First Brazilian Consensus on Multimodal Treatment of Colorectal Liver Metastases. Module 1: Pre-Treatment Evaluation

Abstract

Background: Liver metastases of colorectal cancer are frequent and potentially fatal event in the evolution of patients with these tumors. Aim: In this module, was contextualized the clinical situations and parameterized epidemiological data and results of the various treatment modalities established. Method: Was realized deep discussion on detecting and staging metastatic colorectal cancer, as well as employment of imaging methods in the evaluation of response to instituted systemic therapy. Results: The next step was based on the definition of which patients would have their metastases considered resectable and how to expand the amount of patients elegible for modalities with curative intent. Conclusion: Were presented clinical, pathological and molecular prognostic factors, validated to be taken into account in clinical practice.

Colorectal Liver Metastases

“…The adenocarcinoma of the colon and rectum (CRC) affect more than 1.3 million patients each year, being the third most common malignancy in the world [1]. Approximately, 30-50% of these patients will present with liver metastasis at the time of diagnosis or will develop metastasis later [2,3].…”

“…The most common site of metastatic CRC is the liver, occurring in 80% of cases, representing nearly half of all patients with CRC. It is also the single site of metastasis in 20-50% of the cases [2]. The majority of metastatic CRC liver disease will be potentially resectable at the time of diagnosis, approximately 75-80% of cases [3].…”

“…A majority of CRC metastases (mCRC) occurs within the first 3 years. The incidence of mCRC is approximately 4.3% at 1 year, 8.7% at 2 years, 12% at 3 years, and 16.5% at 5 years after resection [2]. The frequency of metachronous CRC metastases is highly variable in the literature, arising from database differences and diversity of definitions.…”

“…In prospective observational studies and population studies, this frequency is lower, ranging from 5.7 to 16.3% [5]. In population studies, the frequency of synchronous liver metastases from CRC varies from 14.5 to 24% [2]. Patients presenting with stage 4 disease at the time of the diagnosis will have liver-confined metastases (synchronous metastases) in 77% of the cases [6].…”

Metachronous Colorectal Liver Metastases Has Better Prognosis - Is It True?

“…Hepatic metastases from colorectal cancer are an important public health problem due to the increasing incidence of colorectal cancer worldwide (1) . Hepatic metastases from colorectal cancer may be present in 15% to 20% of cases at diagnosis and in up to 60% of cases during the life of these patients (2) .…”