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Hepatic Colorectal Metastases (hepatic + colorectal_metastase)
Selected AbstractsResection of liver metastases from colorectal cancer: does preoperative chemotherapy affect the accuracy of PET in preoperative planning?ANZ JOURNAL OF SURGERY, Issue 5 2009Sam Adie Abstract Background:, Preoperative scanning for hepatic colorectal metastases surgery remains a challenge, especially in the age of preoperative chemotherapy, which has marked biochemical and physical effects on the liver. Integrated fluoro-deoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) has applications for detecting extrahepatic disease. The aim of the present study was to investigate FDG-PET/CT as a preoperative planning tool for detecting liver lesions in patients with and without preoperative chemotherapy. Methods:, Patients who had resection of hepatic colorectal metastases between January 2004 and June 2006 were included. Patients were divided into those who received preoperative chemotherapy and those who did not. Malignant hepatic lesions found on each scan were compared with those found on histopathology, intraoperative examination and/or intraoperative ultrasound. Accurate scans (scan lesions corresponded to true lesions), false positives (scan lesions detected at least one non-lesion) and false negatives (scan lesions missed at least one true lesions) were recorded. Results were also compared on a per lesion basis. Results:, A total of 21 patients had preoperative FDG-PET/CT scans with preoperative chemotherapy and 53 without. Accurate tests were six (29%) for the chemotherapy group versus 28 (53%) for the non-chemotherapy group (P= 0.06). Notably, there were 11 (52%) underestimations in the chemotherapy group versus 18 (34%) in the non-chemotherapy group. A total of 1.7 lesions were missed per patient in the chemotherapy group versus 0.7 in those who did not receive chemotherapy. Conclusion:, Preoperative assessment with FDG-PET/CT is not useful for hepatic colorectal metastases, particularly when preoperative chemotherapy is used, with a trend towards underestimation of lesions. [source] HP36P DOES NEO-ADJUVANT CHEMOTHERAPY AFFECT THE ACCURACY OF HELICAL CT AND CT PORTOGRAPHY FOR PRE-OPERATIVE PLANNING IN HEPATIC COLORECTAL METASTASES?ANZ JOURNAL OF SURGERY, Issue 2007S. Adie Purpose Pre-operative scanning for hepatic colorectal metastases surgery remains a challenge, especially in the age of neo-adjuvant chemo, which has marked biochemical & physical effects on the liver. We investigated helical CT and CT portography as pre-op planning tools. Methodology All patients who had resection of hepatic colorectal metastases between Jan 2004 and June 2006 were included. Patients were divided into those who received neo-adjuvant chemo and those who did not. The number of malignant hepatic lesions found on each scan was compared with those found on histopathology & intra-op ultrasound/examination. Accurate scans (scan lesions = true lesions), over-estimations (scan lesions > true lesions) and under-estimations (scan lesions < true lesions) were recorded. Results 25 patients had pre-op CT portography with neo-adjuvant chemo and 63 without. Accurate scans on a per-patient basis were 2 (8%) for the chemo group vs. 27 (43%) for the non-chemo group, p < 0.002. Notably, there were 17 (68%) over-estimates in the chemo group vs. 25 (40%) in the non-chemo group. There were 6 (24%) vs. 11 (17%) under-estimates respectively. 23 patients had pre-op helical CT with neo-adjuvant chemo and 64 without. Accurate scans on a per-patient basis were 7 (30%) for the chemo group vs. 26 (41%) in the non-chemo group, p = 0.388. There were 8 (35%) over-estimates in the chemo group vs. 12 (19%) in the non-chemo group. There were 8 (35%) vs. 26 (41%) under-estimates respectively. Conclusion While CT portography is useful for detecting occult hepatic metastases, there is evidence that over-estimation of disease is a problem, particularly when neo-adjuvant chemo was used. Helical CT also shows this trend although to a lesser extent. [source] Tumour growth following portal branch ligation in an experimental model of liver metastases,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 6 2010O. Kollmar Background: Portal branch ligation (PBL) is being used increasingly before hepatectomy for colorectal metastases. This study evaluated the effect of PBL on angiogenesis, growth factor expression and tumour growth in a mouse model of hepatic colorectal metastases. Methods: CT26.WT cells were implanted into the left liver lobe of BALB/c mice. Animals underwent PBL of the left liver lobe or sham treatment. Angiogenesis, microcirculation, growth factor expression, cell proliferation and tumour growth were studied over 14 and 21 days by intravital multifluorescence microscopy, laser Doppler flowmetry, immunohistochemistry and western blotting. Results: Left hilar blood flow and tumour microcirculation were significantly diminished during the first 7 days after PBL. This resulted in tumour volume being 20 per cent less than in sham controls by day 14. Subsequently, PBL-treated animals demonstrated recovery of left hilar blood flow and increased expression of hepatocyte growth factor and transforming growth factor ,, associated with increased cell proliferation and acceleration of growth by day 21. Conclusion: PBL initially reduced vascular perfusion and tumour growth, but this was followed by increased growth factor expression and cell proliferation. This resulted in delayed acceleration of tumour growth, which might explain the stimulated tumour growth observed occasionally after PBL. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Radioembolization of colorectal hepatic metastases using yttrium-90 microspheresCANCER, Issue 9 2009Mary F. Mulcahy MD Abstract BACKGROUND: The objective of the current study was to determine the safety and efficacy of Yttrium-90 (Y90) microsphere treatment in patients with liver-dominant colorectal metastases. METHODS: Seventy-two patients with unresectable hepatic colorectal metastases were treated at a targeted absorbed dose of 120 Gray (Gy). Safety and toxicity were assessed using version 3 of the National Cancer Institute Common Terminology Criteria. Response was assessed by anatomic imaging and positron emission tomography (PET). Survival from the diagnosis of hepatic metastases and first treatment were estimated using the Kaplan-Meier method. Substratification analyses were performed. RESULTS: The median dose delivered was 118 Gy. Treatment-related toxicities included fatigue (61%), nausea (21%), and abdominal pain (25%). Grade 3 and 4 bilirubin toxicities were observed in 9 of 72 patients (12.6%). The tumor response rate was 40.3%. The median time to hepatic progression was 15.4 months, and the median response duration was 15 months. The PET response rate was 77%. Overall survival from the first Y90 treatment was 14.5 months. Tumor replacement (,25% vs >25%) was associated with significantly greater median survival (18.7 months vs 5.2 months). The presence of extrahepatic disease was associated negatively with overall survival (7.9 months vs 21 months). Overall survival from the date of initial hepatic metastases was 34.6 months. A subset analysis of patients who had an Eastern Cooperative Oncology Group performance status of 0 demonstrated a median survival of 42.8 months and 23.5 months from the time of hepatic metastases and Y90 treatment, respectively. CONCLUSIONS: Y90 liver therapy appears to provide sustained disease stabilization with acceptable toxicity. Asymptomatic patients with preserved liver function at the time of Y90 appeared to benefit most from treatment. Cancer 2009. © 2009 American Cancer Society. [source] | ||||||||||