Liver metastases of colorectal cancer — what are the limitations of multimodality treatment?
Abstract
The prognosis of patients with liver-only metastases of colorectal cancer varies significantly, depending mostly
on technical resectability of metastases. Possible treatment modalities include surgical resection, methods of
local ablative treatment, as well as systemic chemotherapy. Hereunder, we present a case of a 52-year-old male
patient with colon cancer metastases limited initially to the liver, who underwent multimodality treatment consisting
of systemic chemotherapy and several forms of localised treatment: radioembolisation, non-anatomical resection
and thermoablation of liver metastases, and wedge resection of lung metastasis. Despite achieving long-lasting
control of liver metastases, localised treatment resulted also in chronic thrombocytopaenia, which prevented
introduction of optimal subsequent systemic treatment.
Keywords: colorectal cancermetastasesradioisotope therapysurgerychemotherapy
References
- Van Cutsem E, Cervantes A, Adam R, et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol. 2016; 27(8): 1386–1422.
- Fong Y, Fortner J, Sun R, et al. Clinical Score for Predicting Recurrence After Hepatic Resection for Metastatic Colorectal Cancer. Annals of Surgery. 1999; 230(3): 309.
- Nordlinger B, Sorbye H, Glimelius B, et al. Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial. The Lancet Oncology. 2013; 14(12): 1208–1215.
- Ruers T, Punt C, Coevorden FV, et al. Radiofrequency ablation combined with systemic treatment versus systemic treatment alone in patients with non-resectable colorectal liver metastases: a randomized EORTC Intergroup phase II study (EORTC 40004). Annals of Oncology. 2012; 23(10): 2619–2626.
- Scorsetti M, Arcangeli S, Tozzi A, et al. Is Stereotactic Body Radiation Therapy an Attractive Option for Unresectable Liver Metastases? A Preliminary Report From a Phase 2 Trial. International Journal of Radiation Oncology*Biology*Physics. 2013; 86(2): 336–342.
- Fiorentini G, Aliberti C, Tilli M, et al. Intra-arterial infusion of irinotecan-loaded drug-eluting beads (DEBIRI) versus intravenous therapy (FOLFIRI) for hepatic metastases from colorectal cancer: final results of a phase III study. Anticancer Res. 2012; 32(4): 1387–1395.
- van Hazel GA, Heinemann V, Sharma NK, et al. SIRFLOX: Randomized Phase III Trial Comparing First-Line mFOLFOX6 (Plus or Minus Bevacizumab) Versus mFOLFOX6 (Plus or Minus Bevacizumab) Plus Selective Internal Radiation Therapy in Patients With Metastatic Colorectal Cancer. J Clin Oncol. 2016; 34(15): 1723–1731.
- Sharma RA, Wasan HS, Van Ha, et al. Overall survival analysis of the FOXFIRE prospective randomized studies of first-line selective internal radiotherapy (SIRT) in patients with liver metastases from colorectal cancer. Journal of Clinical Oncology. 2017;35(15_suppl. (suppl.3507): 3507.
- Ye LC, Liu TS, Ren Li, et al. Randomized controlled trial of cetuximab plus chemotherapy for patients with KRAS wild-type unresectable colorectal liver-limited metastases. J Clin Oncol. 2013; 31(16): 1931–1938.
- Gruenberger T, Bridgewater J, Chau I, et al. Bevacizumab plus mFOLFOX-6 or FOLFOXIRI in patients with initially unresectable liver metastases from colorectal cancer: the OLIVIA multinational randomised phase II trial. Ann Oncol. 2015; 26(4): 702–708.
- Tournigand C, André T, Achille E, et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol. 2004; 22(2): 229–237.
- Heinemann V, von Weikersthal LF, Decker T, et al. FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a randomised, open-label, phase 3 trial. Lancet Oncol. 2014; 15(10): 1065–1075.