provide useful indicators for deciding on lung resection of IPNs in CRC.
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Patterns and Treatment of Recurrence Following Pulmonary Resection for Colorectal Metastases. World J Surg 2015; 39:1758-66. [DOI: 10.1007/s00268-015-3006-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Gonzalez M, Gervaz P. Risk factors for survival after lung metastasectomy in colorectal cancer patients: systematic review and meta-analysis. Future Oncol 2015; 11:31-3. [DOI: 10.2217/fon.14.259] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
ABSTRACT Despite the lack of randomized trials, lung metastasectomy is currently proposed for colorectal cancer patients under certain conditions. Many retrospective studies have reported different prognostic factors of poorer survival, but eligibility for pulmonary metastasectomy remains determined by the complete resection of all pulmonary metastases. The aim of this review is to clarify which pre-operative risk factors reported in systematic reviews or meta-analysis are determinant for survival in colorectal metastatic patients. Different criteria have been now identified to select which patient will really benefit from lung metastasectomy.
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Affiliation(s)
- Michel Gonzalez
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Pascal Gervaz
- Coloproctology Unit, Clinique la Colline, Geneva, Switzerland
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Suzuki H, Kiyoshima M, Kitahara M, Asato Y, Amemiya R. Long-term outcomes after surgical resection of pulmonary metastases from colorectal cancer. Ann Thorac Surg 2014; 99:435-40. [PMID: 25499475 DOI: 10.1016/j.athoracsur.2014.09.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/16/2014] [Accepted: 09/19/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Surgical resection has been widely performed on patients with pulmonary metastases from colorectal cancer with favorable outcomes. However, there are currently no standard surgical indications for pulmonary metastases. METHODS We reviewed 94 patients who underwent complete resection of pulmonary metastases from colorectal cancer between November 1991 and April 2013. The cumulative survival rate after pulmonary metastasectomy was calculated, and prognostic factors for long-term survival were analyzed. RESULTS There were 60 men and 34 women, and their median age was 66 years. The 5-year survival rate was 45.5% after pulmonary metastasectomy. The 5-year survival of patients with colon and rectal cancers was 62.4% and 33.8%, respectively (p = 0.030), and the 5-year survival of those with normal and high carcinoembryonic antigen (CEA) levels before pulmonary resection was 57.0% and 30.9%, respectively (p = 0.038). Multivariate analysis revealed the preoperative CEA level was an independent prognostic factor. Recurrence was identified in 65 of the 94 patients (69.1%) after pulmonary metastasectomy, and the patients who underwent surgical resection for recurrent lesions in the liver or lungs, or both, had better survival than those who received other treatments or palliative care. CONCLUSIONS Surgical resection offers a chance to prolong survival in colorectal cancer patients with resectable pulmonary metastases. Owing to the high recurrence rate, careful postoperative follow-up for early detection is recommended, and even for recurrence, surgical resection should be considered for better survival if the lesions are limited to the liver or lungs, or both.
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Affiliation(s)
- Hisashi Suzuki
- Department of Thoracic Surgery, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan.
| | - Moriyuki Kiyoshima
- Department of Thoracic Surgery, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan
| | - Miyuki Kitahara
- Department of Thoracic Surgery, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan
| | - Yuji Asato
- Department of Thoracic Surgery, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan
| | - Ryuta Amemiya
- Department of Thoracic Surgery, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan
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Pagès PB, Derangere V, Bouchot O, Magnin G, Charon-Barra C, Lokiec F, Ghiringhelli F, Bernard A. Acute and delayed toxicity of gemcitabine administered during isolated lung perfusion: a preclinical dose-escalation study in pigs. Eur J Cardiothorac Surg 2014; 48:228-35. [PMID: 25414426 DOI: 10.1093/ejcts/ezu441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 10/19/2014] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Colorectal cancer is the third most commonly diagnosed cancer worldwide, with up to 25% of patients presenting with metastases at the time of diagnosis. Despite pulmonary metastasectomy many patients go on to develop pulmonary recurrence, which might be linked to the presence of lung micrometastases. In this setting, the adjuvant administration of high-dose chemotherapy by isolated lung perfusion (ILP) has shown encouraging results. However, the tolerance to and efficacy of modern gemcitabine (GEM)-based chemotherapy regimens during adjuvant ILP remain unknown. We conducted a dose-escalating preclinical study to evaluate the immediate and delayed toxicity of GEM in a pig model to define dose-limiting toxicity (DLT) and maximum tolerated concentration. METHODS Twenty-three pigs were given increasing concentrations of GEM during ILP, and were awakened at the end of the procedure. The concentrations of GEM were 40, 80, 160, 320, 640 and 1280 µg/ml. Serum and lung samples were taken to measure GEM concentrations. Pulmonary damage was evaluated by histological examination and cleaved caspase-3 detection. Immediate and delayed (1 month) toxicity were recorded. RESULTS All of the animals underwent successful ILP with GEM. No systemic leak was observed. The three pigs that received a concentration of GEM of 1280 µg/ml died of hypoxia after lung recirculation at the end of the procedure. Eleven pigs survived for 1 month. Major lung toxicity was observed for the concentration of GEM of 640 µg/ml, both at the end of the procedure and after 1 month. DLT was defined at the concentration of 640 µg/ml and the maximum tolerated dose (MTD) was defined at the concentration of 320 µg/ml. CONCLUSIONS ILP with GEM is a safe and reproducible technique in this large-animal model, which includes 1 month of survival. The MTD in this pig model was a concentration of GEM of 320 µg/ml.
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Affiliation(s)
- Pierre-Benoit Pagès
- INSERM UMR 866, CHU Bocage, University of Burgundy, Dijon, France Department of Thoracic and Cardiovascular Surgery, CHU Bocage, University of Burgundy, Dijon, France
| | | | - Olivier Bouchot
- Department of Thoracic and Cardiovascular Surgery, CHU Bocage, University of Burgundy, Dijon, France
| | - Guy Magnin
- Department of Anesthesiology, CHU Bocage, University of Burgundy, Dijon, France
| | - Céline Charon-Barra
- Department of Pathology, Georges-Francois Leclerc Center, University of Burgundy, Dijon, France
| | - François Lokiec
- Department of Pharmacology, Centre René Huguenin, Saint-Cloud, France
| | - François Ghiringhelli
- INSERM UMR 866, CHU Bocage, University of Burgundy, Dijon, France Department of Medical Oncology, Georges-Francois Leclerc Center, University of Burgundy, Dijon, France
| | - Alain Bernard
- Department of Thoracic and Cardiovascular Surgery, CHU Bocage, University of Burgundy, Dijon, France
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Uppal A, Ferguson MK, Posner MC, Hellman S, Khodarev NN, Weichselbaum RR. Towards a molecular basis of oligometastatic disease: potential role of micro-RNAs. Clin Exp Metastasis 2014; 31:735-48. [PMID: 24968866 PMCID: PMC4138440 DOI: 10.1007/s10585-014-9664-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 06/09/2014] [Indexed: 02/06/2023]
Abstract
Oligometastasis is a cancer disease state characterized by a limited number of metastatic tumors involving single or few organs and with biological properties that make them potentially amenable to locoregional antitumor therapy. Current clinical data show that they are potentially curable with surgical resection or/and radiotherapy. Yet, mechanisms of progression from primary tumor to oligometastasis, rather than to polymetastases, is lacking in detail. In the current review we focus on the role of micro-RNAs in the regulation of metastases development and the role they may play in the differentiation of oligometastatic from polymetastatic progression. We also discuss the analyses of metastatic samples from oligo-and polymetastatic patients, which suggest that oligometastasis is a distinct biologic entity regulated in part by micro-RNAs. In addition, a review of the known functions of oligometastatic-specific micro-RNAs suggest that they regulate multiple steps in the metastatic cascade, including epithelial–mesenchymal transition, tumor invasion, intravasation, distant vascular extravasation and proliferation in a distant organ. Understanding the role of micro-RNAs and their target genes in oligometastatic disease may allow for the development of targeted therapies to effectively conrol the spread of metastases.
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Affiliation(s)
- Abhineet Uppal
- Department of Surgery, The University of Chicago, MC 5029, 5841 S. Maryland Ave, Chicago, IL, 60637, USA,
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Kim HK, Cho JH, Lee HY, Lee J, Kim J. Pulmonary metastasectomy for colorectal cancer: How many nodules, how many times? World J Gastroenterol 2014; 20:6133-6145. [PMID: 24876735 PMCID: PMC4033452 DOI: 10.3748/wjg.v20.i20.6133] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 11/01/2013] [Accepted: 03/05/2014] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most common cancers worldwide, with 5%-15% of CRC patients eventually developing lung metastasis (LM). Despite doubts about the role of locoregional therapy in the management of systemic disease, many surgeons have performed pulmonary metastasectomy (PM) for CRC in properly selected patients. However, the use of pulmonary metastasectomy remains controversial due to the lack of randomized controlled studies. This article reviews the results of surgical treatment of pulmonary metastases for CRC, focusing on (1) current treatment guidelines and surgical techniques of PM in patients with LM from CRC; (2) outcomes of PM and its prognostic factors; and (3) controversial issues in PM, focusing on repeated metastasectomy, bilateral multiple metastases, and combined liver and lung metastasectomy.
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Schweiger T, Hegedüs B, Nikolowsky C, Hegedüs Z, Szirtes I, Mair R, Birner P, Döme B, Lang G, Klepetko W, Ankersmit HJ, Hoetzenecker K. EGFR, BRAF and KRAS status in patients undergoing pulmonary metastasectomy from primary colorectal carcinoma: a prospective follow-up study. Ann Surg Oncol 2013; 21:946-54. [PMID: 24281417 DOI: 10.1245/s10434-013-3386-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pulmonary metastasectomy is an integral part of the interdisciplinary treatment of patients with pulmonary metastases (PMs) from colorectal carcinoma (CRC). Although alterations in the epidermal growth factor receptor (EGFR) pathway are common in CRC, there is still insufficient data regarding PM. We hypothesized that EGFR expression and Kirsten rat sarcoma viral oncogene homolog (KRAS)/BRAF mutations (Mts) might be associated with clinicopathological variables and the outcome in patients undergoing pulmonary metastasectomy. METHODS In this single-center study, 44 patients undergoing pulmonary metastasectomy from primary CRC were included and prospectively followed up. Tissue specimens of resected PMs were assessed. Restriction fragment length analysis was used for BRAF V600E and KRAS codons 12 and 13 Mt analyses. EGFR expression was evaluated by immunohistochemistry. Patients were followed up in 3-6-month intervals. RESULTS EGFR expression was evident in 49 % of the PMs, whereas Mts in KRAS and BRAF were detected in 48 and 0 %, respectively. Time to lung-specific recurrence after metastasectomy was significantly decreased in patients with KRAS mutated PMs in univariate (p = 0.013) and multivariate analysis (p = 0.035), whereas EGFR expression had no impact on recurrence free survival. Moreover, KRAS Mts were associated with the number of PMs (p = 0.037) and with the lung as first site of recurrence after metastasectomy (p = 0.047). DISCUSSION This is the first evaluation of EGFR pathway alterations in the setting of pulmonary metastasectomy. Our data suggest that patients with KRAS Mts are at high risk for early pulmonary recurrence and have a more diffuse pattern of metastasis. These findings may have impact on the therapeutic management of CRC patients with pulmonary spreading.
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Affiliation(s)
- Thomas Schweiger
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
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Hiraki M, Nishimura J, Ohtsuka M, Shiomi H, Uemura M, Haraguchi N, Hata T, Hayashi T, Takemasa I, Mizushima T, Isohashi F, Yoshioka Y, Ogawa K, Doki Y, Mori M, Yamamoto H. Impact of stereotactic body radiotherapy on colorectal cancer with distant metastases. Oncol Rep 2013; 31:795-9. [PMID: 24284831 DOI: 10.3892/or.2013.2871] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 10/11/2013] [Indexed: 11/06/2022] Open
Abstract
Stereotactic radiotherapy is a minimally invasive technique for delivering highly focused ionizing radiation with extreme precision. This technique was initially developed in neurosurgical practice and applied to extracranial lesions in the 1990s, and was termed stereotactic body radiotherapy (SBRT). Studies have reported that the resection of distant metastases from colorectal cancer (CRC) contributes to relatively long-term survival. However, the resection of pulmonary and liver metastases is not possible for various reasons. SBRT offers a therapeutic alternative to unresectable metastatic lesions. The present study describes three cases of distant metastasis from CRC that exhibited a complete response (CR) to SBRT. Case 1 is a 70-year-old man with recurrent liver metastases after surgery for rectal cancer with liver metastasis (S3: diameter 1.8 cm and volume 3.0 ml; S6: diameter 1.3 cm and volume 1.2 ml). Cases 2 and 3 were 65-year-old and 70-year-old men, respectively. Both patients had pulmonary metastasis after surgery for rectal and cecum cancer (Case 2: diameter 1.2 cm and volume 0.9 ml; Case 3: diameter 0.8 cm and volume 0.27 ml). All cases were moderately differentiated adenocarcinomas. No serious adverse side-effects were observed during the therapy. CR was obtained in all patients on the basis of computed tomography 15-33 months after radiotherapy. Our experience supports that SBRT is a safe and alternative technique for resection in patients with distant metastasis from CRC who have small metastatic tumor volume.
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Affiliation(s)
- Masayuki Hiraki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Junichi Nishimura
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Masahisa Ohtsuka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Hiroya Shiomi
- Department of Radiation Oncology, Saito Yukoukai Hospital, Osaka 567-0085, Japan
| | - Mamoru Uemura
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Naotsugu Haraguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Taishi Hata
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Taro Hayashi
- Department of Surgical Oncology, Saito Yukoukai Hospital, Osaka 567-0085, Japan
| | - Ichiro Takemasa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Tsunekazu Mizushima
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Fumiaki Isohashi
- Department of Radiation Oncology, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Yasuo Yoshioka
- Department of Radiation Oncology, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Masaki Mori
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Hirofumi Yamamoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
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