Tumor response and outcome after reverse treatment for patients with synchronous colorectal liver metastasis: a cohort study

Abstract

Background: The reverse treatment of patients with synchronous colorectal liver metastases (CRLM) is a sequential approach with systemic chemotherapy first, followed by liver resection, and finally, primary tumor resection. The aim of this study was to assess the feasibility, the radiological and pathological tumor response to neoadjuvant therapy, recurrence rates and long-term survival after reverse treatment in a cohort study. Methods: Data from patients with CRLM who underwent a reverse treatment from August 2008 to October 2016 were extracted from our prospective hepato-biliary database and retrospectively analyzed for response rates and survival outcomes. Radiological tumor response was assessed by RECIST (Response Evaluation Criteria In Solid Tumor) criteria and pathological response according to TRG (Tumor Regression Grade). Disease-free and overall survival were estimated with Kaplan-Meier survival curves. Results: There were 44 patients with 19 rectal and 25 colonic tumors. The reverse treatment was fully completed until primary tumor resection in 41 patients (93%). Radiological assessment after chemotherapy showed 61% of complete/partial response. Pathological tumor response was major or partial in 52% of patients (TRG 1-3). Median disease-free survival after primary tumor resection was 10 months (95% CI 5-15 months). Disease-free survival at 3 and 5 years was 25% and 25%, respectively. Median overall survival was 50 months (95% CI 42-58 months). Overall survival at 3 and 5 years was 59% and 39%, respectively. Conclusion: The reverse treatment approach was feasible with a high rate of patients with complete treatment sequence and offers promising long-term survival for selected patients with advanced simultaneous colorectal liver metastases.

Granzyme B PET Imaging of Combined Chemotherapy and Immune Checkpoint Inhibitor Therapy in Colon Cancer

“…Chemotherapy response is classically defined by evaluating morphologic changes in tumor volume defined by CT or MRI following RECIST criteria [ 22 ]. However, tumors treated with ICIs may remain stable or even increase in size before ultimately responding to therapy [ 23 ].…”

Colorectal Cancer, Liver Metastases and Biotherapies

“…Hepatic resections are divided into three groups: (1) sequential resection (SeR), in which surgical teams are able to resect colorectal cancer and liver metastases without delivering interval chemotherapy; (2) delayed resection (DeR) in which we deliver interval chemotherapy between staged colonic cancer resection and hepatic resection of CRC metastases; and (3) simultaneous resection (SiR), single-stage resection of primary colorectal cancer and liver metastases simultaneously. SiR is performed in patients who fulfil certain criteria (1) the primary tumour was located in the right colon regardless of the tumour disease burden of liver metastases; (2) the tumour disease burden was not heavy, and the tumour number was less than two if the primary tumour was located in the left colon or rectum [ 38 , 39 ].…”

Automatic segmentation of hepatic metastases on DWI images based on a deep learning method: assessment of tumor treatment response according to the RECIST 1.1 criteria

“…Response Evaluation Criteria in Solid Tumor 1.1 (RECIST 1.1) is accepted as a standard method and widely used clinical guideline for the evaluation of response and progress of solid tumors [ 7 , 8 ]. The application of the RECIST1.1 guideline involves a series of tumor size measurements, which is an important surrogate marker of therapeutic efficacy [ 9 ].…”