Therapeutic approaches to metastasis confined to the liver

Current Oncology Reports (Impact Factor: 2.89). 02/2001; 3(2):109-115. DOI: 10.1007/s11912-001-0009-4


Liver metastases nearly always represent disseminated cancer, and systemic therapies are usually indicated. However, in a
minority of patients—some with colorectal cancer, others with selected tumors—management of the hepatic disease may be clinically
important and even curative. This review identifies unique patient subgroups and novel treatment approaches that may be indicated
in patients with liver metastases.

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    ABSTRACT: To evaluate computed tomographic (CT) colonography in patients with clinical suspicion of colorectal cancer and in whom colonoscopy was incomplete. After incomplete colonoscopy, 34 patients underwent CT colonography before and after intravenous injection of iodinated contrast agent, in supine and prone positions. Twenty patients with no evidence of colon cancer after complete colonoscopy were included as a control group. Sensitivity and specificity of CT colonography were determined for detection of cancers, polyps, and metastases to liver. In 29 patients, surgery revealed 30 colorectal cancers (three synchronous cancers) and two ischemic lesions of the descending colon. Colonoscopy missed 10 colorectal cancers and three synchronous cancers; all were detected with CT colonography. Sensitivity and specificity for detection of colorectal cancer were 56% and 92%, respectively, for incomplete colonoscopy and 100% and 96%, respectively, for CT colonography (P <.01). Sensitivity and specificity of CT colonography in detection of polyps were 86% and 70%, respectively, for diameters of 5 mm or less; 100% and 80%, respectively, for 5-10-mm diameters; and 100% for diameters greater than 10 mm. Spiral CT of the liver revealed four metastases (2-5 cm); sensitivity and specificity were 100% and 43% for nonenhanced scans and 100% for contrast-enhanced scans (P <.01). In this selected group of patients, CT colonography provided complete information to properly address surgery of colorectal cancer and treatment of liver metastases.
    Radiology 07/2002; 223(3):615-9. DOI:10.1148/radiol.2233010928 · 6.87 Impact Factor
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    ABSTRACT: Background and Objectives In colorectal cancer (CRC) patients, tumour recurrence is common following potentially curative surgery for liver metastases. This may be caused by occult tumour cells present at the time of surgery. Dissemination of micrometastatic cells may occur early in patients with solid cancer, and micrometastases may signify a poor prognosis. The aim of the present study was to evaluate the frequency of micrometastatic cells in the bone marrow of patients with potentially resectable liver metastases.Methods Twenty millilitres of bone marrow was aspirated from both anterior iliac crests from 48 patients. Mononuclear cells were isolated and incubated with superparamagnetic Dynabeads® coated with an anti-epithelial monoclonal antibody (MOC31). Magnetically selected cells were identified by light microscopy as cells with bead rosettes (>5 beads/cell).ResultsMicrometastatic tumour cells were identified in four of 48 (8%) patients who all had their liver metastases surgically removed. Two of the four died after 17 and 18 months, respectively, whereas two are alive after 10 and 12 months. None of the 19 inoperable patients had micrometastases.Conclusions The frequency of bone marrow micrometastases in patients with clinically isolated liver metastases from CRC was low. This is biologically interesting, but bone marrow status should not affect current treatment protocols. J. Surg. Oncol. 2003;82:224–227. © 2003 Wiley-Liss, Inc.
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