ABSTRACT
This article deals with the treatment of metastatic colorectal cancer (stage IV). The treatment goals and approaches are determined by the resectability status of the metastases: resectable liver and lung metastases are primarily resected and perioperative chemotherapy appears to be dispensable. In potentially resectable metastases, a conversion therapy is attempted to enable a potentially curative resection. In the case of nonresectability the treatment goal is palliative. Induction and maintenance therapy as well as drug holidays are suggested in an attempt to achieve extended survival while maintaining the quality of life, beginning with the best possible individual treatment. For some patients with stage IV, molecular targeted therapies are available. The study situation and approval status are dealt with in detail. With improved molecular characterization of tumors the treatment can be further individualized.
Subject(s)
Colonic Neoplasms/drug therapy , Colonic Neoplasms/surgery , Colorectal Neoplasms/drug therapy , Colorectal Neoplasms/surgery , Liver Neoplasms/drug therapy , Liver Neoplasms/secondary , Liver Neoplasms/surgery , Rectal Neoplasms/drug therapy , Rectal Neoplasms/secondary , Rectal Neoplasms/surgery , Humans , Molecular Targeted Therapy , Neoadjuvant Therapy , Neoplasm Metastasis , Precision Medicine , Quality of Life , Treatment OutcomeABSTRACT
Objective: To investigate the efficacious and safe therapy for urothelial carcinoma patients with liver metastasis. Methods: A total of 42 urothelial carcinoma patients with liver metastasis from December 2006 to December 2016 at Department of Renal Carcinoma and Melanoma in Beijing Cancer Hospital were included in this retrospective study. All patients were divided into three groups, and treated with paclitaxel plus gemcitabine, paclitaxel plus gemcitabine and cisplatin, or paclitaxel plus gemcitabine combined with transcatheter arterial chemoembolization (TACE), respectively. The treatment continued until disease progression or intolerable adverse reactions occurred. The efficacy and treatment-related adverse reactions in different groups were analyzed specifically. Results: For the 42 patients, the median progression-free survival time (PFS) was 2.0±0.7 months [95% confidence interval (CI): 0.6-3.4], and the median overall survival time (OS) was 6.1±1.7 months (95% CI: 4.1-9.9). For the 12 patients receiving TACE combined with systemic chemotherapy, the median PFS was 7.1 ±0.7 months (95% CI: 5.7-8.5), the median OS was 14.1 ±3.0 months (95% CI: 8.3-19.9), which were statistically different from those in systemic chemotherapy group (both P < 0.01). The patients could tolerate TACE combined with systemic chemotherapy. The common adverse effects were gastrointestinal reaction at grade 1-2, upper abdominal pain and leukopenia. Conclusion: TACE combined with systemic chemotherapy is an efficacious and safe treatment regimen for urothelial carcinoma patients with liver metastasis.
ABSTRACT
Objective To investigate the differences in tumor volume and metastatic tumors of the liver and regional lymph nodes between contrast-enhanced computed tomography (CT) and diffusion-weighted magnetic resonance imaging (DWMRI) through a comparative analysis,as well the useful information for target volume delineation,and to guide radiotherapy in clinical practice.Methods A total of 40 patients with pancreatic cancer were enrolled and underwent contrast-enhanced CT and DWMRI in the same position.The target volume was delineated,the major axis of the maximum tumor section was measured,and the numbers of liver metastatic tumors and metastatic tumors of the lymph nodes with a diameter of 5-8 mm or＞8 mm were measured based on the CT and DWMRI images.The analysis was performed by using paired t-test or paired Wilcoxon rank sum test.Results The mean gross tumor volume (GTV) delineated by contrast-enhanced CT and DWMRI was 54.95 cm3 and 41.67 cm3(P =0.000),and the mean value-different value was 13.28 cm3.The major axis of the maximum tumor section measured by contrast-enhanced CT and DWMRI were 4.18 cm and 3.94 cm (P=0.000),respectively,and in two patients,dCT was smaller than dDWMRI.A total of 83 liver metastatic tumors were identified by contrast-enhanced CT,and 112 were identified by DWMRI;the liver metastatic tumors detected by contrast-enhanced CT accounted for 74％ of those detected by DWMRI.As for the metastatic tumors of the lymph nodes with a diameter of 5-8 mm or＞8 mm,103 or 46 were detected by contrast-enhanced CT,and 200 or 56 were detected by DWMRI,and the tumors detected contrast-enhanced CT accounted for 52％ or 82％ of those detected by DWMRI.There were significant differences in all data between contrast-enhanced CT and DWMRI.Conclusions GTV and the major axis of the maximum tumor section measured by DWMRI are lower than those measured by contrast-enhanced CT,and contrast-enhanced CT is sensitive in detecting the metastatic tumors of the liver and lymph nodes.However,it is necessary to conduct further controlled experiments with reference to pathology.
