EP.FRI.121 Unusual sites of colorectal cancer metastases – A complete systematic review

Abstract Background While colorectal cancer (CRC) usually metastasizes to liver, lungs and central nervous system, spread to more unusual sites is rarely reported in literature. We aimed to investigate unusual colorectal metastases (UCRM), their clinical course and disease progression. Methods MEDLINE, EMBASE and Cochrane Library were searched by independent reviewers to identify clinical studies to date that reported UCRM and relevant demographic/clinical data were extracted. Results We identified 349 patients, involving 28 sites (bone, musculo-skeletal, skin, brain/spinal cord, head, eye, oral mucosa, thyroid, mediastinum, heart, bronchus, breast, biliary/GI tract, stomach, pancreas, spleen, adrenal, urinary tract, inguinal canal, ovaries, vagina, vulva, testes, spermatic cord, prostate, penis) with male preponderance and median age of 59 years (IQR=54.5-65). These were diagnosed at a median interval of 18 months (IQR=6-36)) after a median follow-up of 12 months (IQR=6-22.5). More were metachronous (n = 210) with recurrence rate of 15.75%. Primary CRC staging revealed T3 in 61% (28%-T4), equal distribution of N0/N1 (38%/37%) and M0 in 85%. 74% of primaries were surgically resected (96%=adenocarcinomas) and 54% underwent adjuvant therapy. UCRM were resected in 45% of cases and showed same histology as primary. 30% had chemotherapy. Only 8% were palliated. Overall morality was 35.24%. Conclusion This is the first comprehensive review looking at clinical course and outcomes of patients with UCRM. Most of these developed in patients with primary T3/N0 staging. Outlook of these patients is comparable to those with usual metastatic disease. Judicious and rigorous surveillance is the key to early detection and timely management.

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1560 Unusual Sites of Colorectal Cancer Metastases – A Complete Systematic Review

British Journal of Surgery ◽

10.1093/bjs/znab259.957 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

J Alfred ◽

K Altaf ◽

A Anuar ◽

R Williams ◽

G Titley-Wilson ◽

...

Keyword(s):

Colorectal Cancer ◽

Clinical Course ◽

Colorectal Metastases ◽

Cochrane Library ◽

Equal Distribution ◽

Cancer Metastases ◽

Male Preponderance ◽

Colorectal Cancer Metastases ◽

Median Interval

Abstract Background While colorectal cancer (CRC) usually metastasizes to liver, lungs, and central nervous system, spread to more unusual sites is rarely reported in literature. We aimed to investigate unusual colorectal metastases (UCRM), their clinical course and disease progression. Method MEDLINE, EMBASE and Cochrane Library were searched by independent reviewers to identify clinical studies to date that reported UCRM and relevant demographic/clinical data were extracted. Results We identified 349 patients, involving 28 sites (bone, musculo-skeletal, skin, brain/spinal cord, head, eye, oral mucosa, thyroid, mediastinum, heart, bronchus, breast, biliary/GI tract, stomach, pancreas, spleen, adrenal, urinary tract, inguinal canal, ovaries, vagina, vulva, testes, spermatic cord, prostate, penis) with male preponderance and median age of 59 years (IQR=54.5-65). These were diagnosed at a median interval of 18 months (IQR=6-36)) after a median follow-up of 12 months (IQR=6-22.5). More were metachronous (n = 210) with recurrence rate of 15.75%. Primary CRC staging revealed T3 in 61% (28%-T4), equal distribution of N0/N1 (38%/37%) and M0 in 85%. 74% of primaries were surgically resected (96%=adenocarcinomas) and 54% underwent adjuvant therapy. UCRM were resected in 45% of cases and showed same histology as primary. 30% had chemotherapy. Only 8% were palliated. Overall morality was 35.24%. Conclusions This is the first comprehensive review looking at clinical course and outcomes of patients with UCRM. Most of these developed in patients with primary T3/N0 staging. Outlook of these patients is comparable to those with usual metastatic disease. Judicious and rigorous surveillance is the key to early detection and timely management.

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Small Particle DEBIRI TACE as Salvage Therapy in Patients with Liver Dominant Colorectal Cancer Metastasis: Retrospective Analysis of Safety and Outcomes

Current Oncology ◽

10.3390/curroncol29010020 ◽

2022 ◽

Vol 29 (1) ◽

pp. 209-220

Author(s):

Nicolas Voizard ◽

Tiffany Ni ◽

Alex Kiss ◽

Robyn Pugash ◽

Michael Jonathon Raphael ◽

...

Keyword(s):

Colorectal Cancer ◽

Small Particle ◽

Cancer Metastasis ◽

Cancer Metastases ◽

Average Survival ◽

Colorectal Cancer Metastasis ◽

Unresectable Liver Metastases ◽

Colorectal Cancer Metastases ◽

Postembolization Syndrome

The aim of this study was to examine the safety and efficacy of 40 µm and 75 µm calibrated irinotecan-eluting beads (DEBIRI-TACE) for the treatment of colorectal cancer metastases. We conducted a retrospective review of 36 patients with unresectable liver metastases from colorectal cancer who were treated with DEBIRI-TACE between 2017 to 2020. Patients who received at least one session of DEBIRI were included in our analysis. A total of 105 DEBIRI sessions were completed. 86% of patients (n = 31) underwent one round of treatment, 14% of patients (n = 5) underwent two distinct rounds of treatment. The majority of patients were discharged the next day (92%, n = 33 patients) with no 30-day post-DEBIRI mortality. Five high-grade adverse events occurred, including longer stay for pain management (n = 2), postembolization syndrome requiring readmission (n = 2), and liver abscess (n = 1). The average survival from diagnosis of metastatic disease was 33.3 months (range 11–95, median 28). Nine of 36 patients are still alive (December 2020) and have an average follow-up time of 36.8 months from T0 (range 12–63, median 39). Small particle DEBIRI is safe and well-tolerated in the salvage setting, with outcomes comparable to that of larger bead sizes.

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Evaluation of the potential association of preoperative chemotherapy with steatohepatitis in surgical patients with hepatic colorectal metastases

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e15009 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e15009-e15009

Author(s):

A. Artinyan ◽

E. Castillo ◽

B. Foster ◽

L. Wagman

Keyword(s):

Colorectal Cancer ◽

Liver Resection ◽

Preoperative Chemotherapy ◽

Surgical Patients ◽

Colorectal Metastases ◽

Individual Agent ◽

Cancer Metastases ◽

Significant Difference ◽

Colorectal Cancer Metastases ◽

Contrast Ct

e15009 Background: The treatment of hepatic colorectal cancer metastases is increasingly multi-modal. Preoperative chemotherapy may be associated with steatohepatitis, which may increase morbidity in patients undergoing resection. Our objective was to determine if preoperative chemotherapy is associated with steatohepatitis and to determine which agents confer the greatest risk. Materials and Methods: 149 patients who had undergone liver resection or biopsy for hepatic colorectal cancer metastases were identified from an institutional database. Surgical specimens were assessed for percent steatosis and the presence of steatohepatitis as defined by the Kleiner score. The medical record was reviewed for details of preoperative chemotherapy and post-operative course. The association of preoperative chemotherapy with steatosis and steatohepatitis was assessed. Preoperative non-contrast CT scans were reviewed for evidence of steatosis as determined by the radiographic liver/spleen (L/S) ratio. The association of the L/S ratio with the presence of steatohepatitis was determined. Post-operative outcome was compared in patients with and without steatohepatitis. Results: The mean age of the population was 60.8 ±11.6 years, 56% of patients were male, and 37% of patients received preoperative chemotherapy. Steatohepatitis was identified in 45.7% of specimens. There was no statistically significant difference in the rate of steatohepatitis (59% vs. 50%, p=0.49) or percent steatosis (37% vs. 32%, p=0.29) with or without preoperative chemotherapy. No individual agent predicted a greater risk of steatohepatitis or a greater degree of steatosis. There was no significant difference in the L/S ratio in patients with or without steatohepatitis (p=NS). In patients undergoing liver resection, there was no difference in total ICU stay, blood loss, total surgery time or total length of stay between the steatohepatitis and non-steatohepatitis groups. Conclusions: Although steatohepatitis remains a potential complication of systemic chemotherapy in surgical patients with hepatic colorectal metastases, the risk and impact of chemotherapy associated steatohepatitis have not been significant in our patient population. No significant financial relationships to disclose.

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Correlation of postoperative CEA trends with survival and patterns of recurrence after hepatectomy for colorectal cancer metastases.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.436 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 436-436 ◽

Cited By ~ 1

Author(s):

Lawrence Andrew Shirley ◽

Megan McNally ◽

Justin Huntington ◽

Natalie Jones ◽

Lavina Malhotra ◽

...

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Progression Free Survival ◽

Locoregional Therapy ◽

Free Survival ◽

Cancer Metastases ◽

Significant Difference ◽

Colorectal Cancer Metastases ◽

Patterns Of Recurrence

436 Background: Pre-operative carcinoembryonic antigen (CEA) level is associated with outcome after hepatectomy for colorectal cancer metastases. In this study we sought to determine the relationship between post-operative CEA and outcome after hepatectomy. Methods: A single institution retrospective review of hospital records from 1993 to 2010 found 339 patients who underwent a liver resection for CRC metastases. Of these, 140 had CEA levels drawn pre-operatively, post-operatively, and at least once more in follow-up. A ΔCEA level was calculated by subtracting the initial post-operative CEA level from the highest CEA level drawn in follow-up. Outcomes were compared between patients with ΔCEA less than 5 and greater than 5. Results: Of 140 patients, 61 had ΔCEA less than 5 and 79 had ΔCEA greater than 5. Patients with low ΔCEA had improved median overall survival (OS) (70.2 months) compared to those with high ΔCEA (38.7 months, P=0.0001). However, there was no significant difference in progression-free survival (PFS) (13.0 months vs. 12.3 months, P=0.982). 100 patients had recurrence after hepatectomy, 69 with high ΔCEA and 31 with low ΔCEA. Patients with low ΔCEA were more likely to have a single site of recurrence (77.4% vs. 53.6%, P<0.0001). Conclusions: Although a rising CEA after hepatectomy for CRC metastases is associated with worse overall survival, there is no difference in progression-free survival between patients with rising CEA and those with stable-to-decreasing CEA. Patients with stable-to-decreasing CEA have patterns of recurrence more amenable to locoregional therapy. Post-operative CEA values are an important component of oncologic surveillance, and patterns of rise and fall may indicate patterns of recurrence.

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Directing Minimal Invasive Image Guided Therapy of Hepatic Colorectal Cancer Metastases – Imaging Strategies for Patient Evaluation, Therapy Planning, Therapy Monitoring, and Follow-Up

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/157340509788185342 ◽

2009 ◽

Vol 5 (2) ◽

pp. 128-135

Author(s):

Dirk Schnapauff ◽

Christian Grieser ◽

Timm Denecke

Keyword(s):

Colorectal Cancer ◽

Therapy Monitoring ◽

Minimal Invasive ◽

Patient Evaluation ◽

Therapy Planning ◽

Image Guided ◽

Cancer Metastases ◽

Colorectal Cancer Metastases ◽

Guided Therapy

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REGIONAL CHEMOTHERAPY IN TREATMENT FOR UNRESECTABLE COLORECTAL CANCER METASTASES TO THE LIVER RESISTANT TO SYSTEMIC CHEMOTHERAPY

Problems in oncology ◽

10.37469/0507-3758-2018-64-4-499-503 ◽

2018 ◽

Vol 64 (4) ◽

pp. 499-503

Author(s):

Aleksey Polikarpov ◽

Pavel Tarazov ◽

Dmitriy Granov ◽

T. Kagacheva

Keyword(s):

Colorectal Cancer ◽

Systemic Chemotherapy ◽

Arterial Occlusion ◽

Hepatic Arterial Infusion ◽

Regional Chemotherapy ◽

Colorectal Metastases ◽

Arterial Infusion ◽

Cancer Metastases ◽

Colorectal Cancer Metastases ◽

Arterial Chemoembolization

Aim. To determine the effectiveness of regional chemotherapy (RChT) in the treatment of patients with unresectable colorectal metastases to the liver, resistant to systemic chemotherapy (SChT). Materials and methods. Between 2011 and 2017, we treated 60 patients with unresectable colorectal metastases to the liver, resistant to SChT from 2011 to 2017 y. All patients received previously 3-35 cycles of SCht which were ineffective in 54 and was discontinued in 6 patients because of grade III-IV toxicity. In all patients, antitumor drugs which were most effective in SChT were used for RChT,. In the absence of effect on any schemes of SChT, monotherapy with the Mitomycinum C was done. Hepatic arterial infusion (HAI) was carried out for hypovascular metastases using 4-6 gr 5-fluorouracil, 15-20 mg mitomycinum C, 150-200 mg oxaliplatinum, 160200 mg irinotecan. Transcatheter arterial chemoembolization (TACE) for hypervascular metastases was performed by selective infusion of suspension of Lipidol with chemotherapeutic drug: mitomycin C 10-20 mg or irinotecan 160-200 mg or doxorubicinum 50-80 mg and followed by arterial occlusion by gelfoam. Combination, TACE+HAI, was performed with difficult anatomical variants of hepatic artery. Results. We performed 222 cycles of RChT (from 2 to 15, average 6 per patient). There were no complication and lethality. Time to progression after the onset of RChT was 12.4 months in both groups. The median survival from the start of the first cycle SChT was 22 mo in the group with synchronous metastases of colorectal cancer to the liver and 23 mon for metachronic group. Conclusion. Our preliminary results showed prospect of using RChT in the treatment of patients with chemo-resistant colorectal metastases to the liver.

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Eight years after introducing liver resection at the Oncology Institute of Vojvodina

Archive of oncology ◽

10.2298/aoo1304101m ◽

2013 ◽

Vol 21 (3-4) ◽

pp. 101-104

Author(s):

Ivan Majdevac ◽

Nikola Budisin ◽

Milan Ranisavljevic ◽

Dejan Lukic ◽

Imre Lovas ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Resection ◽

Liver Tumors ◽

Liver Parenchyma ◽

Malignant Neoplasms ◽

Chemotherapy Treatment ◽

Primary Liver Tumors ◽

Cancer Metastases ◽

Colorectal Cancer Metastases ◽

Medical Histories

Background: Hepatectomies are mostly performed for the treatment of hepatic benign or malignant neoplasms, intrahepatic gallstones, or parasitic cysts of the liver. The most common malignant neoplasms of the liver are metastases from colorectal cancer. Anatomic liver resection involves two or more hepatic segments, while non-anatomic liver resection involves resection of the metastases with a margin of uninvolved tissue. The aim of this manuscript was to show results of hepatectomies performed at the Oncology Institute of Vojvodina. Methods: We performed 133 liver resections from January 1997 to December 2013. Clinical and histopathological data were obtained from operative protocols, histopathological reports, and patients? medical histories. Results: We did 80 metastasectomies, 51 segmentectomies, and 18 radiofrequent ablations (RFA). Average number of colorectal cancer metastases was 1.67 per patient. We also made 10 left hepatectomies. In all cases, we made non-anatomic resections. Conclusion: Decision about anatomic versus non-anatomic resections for colorectal metastasis and primary liver tumors should be made before surgical exploration. Preservation of liver parenchyma is important with respect to liver failure and postoperative chemotherapy treatment.

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Transarterial Radioembolization of Hepatocellular Carcinoma, Liver-Dominant Hepatic Colorectal Cancer Metastases, and Cholangiocarcinoma Using Yttrium90 Microspheres: Eight-Year Single-Center Real-Life Experience

Diagnostics ◽

10.3390/diagnostics11010122 ◽

2021 ◽

Vol 11 (1) ◽

pp. 122

Author(s):

Julie Pellegrinelli ◽

Olivier Chevallier ◽

Sylvain Manfredi ◽

Inna Dygai-Cochet ◽

Claire Tabouret-Viaud ◽

...

Keyword(s):

Colorectal Cancer ◽

Hepatocellular Carcinoma ◽

Liver Tumors ◽

Progression Free Survival ◽

Single Center ◽

Free Survival ◽

Risk Of Death ◽

Transarterial Radioembolization ◽

Cancer Metastases ◽

Colorectal Cancer Metastases

Liver tumors are common and may be unamenable to surgery or ablative treatments. Consequently, other treatments have been devised. To assess the safety and efficacy of transarterial radioembolization (TARE) with Yttrium-90 for hepatocellular carcinoma (HCC), liver-dominant hepatic colorectal cancer metastases (mCRC), and cholangiocarcinoma (CCA), performed according to current recommendations, we conducted a single-center retrospective study in 70 patients treated with TARE (HCC, n = 44; mCRC, n = 20; CCA, n = 6). Safety and toxicity were assessed using the National Cancer Institute Common Terminology Criteria. Treatment response was evaluated every 3 months on imaging studies using Response Evaluation Criteria in Solid Tumors (RECIST) or mRECIST criteria. Overall survival and progression-free survival were estimated using the Kaplan-Meier method. The median delivered dose was 1.6 GBq, with SIR-Spheres® or TheraSphere® microspheres. TARE-related grade 3 adverse events affected 17.1% of patients. Median follow-up was 32.1 months. Median progression-free survival was 5.6 months and median overall time from TARE to death was 16.1 months and was significantly shorter in men. Progression-free survival was significantly longer in women (HR, 0.49; 95%CI, 0.26–0.90; p = 0.031). Risk of death or progression increased with the number of systemic chemotherapy lines. TARE can be safe and effective in patients with intermediate- or advanced-stage HCC, CCA, or mCRC refractory or intolerant to appropriate treatments.

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Circulating tumor cell-related transcripts in blood as prognostic biomarkers of early recurrence after liver resection for colorectal metastases

The International Journal of Biological Markers ◽

10.1177/1724600819849438 ◽

2019 ◽

Vol 34 (3) ◽

pp. 269-275

Author(s):

Felice Giuliante ◽

Elena Panettieri ◽

Francesco Ardito ◽

Agostino De Rose ◽

Krizia Pocino ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Resection ◽

Tumor Cell ◽

Carcinoembryonic Antigen ◽

Growth Factor Receptor ◽

Predictive Biomarker ◽

Circulating Tumor Cell ◽

Early Recurrence ◽

Colorectal Metastases

Background: Several prognostic factors were proposed to improve early detection of recurrence after liver resection of metastases of colorectal cancer. Circulating tumor cell-related transcripts were evaluated in colorectal cancer patients with conflicting results. The aim of this study was to investigate usefulness of carcinoembryonic antigen CAM5, epidermal growth factor receptor, and ERCC1 transcripts in the bloodstream as predictive factors of recurrence in patients who underwent liver resection for metastases of colorectal cancer. Methods: Peripheral blood was collected from 29 patients at the time of the colorectal cancer liver metastasis resection, and from 25 normal controls. Follow-up draws (FUDs) were also performed at 30 days, and 3 and 12 months since surgery. On each sample, carcinoembryonic antigen CAM5, ERCC1, and GAPDH mRNAs were examined by quantitative reverse transcription (qRT). Results: Carcinoembryonic antigen transcript levels were linearly correlated to the number of spiked cells (qRT analytical limit = five cells). Among 29 patients (20 M/9 F; mean age 63 years (range 32–79), highly significant levels of carcinoembryonic antigen, if compared to the baseline, were detected in those relapsing after surgery ( P <0.05). The main differences were between the 1st- and 12th-month FUDs. Significantly higher levels of carcinoembryonic antigen were also detected in patients who died from disease progression during the follow-up (as evaluated at 30 days and 90 days FUDs). Conclusions: Blood carcinoembryonic antigen-mRNA absolute copy number overtime variation can represent a valid early predictor of relapse after liver resection in colorectal liver metastases patients. Prospective studies, in the context of large clinical trials, will provide further data to also qualify ERCC1 as a predictive biomarker for decisions on therapeutic strategies.

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