Qualitative assessment of EOB-GD-DTPA and Gd-BT-DO3A MR contrast studies in HCC patients and colorectal liver metastases

Abstract Aim To compare liver-specific EOB-GD-DTPA and liver-non-specific Gd-BT-DO3A MR, in hepatocellular carcinoma (HCC) and liver colorectal metastases. Material and methods Seventy HCC patients with 158 nodules and 90 colorectal liver metastases (mCRC) with 370 lesions were included in the retrospective analysis. HCC patients underwent MR at 0 time (MR0), after 3 (MR3) and 6 months (MR6) using two different CM; 69 mCRC patients underwent MR with Gd-EOB-BTPA and 21 mCRC patients with Gd-BT-DO3A. We evaluated arterial phase hyperenhancement, lesion-to-liver contrast during portal phase, hepatobiliary phase parenchymal hyperenhancement. Results In HCC patients arterial phase hyperenhancement degree was statistically higher (p = 0.03) with Gd-BT-DO3A (mean 4) than GD-EOB-DTPA (mean 2.6), while we found no significant statistical differences among mean (2.6) values at MR0 and MR6 using GD-EOB-DTPA. For all 209 patients underwent Gd-EOB-DTPA, we found that lesion-to-liver contrast during portal phase mean value was 4 while for patients underwent MR with Gd-BT-DO3A was 3 (p = 0.04). For HCC hepatobiliary phase parenchymal hyperenhancement mean value was 2.4. For mCRC patients: among 63 patients underwent previous chemotherapy hepatobiliary phase parenchymal hyperenhancement mean value was 3.1 while for 6 patients no underwent previous chemotherapy was 4 (p = 0.05). Conclusions Gd-EOB-DTPA should be chosen in pre surgical setting in patients with colorectal liver metastases.

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Preliminary Results of ‘Liver-First' Reverse Management for Advanced and Aggressive Synchronous Colorectal Liver Metastases: A Propensity-Matched Analysis

Digestive Surgery ◽

10.1159/000370253 ◽

2015 ◽

Vol 32 (1) ◽

pp. 16-22 ◽

Cited By ~ 9

Author(s):

Kuniya Tanaka ◽

Takashi Murakami ◽

Kenichi Matsuo ◽

Yukihiko Hiroshima ◽

Itaru Endo ◽

...

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Classical Group ◽

Tumor Burden ◽

Oncologic Outcomes ◽

Colorectal Metastases ◽

Second Resection ◽

Freedom From Disease ◽

Synchronous Colorectal Liver Metastases ◽

Recurrence Sites

Background: Although a ‘liver-first' approach recently has been advocated in treating synchronous colorectal metastases, little is known about how results compare with those of the classical approach among patients with similar grades of liver metastases. Methods: Propensity-score matching was used to select study subjects. Oncologic outcomes were compared between 10 consecutive patients with unresectable advanced and aggressive synchronous colorectal liver metastases treated with the reverse strategy and 30 comparable classically treated patients. Results: Numbers of recurrence sites and recurrent tumors irrespective of recurrence sites were greater in the reverse group then the classic group (p = 0.003 and p = 0.015, respectively). Rates of freedom from recurrence in the remaining liver and of freedom from disease also were poorer in the reverse group than in the classical group (p = 0.009 and p = 0.043, respectively). Among patients treated with 2-stage hepatectomy, frequency of microvascular invasion surrounding macroscopic metastases at second resection was higher in the reverse group than in the classical group (p = 0.011). Conclusions: Reverse approaches may be feasible in treating synchronous liver metastases, but that strategy should be limited to patients with less liver tumor burden.

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Systematic Review of Treatments for Colorectal Metastases in Elderly Patients to Guide Surveillance Cessation Following Hepatic Resection for Colorectal Liver Metastases

American Journal of Clinical Oncology ◽

10.1097/coc.0000000000000803 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Edward Alabraba ◽

Dhanny Gomez

Keyword(s):

Systematic Review ◽

Elderly Patients ◽

Liver Metastases ◽

Hepatic Resection ◽

Colorectal Liver Metastases ◽

Colorectal Metastases

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Technical Note. Do Arterial Phase Helical CT Images Improve Detection or Characterization of Colorectal Liver Metastases?

Journal of Computer Assisted Tomography ◽

10.1097/00004728-199705000-00010 ◽

1997 ◽

Vol 21 (3) ◽

pp. 391-397 ◽

Cited By ~ 33

Author(s):

Ian Y. Ch'en ◽

Douglas S. Katz ◽

R. Brooke Jeffrey ◽

Bruce L. Daniel ◽

King C. P. Li ◽

...

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Helical Ct ◽

Ct Images ◽

Technical Note ◽

Arterial Phase

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Neo-adjuvant chemotherapy followed by surgery versus surgery alone in high-risk patients with resectable colorectal liver metastases: The CHARISMA randomized multicenter clinical trial.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.tps790 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. TPS790-TPS790

Author(s):

Eric P van der Stok ◽

Cornelis Verhoef ◽

Dirk J. Grunhagen ◽

Keyword(s):

Clinical Trial ◽

High Risk ◽

Adjuvant Chemotherapy ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Risk Profile ◽

Colorectal Metastases ◽

High Risk Patients ◽

Risk Patients ◽

Neo Adjuvant Chemotherapy

TPS790 Background: Colorectal carcinoma is a leading cause of cancer death worldwide, mostly as a consequence of metastatic disease. If metastases are confined to the liver, surgical resection is the only therapy providing potential for cure. Efforts to improve the outcome of hepatectomy for colorectal liver metastases (CRLM) by combining surgery with chemotherapy have failed to demonstrate overall survival (OS) benefit. This may partly be explained by the fact that previous trials on this subject involved strict inclusion criteria. Consequently, patients with a high oncological risk profile - who might benefit the most from chemotherapy – might have been underrepresented in previous trials. Several Clinical Risk Scores (CRS) have been developed predicting patients’ prognosis after resection of CRLM. The most widely used and validated CRS was described by Fong et al., which characterizes 2 risk groups (high versus low) based on 5 independent clinicopathologic prognostic variables. Each variable is assigned 1 point. Multiple retrospective observations showed that neo-/adjuvant chemotherapy induced significant OS benefit in patients with a high-risk profile (CRS of 3 to 5 points). The CHARISMA trial evaluates the impact of neo-adjuvant chemotherapy in patients with high-risk, primarily resectable liver-only colorectal metastases. We hypothesize that adding neo-adjuvant chemotherapy to surgery improves OS in this high-risk patient group. Methods: The CHARISMA trial is a randomized (1:1) phase III trial. Patients receive either surgery only for CRLM (arm A) or 6 cycles of neo-adjuvant Oxaliplatin + Capecitabine, followed by surgery (arm B). The primary endpoint is OS. On basis of retrospective data, the expected hazard ratio for arm B is 0.60. With an expected 5-year OS of 25% in arm A, a two-sided significance level α = 0.05 and power 1 - β = 0.8, 224 patients have to be recruited. Major eligibility criteria are: liver-only metastases, primarily resectable CRLM, high-risk patients (CRS 3-5). The trial is currently accruing in 10 Dutch liver centers and is registered in the “Dutch Trial Register”: NTR4893 ( www.trialregister.nl ). Clinical trial information: NTR4893.

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Contrast Enhanced Ultrasound in the Diagnosis and Evaluation of the Efficiency of Chemotherapy in Patients with Colorectal Liver Metastases

Journal of radiology and nuclear medicine ◽

10.20862/0042-4676-2020-101-6-324-332 ◽

2021 ◽

Vol 101 (6) ◽

pp. 324-332

Author(s):

E. V. Kovaleva ◽

G. T. Sinyukova ◽

T. Yu. Danzanova ◽

P. I. Lepedatu ◽

E. A. Gudilina ◽

...

Keyword(s):

Contrast Agent ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Arterial Phase ◽

Contrast Enhanced Ultrasound ◽

Time Curve ◽

Entire Volume ◽

Contrast Enhanced ◽

Group 2 ◽

Group 1

Objective: to determine the possibilities of contrast-enhanced ultrasound (CEUS) in identifying and evaluating the efficiency of chemotherapy in patients with colorectal liver metastases (CLM).Material and methods. The investigation enrolled 28 patients with CLM. The patients were divided into two groups: Group 1 – 15 pretreatment patients; Group 2 – 13 posttreatment patients with process stabilization. All the patients underwent standard B-mode ultrasound of the liver and that using the contrast agent SonoVue ® (Bracco, Italy), by recording and estimating the parameters of the intensity-time curve (CIV). Liver CEUS assesses the nature of contrasting metastases in three phases (arterial, venous, and delay ones).Results. The investigators identified three types of contrast agent accumulation in CLM in the arterial phase: along the periphery of the lesions (in 60% of the patients of Group 1, in 76.9% in Group 2), homogeneously over the entire volume (in 26.7% in Group 1 and in 0.08% in Group 2), in parallel with intact liver parenchyma (13.3% in Group 1 and 23.02% in Group 2). In the delay phase, more metastases were detected in 4 cases (14.3%). Estimation of CIV parameters showed a difference at the beginning of contrast enhancement stages between the patients in both groups. Group 1 exhibited the early contrasting of liver metastases (19.3 sec); Group 2 displayed the late washout of a contrast agent (65.9 sec).Conclusion. CEUS versus B-mode ultrasound improves the imaging of liver metastases. The change in the vascular architectonics and hemodynamics in CLM after chemotherapy is reflected in the alteration of the rate of contrast accumulation and washout from the metastases, which allows CEUS to be used in the evaluation of the efficiency of this treatment.

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In Colorectal Liver Metastases, the Presence of Extrahepatic Disease Correlates with the Pathology of the Primary Tumour

ISRN Oncology ◽

10.5402/2011/948174 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5

Author(s):

Saleh Abbas ◽

Vincent Lam

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Primary Tumour ◽

False Negative ◽

Pet Scan ◽

Colorectal Metastases ◽

Extrahepatic Disease ◽

Westmead Hospital ◽

Fdg Pet Scan ◽

Extrahepatic Metastases

Background. FDG-PET scan detects extrahepatic metastases in 20% of patients with colorectal liver metastases but it is reported to have approximately 16% false negative rates. Patients and Methods. Patients who had PET scan for metastatic colorectal cancer at Westmead Hospital between March 2006 and March 2010 were reviewed retrospectively. The results of PET scan were correlated with tumour characteristics that were thought to affect the overall prognosis. Results. Degree of tumour differentiation and vascular invasion were significantly predictive for the presence of extrahepatic disease on PET scan, also did the level of CEA. Conclusion. The detection of extrahepatic disease in colorectal liver metastases correlates with the biologic behaviour of the primary tumour. Poorly differentiated tumours and those with lymphovascular invasion behave in aggressive fashion and likely to have wide-spread metastases. This should be considered when contemplating liver resection for colorectal metastases.

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High Survival Rate After Two-Stage Resection of Advanced Colorectal Liver Metastases: Response-Based Selection and Complete Resection Define Outcome

Journal of Clinical Oncology ◽

10.1200/jco.2010.32.6132 ◽

2011 ◽

Vol 29 (8) ◽

pp. 1083-1090 ◽

Cited By ~ 241

Author(s):

Antoine Brouquet ◽

Eddie K. Abdalla ◽

Scott Kopetz ◽

Christopher R. Garrett ◽

Michael J. Overman ◽

...

Keyword(s):

Survival Rate ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Complete Resection ◽

Colorectal Metastases ◽

Medical Group ◽

Two Stage ◽

Second Stage ◽

Mean Size ◽

The Impact

Purpose Prolonged survival after two-stage resection (TSR) of advanced colorectal liver metastases (CLM) may be the result of selection of best responders to chemotherapy. The impact of complete resection in this well-selected group is controversial. Patients and Methods Data on 890 patients undergoing resection and 879 patients who received only chemotherapy for CLM were collected prospectively. We used intent-to-treat analysis to evaluate the survival of patients who underwent TSR. Additionally, we evaluated a cohort of nonsurgically treated patients selected to mirror the TSR population: colorectal metastases with liver-only disease, objective response to chemotherapy, and alive 1 year after chemotherapy initiation. Results Sixty-five patients underwent the first stage of TSR; 62 patients fulfilled the inclusion criteria for the medical group. TSR patients had a mean of 6.7 ± 3.4 CLM with mean size of 4.5 ± 3.1 cm. Nonsurgical patients had a mean of 5.9 ± 2.9 CLM with mean size of 5.4 ± 3.4 cm (not significant). Forty-seven TSR patients (72%) completed the second stage. Progression between stages was the main cause of noncompletion of the second stage (61%). After 50 months median follow-up, the 5-year survival rate was 51% in the TSR group and 15% in the medical group (P = .005). In patients who underwent TSR, noncompletion of TSR and major postoperative complications were independently associated with worse survival. Conclusion TSR is associated with excellent outcome in patients with advanced CLM as a result of both selection by chemotherapy and complete resection of metastatic disease.

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Liver Resection or Resection plus Intraoperative Echo-Guided Ablation in the Treatment of Colorectal Metastases: We are Evaluating Their Effect for Cure

The American Surgeon ◽

10.1177/000313481808400960 ◽

2018 ◽

Vol 84 (9) ◽

pp. 1509-1517

Author(s):

Antonio Chiappa ◽

Diego Foschi ◽

Gabriella Pravettoni ◽

Federico Ambrogi ◽

Nicola Fazio ◽

...

Keyword(s):

Liver Metastases ◽

Hepatic Resection ◽

Colorectal Liver Metastases ◽

Disease Free Survival ◽

Oncologic Outcome ◽

Colorectal Metastases ◽

Multiple Metastases ◽

Group 2 ◽

Group 1

This study determines the oncologic outcome of the combined resection and ablation strategy for colorectal liver metastases. Between January 1994 and December 2015, 373 patients underwent surgery for colorectal liver metastases. There were 284 patients who underwent hepatic resection only (Group 1) and 83 hepatic resection plus ablation (Group 2). Group 2 patients had a higher incidence of multiple metastases (100% in Group 2 vs 28.2% in Group 1; P < 0.001) and bilobar involvement (76.5% in Group 2 vs 12.9% in Group 1; P < 0.001) than Group 1 cases. Perioperative mortality was nil in either group, with a higher postoperative complication rate among Group 1 versus Group 2 cases (18 vs 0, respectively). The median follow-up was 90 months (range, 1–180), with a five-year overall survival for Group 1 and Group 2 of 51 per cent and 80 per cent, respectively (P = 0.193). Mean disease-free survival for patients with R0 resection was 55 per cent, 40 per cent, and 37 per cent at one, two, and three years, respectively, and remained steadily higher (at 50%) in those patients treated with resection combined with ablation up to five years (P = 0.069). The only intraoperative ablation failure was for a large lesion (≥5 cm). Our data support the use of intraoperative ablation when complete hepatic resection cannot be achieved.

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