Limited Liver or Lung Colorectal Cancer Metastases. Systemic Treatment, Surgery, Ablation or SBRT

Mollà, Meritxell; Fernández-Plana, Julen; Albiol, Santiago; Fondevila, Constantino; Vollmer, Iván; Cases, C.; García–Criado, Ángeles; Capdevila, Jaume; Conill, Carles; Fundora, Yliam; Fernández-Martos, Carlos; Pineda, Estela

doi:10.3390/jcm10102131

Cited by 16 publications

(8 citation statements)

References 67 publications

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“…Conversion surgery has been adopted in other oligometastatic neoplasms such as colorectal cancer and gastric cancer, with the aim at improving control of the diseases in patients with major responses to NAT. [15,16] This treatment strategy demonstrated promising outcomes in selected cases, leading us to speculate that it may also be beneficial in mPDAC. However, previously reported survival outcomes of radical resection for mPDAC after NAT demonstrated considerable heterogeneity on the basis of unbalanced sample sizes and patient selection.…”

Section: Discussionmentioning

confidence: 99%

Survival outcomes of conversion surgery for metastatic pancreatic ductal adenocarcinoma after neoadjuvant therapy

Zhu

Gao

et al. 2023

Journal of Pancreatology

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Objective: To evaluate the survival outcomes of patients who underwent conversion surgery for metastatic pancreatic ductal adenocarcinoma (mPDAC) after neoadjuvant therapy (NAT) and to identify potential candidates that may benefit from this treatment strategy. Background: The role and eligibility population of conversion surgery for mPDAC remains controversial in the era of NAT. Methods: A consecutive cohort of patients diagnosed with mPDAC and treated with NAT followed by conversion surgery between 2019 and 2021 were confirmed from a prospective database maintained by the Department of Pancreatic Hepatobiliary Surgery of Changhai Hospital. In accordance with residual metastases and technical resectability after NAT, patients were classified as the complete pathological response of metastases (ypM0) resection group, residual metastases (ypM1) resection group, and exploration group. Median overall survival (mOS) was calculated using the Kaplan-Meier method, uni- and multivariable cox regression was performed to identify clinicopathological predictors of OS. Results: A total of 244 patients with mPDAC were identified from the prospective database, with 19 (7.8%) patients who underwent ypM0 resection, 22 (9.0%) underwent ypM1 resection, and 23 (9.4%) underwent explorative laparotomy. The mOS was 32.6 months for ypM0 resected patients, 15.1 months for ypM1 resected patients, and 13.4 months for those who underwent explorative laparotomy (P < .001). Univariable and multivariable Cox regression analyses confirmed that ypM0 resection, normalization of preoperative CA19-9 levels, and continued adjuvant therapy were independent prognostic factors of conversion surgery for mPDAC after NAT. Subgroup analyses revealed that oligometastases and continued adjuvant therapy were associated with improved prognosis in the ypM1 resection group. Conclusion: In patients with mPDAC who underwent NAT followed by conversion surgery, the complete pathological response of metastases, normalization of preoperative CA19-9 levels, and continued adjuvant therapy were independent risk factors for prognosis. Patients with residual oligometastases after treatment were expected to prolong survival through resection. These patients may benefit from conversion surgery and should be potential candidates for this treatment strategy.

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Section: Discussionmentioning

confidence: 99%

Survival outcomes of conversion surgery for metastatic pancreatic ductal adenocarcinoma after neoadjuvant therapy

Zhu

Gao

et al. 2023

Journal of Pancreatology

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“…Apart from the treated lesion, a margin of 5 mm of normal tissue is usually added. Different schemes and fractions are used, but typical dose schedules range from 3 to 8 fractions delivering 45–60 Gy for liver metastases [ 134 ]. CRC is considered radioresistant, but this resistance can be overcome by the high doses achieved with this technique [ 135 ].…”

Section: Local Ablative Therapiesmentioning

confidence: 99%

Local Treatments in the Unresectable Patient with Colorectal Cancer Metastasis: A Review from the Point of View of the Medical Oncologist

Torres-Jiménez

Esteban-Villarrubia

Ferreiro-Monteagudo

et al. 2021

Cancers

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For patients with isolated liver metastases from colorectal cancer who are not candidates for potentially curative resections, non-surgical local treatments may be useful. Non-surgical local treatments are classified according to how the treatment is administered. Local treatments are applied directly on hepatic parenchyma, such as radiofrequency, microwave hyperthermia and cryotherapy. Locoregional therapies are delivered through the hepatic artery, such as chemoinfusion, chemoembolization or selective internal radiation with Yttrium 90 radioembolization. The purpose of this review is to describe the different interventional therapies that are available for these patients in routine clinical practice, the most important clinical trials that have tried to demonstrate the effectiveness of each therapy and recommendations from principal medical oncologic societies.

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“…5 The term "oligometastasis" describes the pathogenic state characterized by a small number of metastases to a few organs. [6][7][8][9] Detection of oligometastasis provides an opportunity to surgically intervene and therefore improve prognosis. 6,7 In PDAC, however, recurrent lesions similar to those found in oligometastasis often progress rapidly to multi-organ metastases, and the post-recurrent prognosis is poor.…”

Section: Introductionmentioning

confidence: 99%

Oligo‐like liver metastasis: A novel prognostic indicator to improve survival in pancreatic cancer

Saito,

Ban,

Mizui

et al. 2023

Annals of Gastroent Surgery

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PurposeWhether surgical intervention for patients with oligometastatic recurrence can improve their post‐recurrent prognosis is unclear. In this study, we introduce a novel concept of oligometastasis in post‐surgical pancreatic ductal adenocarcinoma (PDAC) patients with hepatic recurrence, which we call “oligo‐like liver metastasis (OLLM).” Patients with OLLM have better post‐recurrence prognosis and could therefore be eligible for surgical intervention.MethodsA total of 121 PDAC patients who underwent radical resection, and who had an initial and single‐organ metastasis to the liver, were analyzed. Independent prognostic factors for overall survival after recurrence (OSAR) were examined, and patients with all of these factors were defined as OLLM. The clinicopathological features and post‐recurrent prognosis of OLLM patients were evaluated. In addition, a detailed analysis using the oligo‐score, which was based on the prognostic factors, was performed.ResultsThe prognostic analysis revealed that short recurrence‐free interval (RFI) (<6 months), short stable disease interval (SDI) (≤3 months), and four or more recurrent tumors were independent poor prognostic factors. OLLM patients were defined as those with all three conditions: long RFI (≥6 months), long SDI (>3 months), and three or less recurrent tumors. OLLM patients had a significantly better prognosis for OSAR than non‐OLLM patients (HR = 0.272, p < 0.001). Further analysis demonstrated that the OSAR of patients could be stratified using the oligo‐score, which was calculated based on the prognostic factors.ConclusionWe recommend that OLLM should be used to predict which patients are most likely to experience better post‐recurrent prognosis after surgery with curative intent.

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Limited Liver or Lung Colorectal Cancer Metastases. Systemic Treatment, Surgery, Ablation or SBRT

Cited by 16 publications

References 67 publications

Survival outcomes of conversion surgery for metastatic pancreatic ductal adenocarcinoma after neoadjuvant therapy

Survival outcomes of conversion surgery for metastatic pancreatic ductal adenocarcinoma after neoadjuvant therapy

Local Treatments in the Unresectable Patient with Colorectal Cancer Metastasis: A Review from the Point of View of the Medical Oncologist

Oligo‐like liver metastasis: A novel prognostic indicator to improve survival in pancreatic cancer

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