Patterns of Failure Following Surgical Resection of Colorectal Cancer Liver Metastases: Rationale for a Multimodal Approach

Historically, the 5-year survival rates for patients with stage 4 (metastatic) colorectal cancer were extremely poor (5%); however, with advances in systemic chemotherapy combined with an ability to push the boundaries of surgical resection, survival rates in the range of 25–40% can be achieved. This multimodal approach of combining neo-adjuvant strategies with surgical resection has raised a number of questions regarding the optimal management and timing of surgery. For the purpose of this review, we will focus on the treatment of stage 4 colorectal cancer with synchronous liver metastases.

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Survival after Yttrium-90 radioembolization in elderly and nonelderly patients with hepatocellular carcinoma or colorectal cancer liver metastases.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.449 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 449-449

Author(s):

Rebecca Ann Redman ◽

Douglas Coldwell ◽

Vivek R. Sharma

Keyword(s):

Colorectal Cancer ◽

Hepatocellular Carcinoma ◽

Liver Metastases ◽

Surgical Resection ◽

Median Survival ◽

The Elderly ◽

Curative Intent ◽

Colorectal Cancer Liver Metastases ◽

Younger Patients ◽

Yttrium 90

449 Background: Systemic treatment of unresectable hepatocellular carcinoma (HCC) or colorectal cancer liver metastases (CLM) in the elderly can be complicated by increased toxicity. In addition, the increasing incidence of comorbidities with age may preclude surgical resection with curative intent. Hepatic arterial therapy is increasingly utilized in patients with HCC or CLM not amenable to surgical resection. Studies of transarterial chemoembolization in the elderly have generally shown similar safety and efficacy as compared to younger patients, although some studies suggest worse outcomes. The selective nature of radioembolization has the potential for improved tolerability in this patient population. Methods: We report the results of a retrospective review of patients with unresectable HCC or metastatic disease to the liver treated with Yttrium-90 radioembolization at a single institution. Results: Patients were referred for treatment after multidisciplinary evaluation, but were not treated as part of a clinical trial. A total of 94 patients treated were evaluable for follow up. There were approximately twice as many males as females (64% vs 36%). Elderly was defined as 70 years of age or older, representing 20 of the 94 patients. Average age of the elderly cohort was 76 (range 70-90), compared to 56 years of age (range 23-69) for the younger patients. Survival was measured from date of first radioembolization. Median survival was similar for elderly and younger patients when considering all tumor types (337 days vs 288 days). There was no difference in median survival between elderly and non-elderly patients with CLM (377 days vs 365 days) or with HCC (370 days vs 363 days). Conclusions: In our experience, survival after Yttrium-90 radioembolization in elderly and younger patients with primary HCC or CLM is similar. Age alone should not preclude consideration for liver-directed therapy.

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The Role of Liver Transplantation for Liver Metastasis from Colorectal Cancer

Digestive Disease Interventions ◽

10.1055/s-0040-1705094 ◽

2020 ◽

Vol 04 (01) ◽

pp. 013-018

Author(s):

Koji Tomiyama ◽

M. Katherine Dokus ◽

Jennie Errigo ◽

Marie Laryea ◽

Roberto Hernandez-Alejandro

Keyword(s):

Colorectal Cancer ◽

Liver Transplantation ◽

Liver Metastases ◽

Surgical Resection ◽

Liver Volume ◽

Remnant Liver ◽

Colorectal Cancer Liver Metastases ◽

Term Survival ◽

Long Term Survival

AbstractAs chemotherapy for colorectal cancer becomes effective for extending long-term survival, its liver metastases (colorectal cancer liver metastases [CRCLM]) are considered as the progression that best defines patient survival. Surgical resection is the most effective and only curative treatment for CRCLM. Although advancement in liver surgery to increase resectability of CRCLM has borne fruit, there are still limitations, namely tumor burden, remnant liver volume, and chemotherapy-related liver damage. CRCLM used to be considered a contraindication for liver transplantation (LTx) based on preliminary experience in the early era of LTx. Recent advancement in chemotherapy and surgical resection for CRCLM as well as improved outcome of LTx have attracted interest in revisiting this old dogma of LTx for CRCLM. Preliminary experience from Norway has shown promising results and potential for long-term survival with LTx. In this article, we review the history of LTx for CRCLM, rationale for revisiting the concept, early experience from Norway and discuss the issues around and future perspectives on LTx for CRCLM.

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Differential regulation of extracellular matrix proteins in three recurrent liver metastases of a single patient with colorectal cancer

Clinical & Experimental Metastasis ◽

10.1007/s10585-020-10058-8 ◽

2020 ◽

Vol 37 (6) ◽

pp. 649-656

Author(s):

Hannah Voß ◽

Marcus Wurlitzer ◽

Daniel J. Smit ◽

Florian Ewald ◽

Malik Alawi ◽

...

Keyword(s):

Colorectal Cancer ◽

Extracellular Matrix ◽

Liver Metastases ◽

Surgical Resection ◽

Treatment Options ◽

Single Patient ◽

Poor Overall Survival ◽

Colorectal Cancer Liver Metastases ◽

The Third ◽

Molecular Features

AbstractColorectal cancer (CRC) patients suffer from the second highest mortality among all cancer entities. In half of all CRC patients, colorectal cancer liver metastases (CRLM) can be observed. Metastatic colorectal cancer is associated with poor overall survival and limited treatment options. Even after successful surgical resection of the primary tumor, metachronous liver metastases occur in one out of eight cases. The only available curative intended treatment is hepatic resection, but metachronous CRLM frequently recur after approximately 1 year. In this study, we performed a proteome analysis of three recurrent liver metastases of a single CRC patient by mass spectrometry. Despite surgical resection of the primary CRC and adjuvant chemotherapy plus cetuximab treatment, the patient developed three metachronous CRLM which occurred consecutively after 9, 21 and 31 months. We identified a set of 1132 proteins expressed in the three metachronous CRLM, of which 481 were differentially regulated, including 81 proteins that were associated with the extracellular matrix (ECM). 56 ECM associated proteins were identified as upregulated in the third metastasis, 26 (46%) of which were previously described as negative prognostic markers in CRC, including tenascin C, nidogen 1, fibulin 1 and vitronectin. These data may reflect an ascending trend of malignancy from the first to the third metachronous colorectal cancer liver metastasis. Additionally, the results indicate different ECM phenotypes for recurrent metachronous metastasis, associated with different grades of malignancy and highlights the importance of individual analysis of molecular features in different, consecutive metastatic events in a single patient.

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