Multidisciplinary Treatment of Colorectal Cancer: The Palliative Team Introduction

Author(s):  
Dagny Faksvåg Haugen
Author(s):  
Alexandre A. Jácome ◽  
Timothy J. Vreeland ◽  
Benny Johnson ◽  
Yoshikuni Kawaguchi ◽  
Steven H. Wei ◽  
...  

Abstract Background The impact of molecular aberrations on survival after resection of colorectal liver metastases (CLM) in patients with early-age-onset (EOCRC) versus late-age-onset colorectal cancer (LOCRC) is unknown. Methods Patients who underwent liver resection for CLM with known RAS, BRAF and MSI status were retrospectively studied. The prognostic impact of RAS mutations by age was analysed with age as a categorical variable and a continuous variable. Results The study included 573 patients, 192 with EOCRC and 381 with LOCRC. The younger the age of onset of CRC, the greater the negative impact on overall survival of RAS mutations in the LOCRC, EOCRC, and ≤40 years (hazard ratio (HR), 1.64 (95% confidence interval (CI), 1.23–2.20), 2.03 (95% CI, 1.30–3.17), and 2.97 (95% CI, 1.44–6.14), respectively. Age-specific mortality risk and linear regression analysis also demonstrated that RAS mutations had a greater impact on survival in EOCRC than in LOCRC (slope: −4.07, 95% CI −8.10 to 0.04, P = 0.047, R2 = 0.08). Conclusion Among patients undergoing CLM resection, RAS mutations have a greater negative influence on survival in patients with EOCRC, more so in patients ≤40 years, than in patients with LOCRC and should be considered as a prognostic factor in multidisciplinary treatment planning.


2011 ◽  
Vol 10 (2) ◽  
pp. 121-125 ◽  
Author(s):  
Emmanouil Fokas ◽  
Martin Henzel ◽  
Klaus Hamm ◽  
Gunnar Surber ◽  
Gabriele Kleinert ◽  
...  

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 653-653 ◽  
Author(s):  
Benedikt Engels ◽  
Thierry Gevaert ◽  
Hendrik Everaert ◽  
Alexandra Sermeus ◽  
Guy Storme ◽  
...  

653 Background: Complete metastasectomy provides a real chance for long-term survival in patients with oligometastatic colorectal cancer (CRC). For patients who are not amenable for metastasectomy, we demonstrated in a previous study the feasibility of moderately hypofractionated intensity-modulated and image-guided radiotherapy (RT) by helical tomotherapy. Aiming at higher response rates, we evaluated in this study helical tomotherapy delivering 50 Gy in daily fractions of 5 Gy. Methods: Inoperable CRC patients with ≤ 5 metastases were enrolled. No limitations concerning dimension or localization of the metastases were imposed. Whole body PET-CT was performed at baseline and 3 months after the initiation of RT to evaluate the metabolic response rate according to PERCIST v 1.0. Side effects were scored using the NCI CTC AE v 3.0 scale. Results: We report the results of the first 22 patients. Thirteen patients (59%) received previous chemotherapy for metastatic disease, displaying residual (n=7) or progressive (n=6) metabolic active metastatic disease at time of inclusion. A total of 51 metastases were treated. Most common sites were the lung, liver and lymphnodes. One patient (5%) experienced grade 3 dysphagia; 2 patients (9%) and 1 patient (5%) grade 2 dysphagia and diarrhea, respectively. Twenty patients were evaluated by post-treatment PET-CT. Five and 6 patients achieved a complete and partial metabolic response, resulting in an overall metabolic response rate of 55%. At a median follow-up of 11 months, 17 patients (77%) developed progressive disease, of which 3 isolated local progression. Five patients (23%) are in remission in all irradiated areas without evidence of distant recurrence. Interestingly, those 5 patients received previous chemotherapy with residual oligometastatic disease at time of inclusion. Conclusions: Ten fractions of 5 Gy resulted in a promising 55% metabolic response rate with limited toxicity. Helical tomotherapy is an attractive modality in the multidisciplinary approach of oligometastatic CRC, more specifically in the consolidation of residual and inoperable oligometastatic disease in patients previously treated with chemotherapy.


BMC Cancer ◽  
2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Xiao-Dong Gu ◽  
Yan-Tao Cai ◽  
Yi-Ming Zhou ◽  
Zhen-Yang Li ◽  
Jian-Bin Xiang ◽  
...  

2015 ◽  
Vol 22 (5) ◽  
pp. 1520-1526 ◽  
Author(s):  
Jeongshim Lee ◽  
Jee Suk Chang ◽  
Sang Joon Shin ◽  
Joon Seok Lim ◽  
Ki Chang Keum ◽  
...  

2016 ◽  
Vol 19 (3) ◽  
pp. A19
Author(s):  
D Sat-Muñoz ◽  
L Balderas-Peña ◽  
U Palomares-Chacon ◽  
C Salas-Barragán ◽  
B Martinez-Herrera

Nowa Medycyna ◽  
2020 ◽  
Vol 27 (3) ◽  
Author(s):  
Jadwiga Snarska ◽  
Dariusz Zadrożny ◽  
Jarosław Parfianowicz ◽  
Radosław Grabysa ◽  
Maciej Michalak ◽  
...  

Gastrointestinal malignancies, colorectal cancer in particular, come second in terms of incidence and mortality among all male and female neoplasms. Early detection guarantees good treatment outcomes. Endoscopy (colonoscopy) with biopsy and imaging (abdominal ultrasound and computed tomography), as well as biochemical markers should be included in the diagnostic process. Depending on the stage of colorectal cancer, combined treatment including surgery, chemotherapy and radiation therapy, is used. Therefore, not only coordinated multidisciplinary treatment, but also prompt diagnosis is important. For this reason, a fast track to diagnose and treat cancer patients, known as the DILO card, was introduced in 2015. Both, medical case conferences, whose aim is to determine further diagnostic and, in particular, therapeutic steps, and coordinators, whose role in this case cannot be overestimated, play an important role in DILO implementation. The DILO card serves as a referral to outpatient cancer clinics and departments, as well as diagnostic laboratories. Properly functioning multidisciplinary medical case conferences and combined treatment approach are the basis for establishing Centres of Competence for the Treatment of Colorectal Cancer.


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