scholarly journals Irinotecan Plus S-1 Followed by Hepatectomy for a Patient with Initially Unresectable Colorectal Liver Metastases, Who Showed Severe Drug Rash with Oxaliplatin Plus 5-FU and Leucovorin (FOLFOX)

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Hiroyuki Komori ◽  
Toru Beppu ◽  
Yasuo Sakamoto ◽  
Yuji Miyamoto ◽  
Hiromitsu Hayashi ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Prior History ◽  
Severe Allergic Reaction ◽  
Lymphocyte Stimulation Test ◽  
Term Survival ◽  
Drug Regimens ◽  
History Of ◽  
Drug Lymphocyte Stimulation Test ◽  
Unresectable Colorectal Liver Metastases

For unresectable colorectal liver metastases (CRLM), hepatic resection with or without chemotherapy is the only curative treatment that sufficiently achieves long-term survival. However, occasional severe allergic responses to anticancer drugs necessitate treatment discontinuation. A 45-year-old woman presented with metachronous unresectable colorectal liver metastases. Chemotherapy with oxaliplatin plus 5-FU and leucovorin (FOLFOX) was initiated, but severe allergic dermatitis developed after the second cycle. Although she reported no prior history of adverse reactions to tegafur-uracil, a drug lymphocyte stimulation test showed an allergic response to 5-FU. We subsequently replaced with Irinotecan plus S-1 (IRIS) chemotherapy which was well tolerated and resulted in a partial response after 3 cycles. As a result, right trisectionectomy was successfully performed and no recurrence was detected in the following 3 years. A severe allergic reaction to intravenous 5-FU-containing drug regimens can be successfully alleviated by switching to S-1-containing regimens such as IRIS or S-1 plus oxaliplatin (SOX).

scholarly journals Surgical Options for Initially Unresectable Colorectal Liver Metastases

HPB Surgery ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-13 ◽  
Author(s):  
Irinel Popescu ◽  
Sorin Tiberiu Alexandrescu
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Palliative Treatment ◽  
Survival Rates ◽  
Portal Vein Ligation ◽  
Term Survival ◽  
Number Of Patients ◽  
Unresectable Colorectal Liver Metastases ◽  
Surgical Options

Although the frontiers of liver resection for colorectal liver metastases have broadened in recent decades, approximately 75% of these patients present with unresectable metastases at the time of their diagnosis. In the past, these patients underwent only palliative treatment, without the chance of a cure. In the previous two decades, several therapeutic strategies have been developed that render resectable those metastases that were initially unresectable, thus offering the chance of long-term survival and even a cure to these patients. The oncosurgical modalities that are available include liver resection following portal vein ligation/embolization, “two-stage” liver resection, one-stage ultrasonically guided liver resection, hepatectomy following conversion chemotherapy, and liver resection combined with thermal ablation. Moreover, in recent years, certain authors have recommended the revisiting of the concept of liver transplantation in highly selected patients with unresectable colorectal liver metastases and favorable prognostic factors. By employing such therapies, the number of patients with colorectal liver metastases who undergo a potentially curative treatment could increase to 40%. The safety profile of these approaches is acceptable (morbidity rates as high as 45%, mortality rates of less than 5%). Furthermore, the 5-year survival rates (approximately 30%) are significantly increased over those that were achieved with palliative treatment.

Radiofrequency ablation of colorectal liver metastases downstaged by chemotherapy

2009 ◽  
Vol 50 (7) ◽  
pp. 716-721 ◽  
Author(s):  
Anders Riegels Knudsen ◽  
Anne-Sofia Kannerup ◽  
Frank Viborg Mortensen ◽  
Dennis Tønner Nielsen
Keyword(s):  
Radiofrequency Ablation ◽  
Liver Metastases ◽  
Multidisciplinary Team ◽  
Colorectal Liver Metastases ◽  
Systemic Chemotherapy ◽  
Local Treatment ◽  
Hepatic Metastases ◽  
Term Survival ◽  
Unresectable Colorectal Liver Metastases ◽  
Chemotherapy Patients

Background: Radiofrequency ablation (RFA) continues to evolve, improving the potentials of this technique. It is now a widely used procedure in the treatment of patients with unresectable colorectal liver metastases, increasing the number of potentially curable patients. Purpose: To evaluate the long-term survival of patients treated by RFA for colorectal liver metastases after downstaging by systemic chemotherapy. Material and Methods: In a retrospective review of our prospective colorectal liver metastasis RFA database, 36 patients (20 males, 16 females; median age 67 years) were identified during an 8-year period (1999–2007). All patients were initially unsuitable for local treatment, and referred to systemic chemotherapy by our multidisciplinary team. Multinodularity and/or location of tumor was the main cause of patients being unsuitable for local treatment. Chemotherapy mainly consisted of 5-fluorouracil and leucovorin combined with oxaliplatin or irinotecan. After downstaging with chemotherapy, patients were treated by RFA. Patients with extrahepatic disease were excluded from RFA treatment. Pre- and posttreatment evaluation was performed with multidetector computed tomography (MDCT) scans. Results: The median time from diagnosis of hepatic metastases to first RFA was 10 months. A total of 158 tumors were treated with RFA during the study period. Median follow-up period was 27 months. The estimated median survival time after diagnosis of hepatic metastasis was 39 months, with a 5-year survival rate of 34%. Conclusion: In selected patients with colorectal liver metastases downstaged by chemotherapy, RFA is an important modality that may contribute to improved survival. Furthermore, all patients responding to systemic chemotherapy should be re-evaluated by a multidisciplinary team.

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