This document summarizes treatment options for patients with synchronous liver metastases and colorectal cancer. It finds that the optimal approach is to treat patients with the most effective systemic chemotherapy in combination with multidisciplinary team evaluation every two months. Liver surgery should be performed once the liver metastases become resectable, followed by systemic treatment before and/or after primary tumor resection for at least six months. However, more research is still needed to determine the best treatment sequence based on individual patient factors.
Nowadays the problem of surgical treatment of Colorectal
Cancer (CRC) is becoming very important due to the high speed of increasing morbidity and mortality, which is registered almost in all economically developed countries in the world [1,2]. In 2012, more than one million new cases of CRC were detected on our planet and about half a million people died from this disease [1]. On the territory of Russia, a primary diagnosis of colorectal cancer is annually established in 6000 people, with the highest incidence rates in the North-West region (St. Petersburg and Leningrad region), where in the general structure of oncopathology, colorectal cancer is in the second
This study investigated long-term survival outcomes of 320 patients who underwent radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) or colorectal liver metastases (CLM) between 1999-2010. Minimum 5-year follow-up data was available for 89% of patients, with median follow-up of 115.3 months. For HCC patients, 5-year and 10-year overall survival rates were 38.5% and 23.4%. For CLM patients, 5-year and 10-year overall survival rates were 27.6% and 15%. The study concludes RFA can provide 10-year overall survival rates of over 23% for HCC and 15% for CLM
Colorectal cancer (CRC) has potential to spread within the peritoneal cavity, and this transcoelomic
dissemination is termed “peritoneal metastases” (PM).The aim of this article was to summarise the current
evidence regarding CRC patients at high risk of PM. Colorectal cancer is the second most common cause of cancer
death in the UK. Prompt investigation of suspicious symptoms is important, but there is increasing evidence that
screening for the disease can produce significant reductions in mortality.High quality surgery is of paramount
importance in achieving good outcomes, particularly in rectal cancer, but adjuvant radiotherapy and chemotherapy
have important parts to play. The treatment of advanced disease is still essentially palliative, although surgery for
limited hepatic metastases may be curative in a small proportion of patients.
Abstract
OBJECTIVE: Complete surgical resection is the only potentially curative treatment of localized pancreatic neuroendocrine tumors. Unfortunately, a significant proportion of these patients present with unresectable locally advanced tumors or massive metastatic disease. Recently, a new therapeutic approach for this subset of patients has emerged consisting of neoadjuvant therapy followed by surgical exploration in responders.
DESIGN: We searched MEDLINE for the purpose of identifying reports regarding neoadjuvant treatment modalities for advanced pancreatic neuroendocrine tumors.
RESULTS: We identified 12 studies, the vast majority of which were either case reports or small case series. Treatment options included chemotherapy, radiotherapy, peptide receptor radionuclide therapy, biological agents or various combina- tions of them.
CONCLUSIONS: Increasing evidence supports the application of neoadjuvant protocols in advanced pancreatic neuroendocrine tumors aiming at tumor downsizing, thus rendering curative resection feasible. Given that prospective and controlled randomized clini- cal trials from high-volume institutions are not feasible, expert panel consensus is needed to define the optimal treatment algorithm.
CAN RESECTION OF LIVER METASTASIS IMPROVE SURVIVAL AFTER RESECTABILITY CONVER...wael mansy
This study examined the efficacy of FOLFOX6 chemotherapy in converting unresectable colorectal cancer liver metastases to resectable. 90 patients with unresectable liver-limited disease received neoadjuvant FOLFOX6 chemotherapy, with 18 (20%) becoming resectable. Those who underwent resection had significantly longer overall survival compared to the unresectable group. Chemotherapy can help convert a portion of patients to resectability, improving outcomes.
management of metastatic ca colon with chemotherapy evolution in ca colon.pptxDr Kartik Kadia
This document discusses the management of metastatic colon carcinoma and the evolution of chemotherapy for this disease. It notes that approximately 50-60% of colon cancer patients will develop metastases, most commonly in the liver. A variety of local therapies can be used for non-surgical candidates to treat metastatic lesions. For chemotherapy, 5-fluorouracil was the first widely used drug but combining it with leucovorin enhances its effectiveness based on preclinical studies. Several clinical trials in the 1980s established 5-FU plus leucovorin as a standard first-line chemotherapy regimen for metastatic colon cancer.
Colorectal Liver Metastases: A Perspectiveasclepiuspdfs
Surgical resection is the most effective treatment approach in colorectal liver metastases (CRLM). The improved survival in Stage IV colorectal cancer (CRC) is associated with a better diagnosis and evaluation, proper decision-making, improved chemotherapy, and the adoption of parenchymal-sparing hepatic resections. Liver surgery was one of the last frontiers reached by minimally invasive surgery. Surgical techniques and specialized equipment evolved to overcome the technical limitations making laparoscopic liver resections safe and feasible. The etiology and pathophysiology of hepatic metastases are discussed along with the rationale for and efficacy of minimally invasive surgery for CRLM. Improved imaging techniques, identification of genomic markers, advances in chemotherapy, and personalized therapy will further improve the outcome of minimally-invasive surgery in the management of Stage IV CRC.
Nowadays the problem of surgical treatment of Colorectal
Cancer (CRC) is becoming very important due to the high speed of increasing morbidity and mortality, which is registered almost in all economically developed countries in the world [1,2]. In 2012, more than one million new cases of CRC were detected on our planet and about half a million people died from this disease [1]. On the territory of Russia, a primary diagnosis of colorectal cancer is annually established in 6000 people, with the highest incidence rates in the North-West region (St. Petersburg and Leningrad region), where in the general structure of oncopathology, colorectal cancer is in the second
This study investigated long-term survival outcomes of 320 patients who underwent radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) or colorectal liver metastases (CLM) between 1999-2010. Minimum 5-year follow-up data was available for 89% of patients, with median follow-up of 115.3 months. For HCC patients, 5-year and 10-year overall survival rates were 38.5% and 23.4%. For CLM patients, 5-year and 10-year overall survival rates were 27.6% and 15%. The study concludes RFA can provide 10-year overall survival rates of over 23% for HCC and 15% for CLM
Colorectal cancer (CRC) has potential to spread within the peritoneal cavity, and this transcoelomic
dissemination is termed “peritoneal metastases” (PM).The aim of this article was to summarise the current
evidence regarding CRC patients at high risk of PM. Colorectal cancer is the second most common cause of cancer
death in the UK. Prompt investigation of suspicious symptoms is important, but there is increasing evidence that
screening for the disease can produce significant reductions in mortality.High quality surgery is of paramount
importance in achieving good outcomes, particularly in rectal cancer, but adjuvant radiotherapy and chemotherapy
have important parts to play. The treatment of advanced disease is still essentially palliative, although surgery for
limited hepatic metastases may be curative in a small proportion of patients.
Abstract
OBJECTIVE: Complete surgical resection is the only potentially curative treatment of localized pancreatic neuroendocrine tumors. Unfortunately, a significant proportion of these patients present with unresectable locally advanced tumors or massive metastatic disease. Recently, a new therapeutic approach for this subset of patients has emerged consisting of neoadjuvant therapy followed by surgical exploration in responders.
DESIGN: We searched MEDLINE for the purpose of identifying reports regarding neoadjuvant treatment modalities for advanced pancreatic neuroendocrine tumors.
RESULTS: We identified 12 studies, the vast majority of which were either case reports or small case series. Treatment options included chemotherapy, radiotherapy, peptide receptor radionuclide therapy, biological agents or various combina- tions of them.
CONCLUSIONS: Increasing evidence supports the application of neoadjuvant protocols in advanced pancreatic neuroendocrine tumors aiming at tumor downsizing, thus rendering curative resection feasible. Given that prospective and controlled randomized clini- cal trials from high-volume institutions are not feasible, expert panel consensus is needed to define the optimal treatment algorithm.
CAN RESECTION OF LIVER METASTASIS IMPROVE SURVIVAL AFTER RESECTABILITY CONVER...wael mansy
This study examined the efficacy of FOLFOX6 chemotherapy in converting unresectable colorectal cancer liver metastases to resectable. 90 patients with unresectable liver-limited disease received neoadjuvant FOLFOX6 chemotherapy, with 18 (20%) becoming resectable. Those who underwent resection had significantly longer overall survival compared to the unresectable group. Chemotherapy can help convert a portion of patients to resectability, improving outcomes.
management of metastatic ca colon with chemotherapy evolution in ca colon.pptxDr Kartik Kadia
This document discusses the management of metastatic colon carcinoma and the evolution of chemotherapy for this disease. It notes that approximately 50-60% of colon cancer patients will develop metastases, most commonly in the liver. A variety of local therapies can be used for non-surgical candidates to treat metastatic lesions. For chemotherapy, 5-fluorouracil was the first widely used drug but combining it with leucovorin enhances its effectiveness based on preclinical studies. Several clinical trials in the 1980s established 5-FU plus leucovorin as a standard first-line chemotherapy regimen for metastatic colon cancer.
Colorectal Liver Metastases: A Perspectiveasclepiuspdfs
Surgical resection is the most effective treatment approach in colorectal liver metastases (CRLM). The improved survival in Stage IV colorectal cancer (CRC) is associated with a better diagnosis and evaluation, proper decision-making, improved chemotherapy, and the adoption of parenchymal-sparing hepatic resections. Liver surgery was one of the last frontiers reached by minimally invasive surgery. Surgical techniques and specialized equipment evolved to overcome the technical limitations making laparoscopic liver resections safe and feasible. The etiology and pathophysiology of hepatic metastases are discussed along with the rationale for and efficacy of minimally invasive surgery for CRLM. Improved imaging techniques, identification of genomic markers, advances in chemotherapy, and personalized therapy will further improve the outcome of minimally-invasive surgery in the management of Stage IV CRC.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...daranisaha
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...JohnJulie1
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...eshaasini
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...NainaAnon
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Clinics of Oncology | Oncology Journals | Open Access JournalEditorSara
Clinics of OncologyTM (ISSN 2640-1037) - Impact Factor 1.920* is a medical specialty that focuses on the use of operative techniques to investigate and resolve certain medical conditions caused by disease or traumatic injury.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
In this retrospective study we enrolled patients with upper rectal or sigmoid junction locally advanced tumors (stages II-III). At the first Institution patients received NCRT followed by surgery (study group); at the second Institution patients were referred to upfront surgery (control group). Overall survival was the main endpoint of the analysis. Local relapse and other clinical variables were also analyzed.
This document discusses transarterial therapies for the treatment of intrahepatic cholangiocarcinoma (ICC), a rare but devastating cancer. It reviews the current evidence for chemoembolization and radioembolization in treating ICC. Several studies show that chemoembolization, using various chemotherapy regimens with or without drug-eluting beads, can provide median survival rates of 9-23 months for unresectable ICC. Emerging evidence also supports the potential role of radioembolization, but further research is still needed. Overall, transarterial therapies may help improve outcomes for ICC when surgery is not possible.
Current evidence for laparoscopic surgery in colorectal cancersApollo Hospitals
This article reviews the current evidence for laparoscopic surgery in treating colorectal cancers. It discusses several large randomized controlled trials that compared short-term and long-term outcomes of laparoscopic versus open surgery. The trials found no significant differences in cancer recurrence rates, survival rates, or number of lymph nodes retrieved between the two surgical methods. Meta-analyses of the trials validated that laparoscopic surgery is as safe and effective as open surgery for treating colorectal cancer. While the laparoscopic approach has benefits like less blood loss and shorter hospital stays, long-term oncologic outcomes are comparable to open surgery.
This document discusses bladder preservation as an alternative to radical cystectomy for muscle-invasive bladder cancer. It describes trimodality therapy (TMT) involving maximal transurethral resection of bladder tumor (TURBT), radiation therapy with concurrent chemotherapy. Observational studies have found no significant difference in survival outcomes between TMT and radical cystectomy. Patient selection factors for TMT include clinical T2-T3a disease, absence of hydronephrosis or extensive carcinoma in situ. Concurrent chemoradiation typically involves cisplatin-based chemotherapy with 40-45Gy radiation to the bladder and pelvis, followed by a boost to the bladder. Follow up involves frequent cystoscopy and urine cytology.
This document discusses treatment approaches for nonmetastatic locally advanced, borderline resectable, and potentially resectable exocrine pancreatic cancer. It recommends initial chemotherapy, often with gemcitabine or FOLFIRINOX, for locally advanced unresectable disease. For those who do not progress on chemotherapy, concurrent chemoradiation using infusional 5-FU is suggested. The evidence for benefit of chemoradiation over radiation alone is reviewed, though data is limited. Oral fluoropyrimidines may substitute for infusional 5-FU as a radiation sensitizer.
Results of Stereotactic Body Radiotherapy (SBRT) for Management of Hepatic Tu...Premier Publishers
PURPOSE: To evaluate early outcomes of hepatic tumors treated with robotic SBRT (cyberknife).
MATERIALS AND METHODS: Between March 2007 and December 2012; 59 patients: 48 Hepatic Metastases (HM), 8 Hepatocellular Carcinoma (HCC), 3 Cholangiocarcinoma (CC).
CTV margin for HCC and CC was 5 mm, PTV margin: 3 mm. no margin for HM.
Median dose: 47.61 Gy in 3 fractions prescribed to 80 % isodose line.
RESULTS: we report 1 grade 3 toxicity.
HCC; overall survival (OS): 41.7% at 1 year, local control (LC): 75% at 1 year.
At 1 and 2 years we report, respectively.
HM; OS: 83.6% and 57%, disease free survival (DFS): 69.5% and 46.1%, LC: 76.3% and 57.9%.
CC; OS: 100% and 50%, DFS and LC: 50% and 0%.
Factors influencing better OS; type of lesion, age < 65 years (p= 0.033), small PTV volume
(p= 0.002), for DFS; dose of 45 Gy (p= 0.001), dose per fraction of 15 Gy (p= 0.001), coverage > 95% for PTV (p= 0.001), For LC; type of lesion, dose to PTV (p= 0.037), coverage > 95% for PTV (p= 0.001).
CONCLUSION: Age, volume of tumor, dose, coverage of target volume are prognostic factors for survival and LC.
This study assessed the prognostic value of lymph node ratio (LNR) and extramural vascular invasion (EMVI) in predicting survival outcomes for 922 patients who underwent curative colon cancer resection between 2006-2012. The results showed that both increasing LNR and presence of EMVI were independently associated with decreased overall and disease-free survival on multivariate analysis. LNR was found to have greater prognostic value compared to the current pN staging system based on Akaike information criterion. Subgroup analysis by EMVI status also confirmed LNR and EMVI as significant predictors of survival.
1) The management of hepatocellular carcinoma (HCC) has improved in recent decades due to better patient stratification using tools like the Barcelona Clinic Liver Cancer staging system and new therapies such as sorafenib.
2) However, HCC remains a major cause of cancer deaths worldwide. Clinical practice guidelines strongly recommend five treatments for HCC - resection, transplantation, radiofrequency ablation, chemoembolization, and sorafenib - based on evidence from clinical trials.
3) Additional research is still needed to clarify the roles of other treatments like radioembolization and adjuvant therapies after resection, as well as second-line therapies for advanced HCC. Many ongoing clinical trials aim to address these
IRF5 Promotes the Progression of Hepatocellular Carcinoma and is Regulated by...NainaAnon
1. The study found that IRF5 was upregulated in hepatocellular carcinoma (HCC) tissues compared to normal tissues based on mRNA and protein levels.
2. Overexpression of IRF5 promoted the growth and colony formation of HCC cells in vitro, while silencing IRF5 inhibited HCC cell growth and proliferation.
3. TRIM35 was found to interact with and promote the degradation of IRF5. TRIM35 expression was negatively correlated with IRF5 levels in HCC clinical samples.
Trimodal Management of Locally Invasive Urinary Bladder CancerNainaAnon
To evaluate the response of the modern bladder-preservation treatment modality; Trimodal Therapy (TMT) in Muscle-Invasive Bladder Cancer (MIBC). Aiming at bladder preservation in MIBC, TMT was to offer a quality- of-life advantage and avoid potential morbidity and mortality of Radical Cystectomy (RC) without compromising oncologic outcomes.
Alterations of Gut Microbiota From Colorectal Adenoma to CarcinomaNainaAnon
The document analyzes differences in gut microbiota between healthy individuals, those with colorectal adenomas (CRA), and those with colorectal cancer (CRC). 16S rRNA sequencing was performed on tissue samples from 11 individuals in each group. Microbial diversity was lower in CRA patients and higher in CRC patients compared to healthy individuals. The relative abundance of Fusobacteria was lower in CRA and higher in CRC. This suggests alterations in gut microbiota occur from adenoma to carcinoma, with Fusobacteria potentially playing a role in colorectal cancer development.
Prognosis of Invasive Micropapillary Carcinoma of the Breast Analyzed by Usin...NainaAnon
Invasive micropapillary carcinoma (IMPC) is a rare type of breast cancer with high frequency of regional lymph node metastasis. However, the prognosis of IMPC has remained controversial for decades. We aimed to compare the differences of prognosis between IMPC and Invasive ductal carcinoma(IDC) of the breast by utilizing Surveillance, Epidemiology, and End Results (SEER) database.
Uretero-Enteric Anastomosis Stricture after Urinary Diversion; Detailed Analy...NainaAnon
To report the lessons we have learned in the management of uretero-enteric anastomosis stricture (UEAS) in a tertiary urology center over a decade of experience.
Clinic Correlation and Prognostic Value of P4HB and GRP78 Expression in Gastr...NainaAnon
Prolyl 4-hydroxylase, beta polypeptide (P4HB) and Glucose‑regulated protein 78 (GRP78) represent for poor prognosis of various cancers, while rare research investigate correlation of them. This study aimed to explore correlation and prognostic value of them in gastric cancer (GC).
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Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...JohnJulie1
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...eshaasini
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
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Clinics of Oncology | Oncology Journals | Open Access JournalEditorSara
Clinics of OncologyTM (ISSN 2640-1037) - Impact Factor 1.920* is a medical specialty that focuses on the use of operative techniques to investigate and resolve certain medical conditions caused by disease or traumatic injury.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
In this retrospective study we enrolled patients with upper rectal or sigmoid junction locally advanced tumors (stages II-III). At the first Institution patients received NCRT followed by surgery (study group); at the second Institution patients were referred to upfront surgery (control group). Overall survival was the main endpoint of the analysis. Local relapse and other clinical variables were also analyzed.
This document discusses transarterial therapies for the treatment of intrahepatic cholangiocarcinoma (ICC), a rare but devastating cancer. It reviews the current evidence for chemoembolization and radioembolization in treating ICC. Several studies show that chemoembolization, using various chemotherapy regimens with or without drug-eluting beads, can provide median survival rates of 9-23 months for unresectable ICC. Emerging evidence also supports the potential role of radioembolization, but further research is still needed. Overall, transarterial therapies may help improve outcomes for ICC when surgery is not possible.
Current evidence for laparoscopic surgery in colorectal cancersApollo Hospitals
This article reviews the current evidence for laparoscopic surgery in treating colorectal cancers. It discusses several large randomized controlled trials that compared short-term and long-term outcomes of laparoscopic versus open surgery. The trials found no significant differences in cancer recurrence rates, survival rates, or number of lymph nodes retrieved between the two surgical methods. Meta-analyses of the trials validated that laparoscopic surgery is as safe and effective as open surgery for treating colorectal cancer. While the laparoscopic approach has benefits like less blood loss and shorter hospital stays, long-term oncologic outcomes are comparable to open surgery.
This document discusses bladder preservation as an alternative to radical cystectomy for muscle-invasive bladder cancer. It describes trimodality therapy (TMT) involving maximal transurethral resection of bladder tumor (TURBT), radiation therapy with concurrent chemotherapy. Observational studies have found no significant difference in survival outcomes between TMT and radical cystectomy. Patient selection factors for TMT include clinical T2-T3a disease, absence of hydronephrosis or extensive carcinoma in situ. Concurrent chemoradiation typically involves cisplatin-based chemotherapy with 40-45Gy radiation to the bladder and pelvis, followed by a boost to the bladder. Follow up involves frequent cystoscopy and urine cytology.
This document discusses treatment approaches for nonmetastatic locally advanced, borderline resectable, and potentially resectable exocrine pancreatic cancer. It recommends initial chemotherapy, often with gemcitabine or FOLFIRINOX, for locally advanced unresectable disease. For those who do not progress on chemotherapy, concurrent chemoradiation using infusional 5-FU is suggested. The evidence for benefit of chemoradiation over radiation alone is reviewed, though data is limited. Oral fluoropyrimidines may substitute for infusional 5-FU as a radiation sensitizer.
Results of Stereotactic Body Radiotherapy (SBRT) for Management of Hepatic Tu...Premier Publishers
PURPOSE: To evaluate early outcomes of hepatic tumors treated with robotic SBRT (cyberknife).
MATERIALS AND METHODS: Between March 2007 and December 2012; 59 patients: 48 Hepatic Metastases (HM), 8 Hepatocellular Carcinoma (HCC), 3 Cholangiocarcinoma (CC).
CTV margin for HCC and CC was 5 mm, PTV margin: 3 mm. no margin for HM.
Median dose: 47.61 Gy in 3 fractions prescribed to 80 % isodose line.
RESULTS: we report 1 grade 3 toxicity.
HCC; overall survival (OS): 41.7% at 1 year, local control (LC): 75% at 1 year.
At 1 and 2 years we report, respectively.
HM; OS: 83.6% and 57%, disease free survival (DFS): 69.5% and 46.1%, LC: 76.3% and 57.9%.
CC; OS: 100% and 50%, DFS and LC: 50% and 0%.
Factors influencing better OS; type of lesion, age < 65 years (p= 0.033), small PTV volume
(p= 0.002), for DFS; dose of 45 Gy (p= 0.001), dose per fraction of 15 Gy (p= 0.001), coverage > 95% for PTV (p= 0.001), For LC; type of lesion, dose to PTV (p= 0.037), coverage > 95% for PTV (p= 0.001).
CONCLUSION: Age, volume of tumor, dose, coverage of target volume are prognostic factors for survival and LC.
This study assessed the prognostic value of lymph node ratio (LNR) and extramural vascular invasion (EMVI) in predicting survival outcomes for 922 patients who underwent curative colon cancer resection between 2006-2012. The results showed that both increasing LNR and presence of EMVI were independently associated with decreased overall and disease-free survival on multivariate analysis. LNR was found to have greater prognostic value compared to the current pN staging system based on Akaike information criterion. Subgroup analysis by EMVI status also confirmed LNR and EMVI as significant predictors of survival.
1) The management of hepatocellular carcinoma (HCC) has improved in recent decades due to better patient stratification using tools like the Barcelona Clinic Liver Cancer staging system and new therapies such as sorafenib.
2) However, HCC remains a major cause of cancer deaths worldwide. Clinical practice guidelines strongly recommend five treatments for HCC - resection, transplantation, radiofrequency ablation, chemoembolization, and sorafenib - based on evidence from clinical trials.
3) Additional research is still needed to clarify the roles of other treatments like radioembolization and adjuvant therapies after resection, as well as second-line therapies for advanced HCC. Many ongoing clinical trials aim to address these
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IRF5 Promotes the Progression of Hepatocellular Carcinoma and is Regulated by...NainaAnon
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Invasive micropapillary carcinoma (IMPC) is a rare type of breast cancer with high frequency of regional lymph node metastasis. However, the prognosis of IMPC has remained controversial for decades. We aimed to compare the differences of prognosis between IMPC and Invasive ductal carcinoma(IDC) of the breast by utilizing Surveillance, Epidemiology, and End Results (SEER) database.
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Analysis of Treatment Option for Synchronous Liver Metastases and Colon Rectal Cancer
1. Clinics of Oncology
ISSN: 2640-1037
Review Article
Analysis of Treatment Option for Synchronous Liver
Metastases and Colon Rectal Cancer
Coco D
1*
and Leanza S
2
1
Ospedali Riuniti Marche Nord, (Pesaro), Italy
2
Carlo Urbani Hospita, Jesi (Ancona), Itay
Volume 2 Issue 1- 2019
Received Date: 03 May 2019
Accepted Date: 26 May 2019
Published Date: 02 Jun 2019
1. Abstract
Colorectal or bowel cancer is one of the major cause of cancer worldwide. Research has shown that
15 to 20 % colorectal cancer patients are also diagnosed with synchronous liver metastases (LM) at
presentation and about one third eventually develop liver lesions (Leporrier, Maurel, Chiche, Bara,
Segol, and Launoy, 2006; Manfredi, Lepage, Hatem, Coatmeur, Faivre, and Bou-vier, 2006).
Management of cases with colorectal cancer comorbid with liver metastases is more complex
(Schmoll, Van Cutsem, Stein, Valentini, Glimelius, Haustermans, Bismuth, Castaing, and Traynor,
1988). This highlights the need for suggesting the need for effective treatment while optimizing
timing during surgical and medical treatment of primary plus metastatic disease. Ac-cording to
Fong, Fortner, Sun, Brennan, and Blumgart, 1999), such patients cases are likely to present with
severe cancer biology and thereby less likely to be long-term survivors.
2. Introduction
Colorectal or bowel cancer is one of the major cause of cancer
worldwide. Research has shown that 15 to 20 % colorectal can-
cer patients are also diagnosed with synchronous liver
metastases (LM) at presentation and about one third eventually
develop liver lesions[1-6]. Management of cases with colorectal
cancer comor-bid with liver metastases is more complex[7-9].
This highlights the need for suggesting the need for effective
treatment while optimizing timing during surgical and medical
treatment of pri-mary plus metastatic disease. According to [9-
11], such patients cases are likely to present with severe cancer
biology and thereby less likely to be long-term survivors.
The question as whether primary lesion surgery should precede
metastases resection is still debatable. Logically, the manage-ment
of these patients can be categorized into two groups. The first case
is where the patients have hepatic disease synchronized with
extrahepatic metastatic condition. These patients are treated with
systemic chemotherapy as provided in the current treat-ment
guidelines for patients with advanced multisite metastatic
colorectal cancer disease [12] National Institute of Clinical Excel-
lence, 2011). The second case is where patients have liver-limited
synchronous metastatic disease which occurs frequently but yet
a rising complex clinical management issue[11-13].
Conventionally, treatment of colorectal synchronous liver me-
tastasis patients comprised colorectal primary tumour resection
and then adjuvant chemotherapy in combination with liver re-
section[10,12,14]. However, Mentha, Majno, Andres, Rubbia-
Brandt, Morel, and Roth (2006) challenged this view by
advocat-ing for advanced synchronous liver metastases
resection before the primary.
For patients with synchronous metastases, major advancements in
liver surgery have led to two alternative options. The first involves
synchronous liver metastases and colorectal primary resection
synchronously [13,14] which aims to remove mac-roscopic tumour
burden through a single operation. However, this approach may
lead to considerable complex morbidity with side effects on
progression-free survival [15]. The second option starts with liver
metastatic disease resection (i.e. reverse or liver-first
approach[16,17]. This approach is commonly indicated for
colorectal synchronous liver metastasis patients where rectal pri-
mary preoperative long-course chemoradiotherapy before surgi-cal
resection is likely to create a ‘window’ for liver resection[14].
*Corresponding Author (s): Danilo Coco, Ospedali Riuniti Marche Nord, Pesaro, Italy,
Tel:+393400546021, E-mail: webcostruction@msn.com
Citation: Coco D and Leanza S, Analysis of Treatment Option for Synchronous Liver Metastases and Colon
clinicsofoncology.com Rectal Cancer. Clinics of Oncology. 2019; 1(7): 1-3.
3. Volume 2 Issue 1 -2019 Review Article
5. Conclusion and Recommendations
In general, this review found that the treatment order for
patients withcolorectal synchronous liver metastasis patients.
The gen-eral observation is that patients with colorectal liver
metastases should be treated with the most effective systemic
chemotherapy in combination multidisciplinary team (MDT) re-
evaluation ev-ery 2 months. However, liver surgery should be
performed once colorectal liver metastases (CRLM) becomes
resectable followed by systemic treatment prior to and/or after
primary resection for at least 6 months. However, this study
recommends the need for future research to ascertain the best
treatment options based on patient needs.
References
1. Adam R. Colorectal cancer with synchronous liver metastases. BJS.
2007; 94: 129-131.
2. Adam R, Lucidi V, Bismuth H. Hepatic colorectal metastases: methods
of improving resectability. SurgClin North Am. 2004; 84: 659-71.
3.Aklilu M,Eng C. The current landscape of locally advanced rectal
Can-cer. Nat Rev ClinOncol.2011; 8:649-59.
4. Bismuth H, Castaing D, Traynor O. Surgery for synchronous hepat-
ic metastases of colorectal Cancer. Scand J Gastroenterol Suppl.1988;
149:144-9.
5. Brouquet A, Mortenson MM, Vauthey JN, Rodriguez-Bigas MA,
Overman MJ, Chang GJ, et al. Surgical strategies for synchronous
colorectal liver metastases in 156 consecutive patients: classic,
combined or reverse strategy? J Am Coll Surg.2010; 210: 934-41.
6. de Haas RJ, Adam R, Wicherts DA, Azoulay D, Bismuth H, Vibert E, et
al. Comparison of simultaneous or delayed liver surgery for limited
synchronous colorectal metastases. Br J Surg.2010; 97: 1279-89.
7. Fong Y1, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score
for predicting recurrence after hepatic resection for metastatic colorectal
Cancer: analysis of 1001 consecutive cases. Ann Surg.1999; 230: 309-18.
8. HillingsøJG, Wille-Jørgensen P. Staged or simultaneous resection of
synchronous liver metastases from colorectal Cancer--a systematic re-
view. Colorectal Dis. 2009;11: 3-10.
9. Leporrier J, Maurel J, Chiche L, Bara S, Segol P, Launoy G. A popula-
tion-based study of the incidence, management and prognosis of hepatic
metastases from colorectal Cancer. Br J Surg. 2006; 93: 465-74.
10. Manfredi S1, Lepage C, Hatem C, Coatmeur O, Faivre J, Bouvier
AM. Epidemiology and management of liver metastases from
colorectal Can-cer. Ann Surg.2006; 244: 254-9.
11. de Jong MC, Ronald MVD, Monique M, Bemelmans MHA,
Damink SWMO, Beets GL, Dejong CHC. The liver-first approach for
synchro-nous colorectal liver metastasis: a 5-year single-centre
experience. HPB.2011; 13: 745-752.
12. Mentha G1, Majno PE, Andres A, Rubbia-Brandt L, Morel P, Roth
AD. Neoadjuvant chemotherapy and resection of advanced synchro-
nous liver metastases before treatment of the colorectal primary. Br J
Surg.2006; 93: 872-8.
13. National Institute of Clinical Excellence. Colorectal Cancer: the di-
agnosis and management of colorectal Cancer. Clinical GuidelineCG.
2011; 131.
14. Sagar J. Colorectal stents for the management of malignant colonic
obstructions. Cochrane Database Syst Rev. 2011; 9.
15. Salman YousufGuraya. Modern oncosurgical treatment strategies
for synchronous liver metastases from colorectal cancer. Journal of
Micros-copy and Ultrastructure, 2013; 1:1–7.
16. Schmoll HJ1, Van Cutsem E, Stein A, Valentini V, Glimelius B,
Haus-termans K. ESMO Consensus guidelines for management of
patients with colon and rectal cancer. a personalized approach to
clinical decision making. Ann Oncol.2012; 23: 2479-516.
17. Siriwardena AK, Mason JM, Mullamitha S, Hancock HC, Jegath-
eeswaran S. Management of colorectal Cancer presenting with
synchro-nous liver metastases. Nat Rev ClinOncol.2014; 11: 446-59.
clinicsofoncology.com 3