Alternating hepatic arterial infusion and systemic chemotherapy for stage IV colorectal cancer with synchronous liver metastasis

Abstract

Abstract. Among 41 patients with synchronous liver metastases of colorectal cancer, 15 patients underwent synchronous resection of their liver metastases and achieved a median survival time (MST) of 1,441 days (versus 748 days for the 26 patients without resection, p=0.038), a median relapse-free survival time of 652 days (MST not reached), and a recurrence rate in the residual liver of 20% (3/15 patients). The alternating hepatic arterial infusion and systemic chemotherapy showed partial response (PR) in 6 cases, stable disease (SD) in 8 cases, and progressive disease (PD) in 1 case (n=15/26). They had an objective response rate of 40% (6/15), tumor control rate (≥ SD) of 93.3% (14/15), one-year progression-free survival rate of 35.7%, 50% time to progression of 270 days, one-year survival rate of 76.2%, and two-year survival rate of 50.8% (MST not reached). Grade 3 leucopenia was observed in 2/15 patients (13.3%). These results suggest that the present alternating therapy may become a standard regimen for patients in whom synchronous resection of liver metastases is impossible and patients who have stage IV colorectal cancer with a risk of recurrence in the remnant liver and/or at extrahepatic sites such as the lungs.

Pelvic recurrence after Miles' operation for anastomotic recurrence in a patient with stage I rectal cancer invading the proper muscle layer: Case report

“…Various studies have shown that the detection of intranodal ONCs in LNs indicates the systemic spread of cancer cells more accurately than the ly and v status of the primary tumor (10)(11)(12)(13)(14)(15)(16). In fact, many clusters of extranodal ONCs were observed in the dissected perinodal fat of the present patient, despite the tumor being ly0 and v0.…”

“…Possible risk factors for the postoperative local recurrence of low rectal cancer including stage I disease are: i) an inadequate resection margin of <2 cm, ii) seeding of tumor cells by large bowel perforation due to operative manipulation or inadequate suturing, iii) implantation of viable tumor cells in the alimentary tract by mechanical anastomosis, and iv) occult microscopic tumor invasion, including visually undetectable microscopic lymph node metastasis and microscopic deposits in the pelvic fat (7)(8)(9). Many studies have also shown a close relationship between the detection of cytokeratin-positive occult neoplastic cells (ONCs) in lymph node sinuses (intranodal ONCs) far from the primary tumor and distant metastasis/recurrence of n0 disease (10)(11)(12)(13)(14)(15)(16).…”

Clinical comparison of QOL and adverse events during postoperative adjuvant chemotherapy in outpatients with node-positive colorectal cancer or gastric cancer

“…ONCs are found in >80% of stage II/III patients with recurrence, while ONC clusters (≤10 ONCs, ~0.2 mm in diameter) and malignant micro-aggregates (>10 ONCs) consisting of numerous floating ONCs bound together are observed in stage III patients. It has been reported that ONCs should be differentiated from isolated tumor cells (ITCs ≤0.2 mm) and micro-metastases (0.2 mm <MM ≤2 mm) anchored in the lymph nodes, because ONCs are an occult form of systemic metastasis with a higher degree of malignancy (11)(12)(13). Therefore, the most important objective of postoperative adjuvant chemotherapy is the eradication of tumor cell clusters and aggregates that circulate in the perioperative period (11)(12)(13).…”

Sensitivity to CPT-11 and platinum derivatives of stage II/Dukes' B colorectal cancer with occult neoplastic cells in lymph node sinuses

“…Solitary free ONCs in LN sinuses distant from the primary tumor can be detected by cytokeratin immunostaining, but ONCs are also defined as including clusters of ≤10 cells, while malignant microaggregates contain >10 cells (10). ONC clusters have the potential to cause tumor metastasis/ recurrence in any organ, and should be differentiated from micrometastases (0.2-2 mm) anchored in LNs or from ITCs (≤0.2 mm), since ONC clusters seem to be have a higher malignant potential (10)(11)(12).…”