Omission of concurrent chemoradiation after a response to neoadjuvant chemotherapy in locally advanced rectal cancer with a synchronous liver metastasis: a note of caution

Craven, Ian; Haselden, John N.; Miller, K.; Miller, George V.; Bradford, I; Sebag‐Montefiore, David

doi:10.1259/bjr/38988181

Cited by 7 publications

(5 citation statements)

References 6 publications

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“…In these patients, long-term survival can be achieved by multidisciplinary integration of technical evaluation as to the feasibility of metastatic radical resection and the oncological evaluation of disease extent, clinical status of the patient and symptoms. There are few published data in this rectal cancer setting of patients [27,28,29]. …”

Section: Discussionmentioning

confidence: 99%

Treatment Strategy for Rectal Cancer with Synchronous Metastasis: 65 Consecutive Italian Cases from the Bologna Multidisciplinary Rectal Cancer Group

et al. 2014

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Background: Twenty percent of rectal cancer patients have synchronous distant metastasis at diagnosis. At present, the treatment strategy in this patient setting is not well defined. This study in one institution evaluates the treatment strategy of three different patient groups. Patients and Methods: Between January 2000 and July 2011, 65 patients with M1 rectal cancer were evaluated. Three different groups were defined: rectal cancer with resectable metastatic disease (group A); rectal cancer with potentially resectable metastatic disease (group B), and rectal cancer with unresectable metastatic disease (group C). Results: Group A included 11 patients (16.9%), group B 28 patients (43.1%) and group C 26 patients (40%). Forty-three (66.2%) patients underwent surgery for primary rectal cancer, and 30 (46.2%) patients for metastasis resection (23 liver, 4 lung and 3 ovary). Median overall survival (OS) by group was: 51 (5-86; group A), 32 (24-40; group B) and 16 (7-26; group C) months. Patients undergoing metastasis resection have higher median OS than unresected patients (44 vs. 15 months; p < 0.001). Conclusions: The treatment strategy in synchronous metastatic rectal cancer must consider the possibility of distant metastasis resection. Long-term survival can be achieved using an integrated approach.

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Section: Discussionmentioning

confidence: 99%

Treatment Strategy for Rectal Cancer with Synchronous Metastasis: 65 Consecutive Italian Cases from the Bologna Multidisciplinary Rectal Cancer Group

et al. 2014

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“…It is questionable whether chemoradiotherapy should be given following a good response to chemotherapy in patients with locally advanced primary disease. Neoadjuvant chemoradiation therapy may be required even after response to systemic neoadjuvant chemotherapy because of microscopic foci of malignancy near the circumferential resection margin37.…”

Section: Discussionmentioning

confidence: 99%

Optimizing the outcome of surgery in patients with rectal cancer and synchronous liver metastases

Pool¹,

Wilt²,

Lalmahomed

et al. 2010

British Journal of Surgery

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“…We combined a systemic and locoregional approach due to the presence of a locally advanced tumour in the rectum (uT3N1) and the isolated metastatic uptake revealed in PET. The literature describes local relapse following surgery of the primary tumour and hepatic resections in patients who had not undergone radiotherapy and presented affectation of the circumferential margin [11]. In our case, surgery was classified as R0 after pathological study.…”

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confidence: 80%

Synchronous isolated adrenal metastasis from rectum adenocarcinoma

et al. 2009

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The treatment of adjuvant metastatic colorectal cancer (MCRC) is protocolised in national and international treatment guidelines [1, 2]. A treatment consensus has been reached for liver metastases of colorectal cancer [3]. Protocolisation of the treatment of extrahepatic localisations such as the lung, peritoneum or adrenal glands will prove much more difficult.Adrenal metastases mainly appear in patients with lung, kidney, breast, colon and rectum cancers [4]. Colorectal cancer is frequently present in the context of a disease disseminated to various organs and isolated adrenal metastases are infrequent [5,6].In MCRC, surgical resection should be considered, as it is the only possible curative option. One third of patients with radically resected hepatic metastasis will have longer survival and be considered cured [7]. Similar survival rates are achieved when a hepatectomy and resection of adrenal metastasis are performed [8].We found no reference to the therapeutic approach to rectal disease with synchronous isolated adrenal metastasis and we want to discuss this point with a clinical case. A 61-year-old female patient, with no particular antecedents, presented in January 2003 with rectorrhagia. Exploration revealed a fixed and non-obstructive lesion and fibrocolonoscopy showed a lesion 8 cm from anal verge. Biopsy was positive for moderately differentiated adenocarcinoma. The determination of carcinoembryonic antigen (CEA) at diagnosis was 513.7 ng/ml. Further studies were performed: thorax X-ray was normal, endoscopic rectal ultrasound evidenced a uT3N1 tumour and abdominal computed tomography (CT) (Fig. 1) and magnetic resonance (MR) evidenced a rectal tumour and a 6-cm mass in the right adrenal gland, suggestive of metastasis. Fine-needle aspiration biopsy (FNAB) of the adrenal mass confirmed histological diagnosis of metastasis of colon adenocarcinoma. Positron emission tomography (PET) did not show any new metastatic lesions besides the already known suprarenal lesion.The patient was diagnosed with locally advanced rectal neoplasia with an isolated right adrenal metastasis, both lesions being resectable. Preoperative chemotherapy was initiated with 5-FU continuous infusion chemotherapy and concomitant radiotherapy on the primary Fig. 1 Abdominal enhanced CT scan, obtained 90 s after intravenous administration of contrast material, demonstrates a large, heterogenous, mostly hypodense mass affecting the right adrenal gland, highly suspicious of malignancy

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Omission of concurrent chemoradiation after a response to neoadjuvant chemotherapy in locally advanced rectal cancer with a synchronous liver metastasis: a note of caution

Cited by 7 publications

References 6 publications

Treatment Strategy for Rectal Cancer with Synchronous Metastasis: 65 Consecutive Italian Cases from the Bologna Multidisciplinary Rectal Cancer Group

Treatment Strategy for Rectal Cancer with Synchronous Metastasis: 65 Consecutive Italian Cases from the Bologna Multidisciplinary Rectal Cancer Group

Optimizing the outcome of surgery in patients with rectal cancer and synchronous liver metastases

Synchronous isolated adrenal metastasis from rectum adenocarcinoma

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