scholarly journals Unresectable Metastasis

2020 ◽  
Author(s):  
Keyword(s):  
Unresectable Metastasis

Prognostic value of pretreatment F-18 fluorodeoxyglucose PET/CT in colorectal cancer with unresectable metastasis

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Eun Kyoung Choi ◽  
Jin Kyoung Oh ◽  
Ye Young Seo ◽  
Jooyeon Jamie Im ◽  
Yong-An Chung
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Value ◽  
Pet Ct ◽  
Unresectable Metastasis ◽  
Fluorodeoxyglucose Pet

Surgery of colorectal metastasis in the Optimox 1 study. A GERCOR Study

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 3522-3522 ◽  
Author(s):  
N. Perez-Staub ◽  
G. Lledo ◽  
F. Paye ◽  
B. Gayet ◽  
M. Flesch ◽  
...  
Keyword(s):  
Median Overall Survival ◽  
Response Rate ◽  
Disease Free Survival ◽  
Complete Response ◽  
Additional Benefit ◽  
Curative Intent ◽  
Free Survival ◽  
Before And After ◽  
Unresectable Metastasis ◽  
Disease Free

3522 Background: Surgery of metastasis can cure arround 20% of metastatic colorectal cancer (MCRC) patients. The Optimox 1 study achieved a response rate over 50% with FOLFOX therapy in patients (pts) with initially unresectable metastasis which allowed to perform surgery in a significant number of pts (JCO 2006). We report here the results in pts who underwent surgery of metastasis (met). Methods: From jan 2000 to june 2002, 620 previously untreated patients with unresectable metastasis were randomized between FOLFOX4 every two weeks until progression (arm A), or FOLFOX7 for 6 cycles, maintenance without oxaliplatin for 12 cycles and reintroduction of FOLFOX7 (arm B). 101 pts were resected with a curative intent, 57 in arm A and 45 in arm B. Results: Patients characteristics were (arm A/B %): metachronous metastasis 77/51, liver met 82/91, lung met 16/11, other met 7/4, PAL < 3 ULN: 98/97, normal LDH: 52/51. 8% of pts achieved a complete response, 72% a partial response, 16% a stable disease. 89 pts had a single resection, 12 had a two-stage surgery. One patient died in arm B. Eleven pts who relapsed had a second surgery. Resection was radical (R0) for 71 pts (43 in arm A and 28 in arm B), 15 were R1 (margin invasion) and 15 were R2. R0/R1 patients had a median overall survival (OS) of 51 mo in arm A and 38 mo in arm B. Median disease-free survival (DFS) since surgery was 12 mo in arm A and 9 mo in arm B, with no statistical difference. 32% of R0/R1 pts were alive with no progression at 3 years in arm A and 20% in arm B. Median time from randomization to surgery was 8 mo. No difference was found between patients resected before 8 mo (n = 50) and after (n = 37) in OS (39 vs 45 mo, p = .67) nor in DFS (11.6 vs 9.5 mo, p = .24). Neither in pts resected before and after 6 mo in OS (p = .77) and DFS (p = .44). Conclusions: FOLFOX treatment allowed 14 % of unresectable patients to be rescued by surgery. There was no additional benefit to perform surgery after 6 months of therapy compared to early surgery. [Table: see text]

Impact on survival of primary tumor resection in patients with colorectal cancer and unresectable metastasis: Pooled analysis of individual patients’ data from four randomized trials.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 3507-3507 ◽  
Author(s):  
Matthieu Faron ◽  
Abderrahmane Bourredjem ◽  
Jean-Pierre Pignon ◽  
Olivier Bouche ◽  
Jean-Yves Douillard ◽  
...  
Keyword(s):  
Primary Tumor ◽  
Tumor Resection ◽  
Tumor Location ◽  
Primary Tumor Resection ◽  
First Line ◽  
Primary Tumor Location ◽  
Impact On Survival ◽  
Colonic Primary ◽  
Unresectable Metastasis ◽  
Line Chemotherapy

3507 Background: In patients with colorectal cancer (CRC) and unresectable metastasis, the prognostic impact of primary tumor resection still remains a matter of debates. The goal of this study was to estimate, after adjustment for prognostic factors, the effect of primary tumor resection on survival. Methods: Individual patients’ data of the 1155 patients with metastatic CRC included in 4 first-line chemotherapy trials (FFCD 9601, FFCD 2000-05, ACCORD 13 and ML 16987) where retrieved. Patients were eligible for this study if they had synchronous metastasis judged unresectable. Primary endpoint was overall survival (OS), secondary endpoint was progression free survival (PFS). A Cox proportional hazard model stratified on the trial was used to estimate the impact on survival. Results: 810 patients beginning first-line chemotherapy with either fluoropyrimidine alone, oxaliplatin, irinotecan and/or bevacizumab were eligible. Patients with a history of resection (n = 478 (59%)), as compared to those without (n = 332 (41%)), were more likely to have colonic primary (p < 0.0001), lower carcino embryonic antigen (CEA) (p < 0.0001) or alkaline phosphatase (ALP) level (p=0.04) and normal white blood cell count (WBC) (p < 0.0001). In the univariate analysis, stratified on the trial, primary tumor resection was associated with a better OS (Hazard Ratio HR: 0.73 [0.63-0.84]; p < 0.0001) and PFS (HR : 0.73 [0.63-0.84]; p < 0.0001). Multivariate analysis, adjusted for primary tumor location, CEA, ALP and WBC levels, OMS performance status and number of metastatic sites confirmed that primary tumor resection was an independent predictor of better OS (HR : 0.63 [0.53-0.75] ; p < 0.0001), and PFS (HR : 0.82 [0.70-0.95] ; p = 0.0007). Significant interactions were found between resection and CEA level (p=0.02) and resection and primary tumor location (p=0.01) for OS (not for PFS) with a lower impact of resection with higher CEA levels or a colonic primary. Conclusions: This study confirmed the independent prognostic value on survival of primary tumor resection in patients with unresectable metastases of CRC.

scholarly journals Palliative bidirectional Glenn anastomosis for unresectable metastasis in the right ventricle from renal cell carcinoma 16 years after nephrectomy

2009 ◽  
Vol 137 (3) ◽  
pp. 775-777 ◽  
Author(s):  
Naoto Morimoto ◽  
Keisuke Morimoto ◽  
Yoshihisa Morimoto ◽  
Toshihito Sakamoto ◽  
Akiko Tanaka ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Right Ventricle ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Bidirectional Glenn ◽  
Unresectable Metastasis ◽  
The Right

Stereotactic body radiotherapy (SBRT) in combination with surgery for primary and metastatic liver tumors.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 347-347
Author(s):  
Erik Lappinen ◽  
Ngoc Thai ◽  
Kusum Tom ◽  
Akhtar Khan ◽  
Ellen Day ◽  
...  
Keyword(s):  
Liver Tumors ◽  
Hepatic Metastases ◽  
Normal Liver ◽  
Liver Parenchyma ◽  
Metastatic Lesion ◽  
Hepatic Lesions ◽  
Unresectable Metastasis ◽  
Metastatic Liver Tumors ◽  
Metastatic Liver

347 Background: Evaluate the feasibility, safety, and efficacy of SBRT in combination with surgery for primary and metastatic liver tumors. Methods: 12 patients completed hepatectomy and SBRT for either hepatocellular carcinoma (HCC) (3) or metastases from colorectal (4), neuroendocrine (2), uterine (2), or sarcoma (1) primary. All patients with metastases completed chemotherapy. Most patients (7) had resection of their operable metastases, total of 19, and gold fiducials placed in the unresectable lesions, total of 9, to facilitate definitive adjuvant SBRT. One patient with an unresectable metastasis received preoperative SBRT. Two patients with HCC had SBRT as a bridge to liver transplant. Two patients had salvage SBRT for recurrence after surgery. All patients completed 4D-CT for ITV definition and SPECT/CT to define functional normal liver parenchyma volume (NLV). MV-fluoro was performed to confirm tumor/fiducial respiratory motion within the PTV. Results: All patients successfully completed a combination of hepatectomy and SBRT. Seventeen hepatic lesions (≤ 2/patient) were treated with SBRT with a mean PTV 186.0 cc (15.1-803.5). The mean dose was 49.3 Gy (39-60) prescribed to the PTV in 5-6 fractions. With median follow-up of 9.2 months (2.8-15.3) there was no RILD > Grade 1 observed. The most common toxicity was Grade ≤ 2 fatigue. Nine patients had reduced SPECT-NLV vs. calculated NLV by a mean of 487.5 cc (p = 0.0004). In 6 of these, the SPECT-NLV vs. the CT-NLV was reduced by a mean of 253.9 cc (44.6 - 1076.2) reflecting the importance of SPECT functional imaging for SBRT planning. Postoperative morbidity was ≤ Grade 1. All surgical margins were negative. Three patients developed intrahepatic failures post SBRT. However, on follow-up imaging no in-field failures have occurred. Conclusions: The combination of liver SBRT with hepatic resection is safe and effective. It can be used preoperatively to increase resectability or to salvage surgical failures. We also report on the combination of limited hepatectomy for peripheral (including bilobar) hepatic metastases with planned SBRT to unresectable metastatic lesion(s). SBRT planning with SPECT/CT allows identification and preservation of the NLV.

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