NEOADJUVANT RADIATION THERAPY FOR RECTAL CANCER WITH SYNCHRONOUS LIVER METASTASES (LITERATURE REVIEW)

Background. In Russia, synchronous distant metastases are annually detected in approximately 6,200 patients and synchronous liver metastases in 4,000 patients. To plan treatment for rectal cancer with synchronous liver metastases, it is necessary to consider the location of the tumor, extent of the primary tumor involvement, tumor-related complications, and resectability of metastases.The purpose of this review was to analyze the results of studies aimed at finding the best regimens for treating rectal cancer patients with synchronous liver metastases.Material and Methods. The review includes both retrospective and prospective studies devoted to treatment of rectal cancer with synchronous liver metastases. Previous reviews and clinical recommendations were analyzed.Results. Most oncologists are in favor of preoperative radiotherapy, especially when rectal cancer is located in the lower-and middle-ampullary regions. However, there are no randomized trials with a representative number of patients to confirm or refute this point of view. Due to the increased life expectancy of patients and introduction of modern minimally invasive surgical approaches, there is an urgent need for radical treatment of rectal cancer patients. Thus, the approaches to the treatment of primary tumors with synchronous metastatic liver damage should be the same as in stage II–III of the disease, and neoadjuvant radiation therapy is an integral part of this strategy.

Role of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio in Predicting the Response to First Line Chemotherapy in Colorectal Cancer Patients with Synchronous Liver Metastases: A Retrospective Study

Background: There is some evidence that showed that the high level of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) is associated with poor survival in several malignancies including colorectal cancer (CRC); however data on the significance of these markers to predict response to systemic therapy is limited. Objectives: The aim of this study was to assess the role of pretreatment NLR and PLR in predicting response to first line chemotherapy in CRC patients with synchronous metastases. Methods: Clinical records of 81 CRC patients with synchronous liver metastases, who underwent upfront chemotherapy, were included in this retrospective study. The optimal cut of value for NLR and PLR was determined according to receiver operating characteristic (ROC) curve analysis. Correlation between response to chemotherapy and NLR or PLR was evaluated. Results: The optimal cut off for NLR and PLR was 2.666 and 182.589, respectively. Patients with low NLR had significantly higher objective response (complete response + partial response) compared to patients with high NLR (54.3% versus 13%, respectively, P: < 0.001). In patients with low PLR, 41.2% had objective response compared to 13.3% of patients with high PLR (P = 0.012). The univariate analysis determined that, both NLR and PLR are significantly associated with better objective response, but in multivariate analysis, only NLR was identified as an independent predictive marker of response [odds ratio = 4.55; P = 0.013]. Conclusions: Results of this study indicate that, measuring NLR might provide us an inexpensive method to predict response to first-line chemotherapy in CRC patients with synchronous liver metastases.

Nationwide Outcomes of Simultaneous Resection of Primary Colorectal Cancer and Synchronous Liver Metastases

Background Of the few studies comparing simultaneous versus staged resection of primary colorectal cancer and synchronous liver metastases, most are limited to resections performed at the same facility. This study was performed to compare outcomes of simultaneous versus staged resection in these patients, including resections performed at a different center. Methods The Nationwide Readmissions Database was queried for all patients undergoing colorectal cancer and metastatic liver resections in the US from 2010 to 2014. Patients undergoing simultaneous resections were compared to patients who underwent liver and colon resections on separate admissions, both liver first and colon first. The outcomes of interest were in-hospital mortality, complications, and total cost. Results During the study period, there were 6,219 patients undergoing resection of primary colorectal cancer and synchronous liver metastases. Separate admission resection was performed at a different hospital in 45.8%. Compared to simultaneous resection, there was a reduced risk for mortality in patients undergoing colon first (OR 0.28, p<0.01) and there was no significant difference in performing liver resection first (OR 0.30, p=0.05). Simultaneous resection was associated with a decreased mean total cost of admissions compared to separate admission resection ($37,278 ±​$34,353 versus $47,985 ​±$​ 28,342, p<0.01). Conclusions Nearly half of separate admission resections of primary colorectal cancer and liver metastases are performed at different hospitals and likely missed by single-center studies. Undergoing colon resection first on a separate admission is costlier, yet patients have more favorable outcomes. Further studies are needed to reveal the underlying factors responsible for these improved outcomes.