Systemic treatment of liver metastases from colorectal cancer

Liver metastases are commonly encountered in patients presenting with metastatic colorectal cancer (mCRC); resection is the treatment of choice. A number of systemic treatment options are currently available for such patients, including the use of 5-fluorouracil-based chemotherapies and oxaliplatin (e.g., FOLFOX) in combination with biologic agents that target angiogenesis (e.g., bevacizumab). For patients with progression following first-line treatment, current second-line options include a change in chemotherapy with bevacizumab (for patients who did or did not receive prior bevacizumab) or FOLFIRI in combination with aflibercept, a more recently approved antiangiogenesis therapy. Neurotoxicity is a well-established adverse event of oxaliplatin-based therapy. The current case details an mCRC patient with liver metastases who was treated with a capecitabine and oxaliplatin regimen (XELOX), and experienced two episodes of transient cortical blindness possibly related to oxaliplatin. After disease progression, the patient was switched to a regimen of FOLFIRI and aflibercept and did well on this second-line regimen.

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Multielectrode Radiofrequency Ablation for Resectable Metachronous Liver Metastasis from Colorectal Cancer

Journal of Clinical Medicine ◽

10.3390/jcm10163712 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3712

Author(s):

Hou-Ying Cheng ◽

Kai-Wen Huang ◽

Jin-Tung Liang ◽

Been-Ren Lin ◽

John Huang ◽

...

Keyword(s):

Colorectal Cancer ◽

Radiofrequency Ablation ◽

Liver Metastases ◽

Median Overall Survival ◽

Systemic Treatment ◽

Recurrence Free Survival ◽

Free Survival ◽

Metachronous Liver Metastasis ◽

Similar Survival

The outcome of radiofrequency ablation (RFA) for liver metastases from colorectal cancer (CRLM) has been thought to be inferior to metastasectomy. However, the recent development of multielectrode RFA (multi-RFA) systems has made the ablation zone larger and more complete. Thus, we assessed the survival benefits of this modality in cases of metachronous CRLM. This retrospective study assessed patients diagnosed with resectable metachronous CRLM between 2013 and 2016; 132 patients were categorized by treatment for liver metastases: multi-RFA (n = 68), hepatectomy (n = 34), or systemic treatment only (n = 30). Therapeutic effectiveness, outcomes, and intervention-related complications were compared between groups. Median overall survival (OS), recurrence-free survival (RFS), and intrahepatic recurrence-free survival (IHRFS) were 69.8, 85.2, and 59.7 months for the hepatectomy group; 53.4, 41.3, and 32.3 months for the multi-RFA group; and 19.1, 7.1, and 7.1 months for the systemic treatment group. No significant differences were observed between the multi-RFA and hepatectomy groups after a median follow-up of 59.8 months. This study demonstrated that multi-RFA and hepatectomy provide similar survival benefits for patients with resectable CRLM. Multi-RFA may represent a reliable treatment option for the management of resectable liver metastases.

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Clinical outcomes for patients with liver-limited metastatic colorectal cancer: Arguing the case for specialist hepatobiliary multidisciplinary assessment.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.637 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 637-637

Author(s):

Kiruthikah Thillai ◽

Dimitra Repana ◽

Ippokratis Korantzis ◽

Andreas Prachalias ◽

Pauline Kane ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Metastases ◽

Metastatic Colorectal Cancer ◽

Systemic Treatment ◽

Clinical History ◽

Synchronous Liver Metastases ◽

The United Kingdom ◽

Multidisciplinary Meetings ◽

Overall Survival Benefit ◽

Cancer Network

637 Background: In patients (pts) with liver-limited metastatic colorectal cancer (mCRC), surgical resection or radiofrequency ablation (RFA) can lead to a significant overall survival benefit. Specialist hepato-biliary (HPB) multidisciplinary meetings (MDMs) are currently believed to provide the best forum to discuss this cohort of pts and assess their suitability for surgery or RFA. Methods: A retrospective analysis was undertaken of pts diagnosed with liver-limited mCRC over a period of 6 months within a specified cancer network in the United Kingdom. In addition to discussed cases, pts who were diagnosed but not referred to the HPB MDM were also discussed within the MDM setting. For these pts, contributors were blinded and decisions were made regarding resectability and appropriateness for RFA based on patient imaging and clinical history. Results: In a six month period, 159 pts were diagnosed with liver-limited mCRC within our cancer network. Of these, 68 (43%) were referred at the time of initial diagnosis, with a further 38 (24%) referred after commencing systemic treatment. 35 (56%) who were discussed at the time of their original diagnosis went on to have either a hepatectomy or RFA, as did 18 (51%) patients referred after initiating systemic treatment. 81 pts (78%) referred to the HPB MDM had synchronous liver metastases. Of the remaining 53 (33%) patients who were not referred to the HPB MDM, the average age was 70.2 years and 38 (86%) had synchronous liver metastases. Imaging was available for 31 (58%) of these pts. Decisions regarding resectability or RFA were made within the MDM based solely on history and radiology findings. Of these cases, 13 (41.9%) were identified as resectable or potentially resectable and 11 (35.5%) may have been suitable for a clinical trial. None of these 31 pts (100%) had hepatic surgery or RFA. Conclusions: Whilst the majority of pts with liver-limited mCRC were referred appropriately, this study highlights that a number of pts with potentially resectable disease are not being discussed at a specialist HPB MDM. A review of all diagnosed cases would ensure that an increased number of pts are offered hepatic resection or RFA.

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