Aggressive surgical management in patients with lung metastases originating from colorectal cancer: addressing the controversy

2012 ◽  
Vol 1 (2) ◽  
pp. 97-103
Author(s):  
Stefan Limmer ◽  
Stefanie Schierholz
Keyword(s):  
Colorectal Cancer ◽  
Surgical Management ◽  
Lung Metastases

Surgical management of patients with colorectal cancer and simultaneous liver and lung metastases

2015 ◽  
Vol 102 (6) ◽  
pp. 691-699 ◽  
Author(s):  
A. Andres ◽  
G. Mentha ◽  
R. Adam ◽  
E. Gerstel ◽  
O. G. Skipenko ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Surgical Management ◽  
Lung Metastases

scholarly journals Role of Thermal Ablation in Colorectal Cancer Lung Metastases

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 908
Author(s):  
Alexandre Delpla ◽  
Thierry de Baere ◽  
Eloi Varin ◽  
Frederic Deschamps ◽  
Charles Roux ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Factors ◽  
Thermal Ablation ◽  
Medical Oncology ◽  
Pulmonary Metastases ◽  
Lung Metastases ◽  
Stereotactic Ablative Radiotherapy ◽  
Chest Drainage ◽  
Results Of Surgery

Background: Consensus guidelines of the European Society for Medical Oncology (ESMO) (2016) provided recommendations for the management of lung metastases. Thermal ablation appears as a tool in the management of these secondary pulmonary lesions, in the same manner as surgical resection or stereotactic ablative radiotherapy (SABR). Methods: Indications, technical considerations, oncological outcomes such as survival (OS) or local control (LC), prognostic factors and complications of thermal ablation in colorectal cancer lung metastases were reviewed and put into perspective with results of surgery and SABR. Results: LC rates varied from 62 to 91%, with size of the metastasis (<2 cm), proximity to the bronchi or vessels, and size of ablation margins (>5 mm) as predictive factors of LC. Median OS varied between 33 and 68 months. Pulmonary free disease interval <12 months, positive carcinoembryonic antigen, absence of neoadjuvant chemotherapy and uncontrolled extra-pulmonary metastases were poor prognostic factors for OS. While chest drainage for less than 48 h was required in 13 to 47% of treatments, major complications were rare. Conclusions: Thermal ablation of a selected subpopulation of patients with colorectal cancer lung metastases is safe and can provide excellent LC and delay systemic chemotherapy.

scholarly journals Nomogram based on homogeneous and heterogeneous associated factors for predicting distant metastases in patients with colorectal cancer

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Tianwen Luo ◽  
Yutong Wang ◽  
Xuefeng Shan ◽  
Ye Bai ◽  
Chun Huang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Lung Metastases ◽  
Roc Curves ◽  
Distant Metastases ◽  
Good Prediction ◽  
Operating Characteristics ◽  
Good Prediction Performance ◽  
Different Types ◽  
Associated Risk Factors

Abstract Background The identification of the homogeneous and heterogeneous risk factors for different types of metastases in colorectal cancer (CRC) may shed light on the aetiology and help individualize prophylactic treatment. The present study characterized the incidence differences and identified the homogeneous and heterogeneous risk factors associated with distant metastases in CRC. Methods CRC patients registered in the SEER database between 2010 and 2016 were included in this study. Logistic regression was used to analyse homogeneous and heterogeneous risk factors for the occurrence of different types of metastases. Nomograms were constructed to predict the risk for developing metastases, and the performance was quantitatively assessed using the receiver operating characteristics (ROC) curve and calibration curve. Results A total of 204,595 eligible CRC patients were included in our study, and 17.07% of them had distant metastases. The overall incidences of liver metastases, lung metastases, bone metastases, and brain metastases were 15.34%, 5.22%, 1.26%, and 0.29%, respectively. The incidence of distant metastases differed by age, gender, and the original CRC sites. Poorly differentiated grade, more lymphatic metastasis, higher carcinoembryonic antigen (CEA), and different metastatic organs were all positively associated with four patterns of metastases. In contrast, age, sex, race, insurance status, position, and T stage were heterogeneously associated with metastases. The calibration and ROC curves exhibited good performance for predicting distant metastases. Conclusions The incidence of distant metastases in CRC exhibited distinct differences, and the patients had homogeneous and heterogeneous associated risk factors. Although limited risk factors were included in the present study, the established nomogram showed good prediction performance.

scholarly journals Outcome of Radical Surgery for Simultaneous Liver and Lung Metastases Synchronous with Primary Colorectal Cancer

2021 ◽  
Author(s):  
Franz Xaver Singhartinger ◽  
Martin Varga ◽  
Tarkan Jäger ◽  
Adam Dinnewitzer ◽  
Oliver Koch ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lung Metastases ◽  
Primary Tumour ◽  
Median Number ◽  
R0 Resection ◽  
Curative Intent ◽  
Median Hospital Stay ◽  
Free Survival ◽  
Colorectal Cancer Patients ◽  
Primary Tumour Site

Abstract Background Colorectal cancer (CRC) leads to metastatic disease in approximately 30% of patients. In patients with newly diagnosed CRC with both liver and lung metastases, curative resection is rarely possible. The aim of this study is to evaluate the overall (OS) and relapse-free survival (RFS) rates of these patients after resection with curative intent. Methods This study is a retrospective analysis of colorectal cancer patients (n=8, median age 54.3 years) with simultaneous liver and lung metastasis undergoing resection with curative intent between May 1st, 2002, to December 31st, 2016, at our institution. Results Colon was the primary tumour site in 2 patients and rectum in 6 patients. The median number of liver and lung metastases was 3 and 2, respectively. Patients received various treatment sequences individualized on tumour disease burden. R0 resection was achieved after all but one procedure. Two severe Clavien-Dindo grade IIIb complications were present. Median hospital stay was 9 (3–24) days per procedure. Tumour relapse was observed in all patients with median RFS of 9 (3–28) months and median OS of 40 (17–52) months. In 4 cases, where repeated resection of recurrent metastases (3 liver and 1 lung) was possible, the median OS was 43 months. Conclusion Our data suggests that patients seem to benefit from resection with curative intent, with tendency to prolonged OS and with acceptable complication rate. Tumour recurrence occurred in all patients. Repeated resection was beneficial and led to further prolonged OS.

Tumor bulk as a prognostic biomarker and predictor of benefit from anti-EGFR therapy in patients with metastatic colorectal cancer: Analysis of 476 patients from the ARCAD Clinical Trials Program.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 108-108
Author(s):  
Benjamin Adam Weinberg ◽  
Manel Rakez ◽  
Benoist Chibaudel ◽  
Tim Maughan ◽  
Richard Adams ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Primary Tumor ◽  
Lung Metastases ◽  
Performance Status ◽  
Progression Free Survival ◽  
Predictive Biomarker ◽  
Wild Type ◽  
Cox Models ◽  
Study Results

108 Background: Primary tumor sidedness has emerged as a prognostic and predictive biomarker for patients (pts) with metastatic colorectal cancer (mCRC). Tumor bulk has also been postulated to predict response to anti-EGFR therapy. We sought to evaluate the role of tumor bulk as a predictive biomarker to anti-EGFR therapy in pts with left- (LS) and right-sided (RS) mCRC. Methods: Data from 476 pts with mCRC enrolled across 2 first-line trials of anti-EGFR plus chemotherapy versus chemotherapy were pooled. Pts were included if there was available information on tumor sidedness and tumor bulk. All were KRAS wild-type and BRAF wild-type or unknown BRAF status. The right colon was defined as the cecum through the transverse colon, and the left colon as the splenic flexure through the rectum. Tumor bulk was the mean tumor size of target lesions at baseline, bulky defined as > 3.5 cm. Overall survival (OS) and progression-free survival (PFS) were assessed using Kaplan-Meier and Cox models adjusting for performance status (PS), platelet count, primary tumor (PT) resection, number of metastatic sites, and stratified by study. Results: Pts with bulky tumors (211, 44%) had higher PS, white blood cell and platelet counts, higher CEA, fewer sites of metastatic disease, more liver than lung metastases, and fewer had PT resection. OS and PFS medians in months (mos) are presented in the table with 95% confidence intervals (95%CIs). Bulky tumors had inferior median OS compared with non-bulky (mOS, 17.9 vs. 21.3 mos, HRadj 1.33, 95% CI 1.05-1.69, P = 0.016) although median PFS was similar (mPFS, 8.6 vs. 8.7 mos, HRadj 1.15, 95% CI 0.92-1.42, P = 0.21). Conclusions: Tumor bulk is an independent prognostic factor for OS in KRAS wild-type and BRAF wild-type or unknown BRAF status pts. Pts with non-bulky RS tumors have survival outcomes similar to pts with bulky LS tumors. Although the mPFS for pts with RS tumors treated with anti-EGFR therapy was the lowest across subgroups, this finding was not statistically significant. Further research is warranted into whether pts with bulky RS tumors benefit from anti-EGFR therapy. Clinical trial information: NCT00182715, NCT00640081. [Table: see text]

scholarly journals Surgical management and outcomes of colorectal cancer liver metastases

2010 ◽  
Vol 97 (7) ◽  
pp. 1110-1118 ◽  
Author(s):  
E. J. A. Morris ◽  
D. Forman ◽  
J. D. Thomas ◽  
P. Quirke ◽  
E. F. Taylor ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Metastases ◽  
Surgical Management ◽  
Colorectal Cancer Liver Metastases

scholarly journals Case Report: Bilateral Pneumothoraces Due To Targeted Tumor Therapy With Regorafenib in a Young Woman With Metastatic Colorectal Cancer

2021 ◽  
Author(s):  
Tobias Rachow ◽  
Tim Sandhaus ◽  
Thomas Ernst ◽  
Helmut Schiffl ◽  
Susanne M. Lang
Keyword(s):  
Colorectal Cancer ◽  
Chest Pain ◽  
Pulmonary Metastases ◽  
Lung Metastases ◽  
Tumor Therapy ◽  
Tension Pneumothorax ◽  
Cancer Case ◽  
Pretreated Patient ◽  
Breath Sounds ◽  
The Right

Abstract Background: Colorectal cancer is one of the most common cancer types, frequently metastasizing into the lungs. Treatment options have been vastly improved over the last years. With the increasing use of targeted therapies novel and rare adverse effects can be seen. In this report, we present the case of recurrent spontaneous bilateral pneumothorax due to fulminant tumor necrosis during the administration of regorafenib in a heavily pretreated patient with multiple lung metastases from colorectal cancer. Case presentation: A 43-year-old woman presented in our oncology department with chest pain and dyspnea. The patient was diagnosed with colorectal cancer seven years earlier and had received chemoradiation, surgery and multiple chemotherapies, before she was started on regorafenib because of progressive pulmonary metastases. Clinical examination revealed no breath sounds in the right hemithorax. The patient was tachycardic and orthopneic. Computed tomography scans demonstrated cavitation of former nodular bilateral pulmonary metastases. After drainage and resolution of the right-sided pneumothorax the patient returned eleven days later with recurrent dyspnea, chest pain and subcutaneous emphysema. Bilateral pneumothoraces were treated with chest tubes. Due to left-sided tension pneumothorax video-assisted thoracoscopy and bilateral pleurodeses were performed. Persistent air leaks with severe pain and pulmonary infiltrates led to the death of the patient. Conclusions: Our case illustrates the effectiveness of regorafenib in a highly pretreated patient. However, in our patient the ensuing cavitation of the multiple nodes led to recurrent pneumothoraces and associated infectious complications. Therefore, special surveillance should be implemented to detect potential transformation of solid pulmonary metastases during treatment with this multi-kinase inhibitor.

scholarly journals Correlation between preoperative CT scan and lung metastases according to surgical approach in patients with colorectal cancer

2021 ◽  
Author(s):  
Jorge Hernández ◽  
Laureano Molins ◽  
Juan J. Fibla ◽  
Ángela Guirao ◽  
Juan J. Rivas ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Ct Scan ◽  
Surgical Approach ◽  
Lung Metastases ◽  
Preoperative Ct
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