Pagina Iniziale » Fegato » Tumori del Fegato » Tumori maligni » Metastasi fegato
Le Metastasi Epatiche
Secondarismi epatici, tumori secondari del fegato, metastasi al fegato
Cosa sono le metastasi epatiche ?
Con il termine “metastasi epatiche” o “secondarismi epatici” vengono definiti i tumori secondari del fegato. Sono “secondari” perché originano in organi diversi dal fegato e si trasferiscono secondariamente al fegato. Non si tratta quindi di tumori epatici veri e propri, ma sono invece propagazioni di altri tumori al fegato.
Nella maggior parte dei casi si manifestano come noduli solidi (o masse) all’interno del fegato stesso che ne alterano l’aspetto.
Possono essere singole o multiple ed essere distribuite in una parte definita del fegato oppure occupare sia la parte sinistra che la parte destra del fegato.
Le metastasi al fegato possono comparire contemporaneamente al tumore primitivo da cui derivano (in questo caso si chiamano “sincrone“) oppure a distanza di tempo (in questo secondo caso vengono definite “metacrone“).
Tutte queste caratteristiche devono essere definite con la migliore accuratezza possibile per poter programmare un possibile trattamento.
Perché si formano le metastasi al fegato?
Il fegato si trova in una situazione anatomica assai particolare nel corpo umano. E’ l’unico organo che riceve sangue sia da un vaso arterioso (attraverso l’arteria epatica, che origina dall’aorta) sia da una vena (la vena porta, che riceve il sangue venoso che proviene dall’intestino dalla vena mesenterica superiore ed il sangue venoso che arriva dalla milza attraverso la vena splenica).
Una delle vie più comuni di diffusione delle cellule tumorali è il sangue. A causa della sua posizione, quindi, il fegato è una sede privilegiata per il deposito di cellule tumorali che provengono da altri organi e che una volta arrivate nel fegato possono dare origine alle metastasi.
I tumori metastatici sono 20 volte più frequentemente nel fegato rispetto ai tumori primitivi quali l’epatocarcinoma ed il colangiocarcinoma).
Le metastasi al fegato più comuni provengono dal:
- tratto gastrointestinale in quasi la metà dei casi, con una frequenza superiore per quelle che provengono dal colon e dal retto;
- tumori della mammella;
- cancro delle ovaie;
- tumore dai polmoni e
- da quelli del rene.
Come si evidenziano le metastasi al fegato? La diagnosi
I pazienti che hanno già avuto un tumore in un qualunque organo sono sottoposti a controlli periodici per il pericolo che il tumore si possa ripresentare nella sede originale o in altre zone del corpo.
La diagnosi precoce di una recidiva tumorale porta alla possibilità di poter trattare nuovamente o rioperare il paziente, con miglioramento dei risultati ottenibili.
Per questo motivo gli accertamenti eseguiti variano in base al tumore primitivo che il paziente ha o ha avuto.
Le metastasi al fegato si possono però presentare in maniera:
- sincrona: quando sono già presenti al momento in cui si rileva la presenza del tumore primitivo;
- metacrona: quando si evidenziano successivamente nel tempo al trattamento o all’intervento chirurgico effettuato al tumore primitivo.
I modi per giungere alla diagnosi di metastasi epatica possono differire. In un numero rilevanti di casi si vedono prima le metastasi al fegato rispetto al tumore primitivo, la cui presenza viene rilevata solo durante l’approfondimento degli esami.
Per essere schematici, i principali esami che vengono usati per la diagnosi nei pazienti portatori di metastasi al fegato sono:
- marcatori tumorali: sono proteine o altre sostanze che vengono rilevate nel sangue del paziente a livelli superiori della norma perché sono prodotte proprio dalle cellule tumorali. Purtroppo questi marcatori non sono perfetti: non sono sempre elevati quando è presente il tumore. Per questo motivo non possono essere usati e considerati da soli nella diagnosi e il loro significato deve sempre essere inquadrato nel quadro clinico dell’ammalato. Fra i più comuni:
- CEA: viene usato nella diagnosi di molti tumori del tratto gastrointestinale, in particolare del colon-retto, ma anche in quelli della mammella;
- CA 19-9: impiegato nella diagnosi di tumori maligni del pancreas e delle vie biliari;
- Ca 15-5 e Ca 27.29: nella diagnosi dei tumori della mammella.
- CEA: viene usato nella diagnosi di molti tumori del tratto gastrointestinale, in particolare del colon-retto, ma anche in quelli della mammella;
- Ecografia epatica: è la metodica di prima linea per l’esplorazione del fegato. Il suo uso viene suggerito come routine nel seguire pazienti che hanno già ricevuto un qualche trattamento per un tumore insorto in sedi diverse dal fegato. Se eseguito da professionisti con esperienza nello studio del fegato, fornisce informazioni assai particolareggiate sulla possibile presenza delle metastasi, sul loro numero e sulla loro localizzazione all’interno del fegato;
- TC: oggi è un esame facile da fare e facile da prenotare. Per questo motivo rappresenta l’esame di “secondo livello” preferito nello studio di possibili malattie del fegato. Oggigiorno la TC dovrebbe sempre essere eseguita con la somministrazione del mezzo di contrasto endovenoso, a meno che il paziente non abbia avuto certi precedenti di allergia proprio al mezzo di contrasto o sia portatore di altre condizioni che ne sconsiglino specificatamente l’impiego.
L’esame dovrebbe essere eseguito con la metodica “trifasica“: l’esame dovrebbe cioè mostrare la sequenza arteriosa (prima fase), la sequenza venosa/portale (seconda fase) e la sequenza venosa tardiva (terza fase).
Sempre se possibile, alla TC dell’addome dovrebbe anche essere aggiunta la TC del torace.
La TC deve fornire informazioni sul numero, sulla sede all’interno del fegato e sulle dimensioni di tutte le metastasi presenti nel fegato. L’esame è indispensabile per pianificare l’esecuzione di un eventuale intervento chirurgico. - RM: Metodica più recente della TC ma assai consolidata nella pratica ed il cui uso è in continua evoluzione grazie alla moderna tecnologia. E’ probabilmente la metodica più raffinata e precisa nello studio del fegato, in particolare per i pazienti portatori di metastasi al fegato che spesso hanno già eseguito trattamenti precedenti con la chemioterapia. Anche questo accertamento dovrebbe essere eseguito con la somministrazione di mezzo di contrasto “epatospecifico”.
- PET Total body: l’indagine è un esame di Medicina Nucleare che si effettua con la somministrazione di uno zucchero marcato. Viene usata spesso nella stadiazione delle malattie tumorali. Importante nella verifica della possibile presenza di tessuto tumorale in più zone del corpo. Non riesce a differenziare fra processi infiammatori e processi tumorali. Il suo uso deve quindi essere valutato nel contesto clinico del singolo paziente.
A completamento delle indagini, è sempre possibile (qualora indicato dalla situazione e dal quadro clinico) eseguire prelievi bioptici del tessuto tumorale per eseguire accertamenti istologici ma, soprattutto, per verificare la possibile presenza di mutazioni geniche che possano aiutare il trattamento del paziente nell’ottica della “medicina di precisione”.
In alcuni casi particolari potrebbe essere possibile visualizzare la presenza delle metastasi nel fegato ma di non essere in grado di identificare il tumore primitivo. In questi casi è sempre necessario pensare alla presenza di un colangiocarcinoma (il cui aspetto radiologico è molto simile a quello delle metastasi epatiche) oppure di un tumore neuroendocrino (che sono però tumori rari). In casi ancora più rari, non è possibile risalire alla sede del tumore primitivo e per questo motivo le metastasi al fegato vengono definite da “tumore occulto”.
Quale è la cura delle metastasi al fegato? La terapia
La terapia delle metastasi al fegato varia in rapporto al tipo di tumore primitivo da cui sono state generate. E’ difficile fare un discorso complessivo sul trattamento delle metastasi epatiche.
Le metastasi epatiche rappresentano un evento avanzato nella storia di una determinata malattia tumorale. Per questo motivo il loro trattamento non può che essere multidisciplinare, integrando quando è possibile il trattamento chirurgico a quello “sistemico” della chemioterapia.
In considerazione dei migliorati risultati ottenuti con la chirurgia, si può di certo affermare che il miglior trattamento per un paziente con metastasi al fegato è quello che viene concordato in gruppi multidisciplinari all’interno dei quali vi sia la presenza di un chirurgo epato-bilio-pancreatico con esperienza.
E’ comunque sempre appropriato, nel percorso terapeutico, acquisire il parere di un chirurgo del fegato per verificare la possibilità di rimuovere chirurgicamente le metastasi dal fegato.
Il parere compiuto sull’operabilità di un paziente può infatti essere formulato solo da chirurghi che si occupano del fegato, in quanto è stata verificata e documentata l’estrema variabilità nei giudizi e nelle opinioni fra medici chi si occupano di altre branche della medicina, come ad esempio gli oncologi o i chirurghi generali che non si occupano di interventi sul fegato, anche su uno stesso quadro clinico.
- Metastasi epatiche da tumori del colon e del retto: non vi è alcun dubbio che la terapia più efficace nel trattamento delle metastasi epatiche che derivano da tumori del colon e del retto sia quella chirurgica. Si tratta cioè di eseguire uno o più interventi di resezione epatica che tendano a rimuovere tutte le metastasi che si sono formate. Sfortunatamente l’intervento chirurgico non è proponibile in tutti i pazienti:
- a causa di motivi tecnici,
- per il numero e la sede delle metastasi all’interno del fegato,
- a causa delle condizioni generali non perfette dell’ammalato oppure
- perché vi è tessuto tumorale non asportabile in altre sedi del corpo, al di fuori del fegato.
- a causa di motivi tecnici,
Per questi motivi la situazione di ogni singolo paziente dovrebbe essere valutata da gruppi multidisciplinari dove vi siano chirurghi del fegato, al fine di intraprendere un trattamento personalizzato anche nei pazienti non operabili immediatamente per rendere possibile l’esecuzione dell’intervento magari in un secondo momento. Per questo bisogna valutare come usare la chemioterapia, che oggi offre ottimi risultati dando la possibilità ad un certo numero di pazienti non operabili di giungere all’intervento. Altre possibilità sono legate alla crescita del fegato con tecniche come l’embolizzazione portale o come l’ALPPS. I pazienti che non riescono ad essere operati vengono invece trattati con la chemioterapia sistemica: il trattamento può essere personalizzato a seconda delle caratteristiche del paziente ed offre buoni risultati in termini di aumento della sopravvivenza e miglioramento della qualità della vita.
Una valutazione dei risultati ottenibili con la resezione epatica può essere ottenuta valutando 5 semplici variabili cliniche che fanno parte del calcolo del punteggio di Fong.
- Metastasi epatiche da tumore della mammella: il trattamento delle metastasi epatiche da tumore della mammella è più controverso. Il motivo risiede nell’assenza di studi che dimostrino l’efficacia degli interventi di resezione epatica per questa malattia. Il motivo di questa assenza risiede nel fatto che le metastasi da tumore della mammella per tanto tempo sono state considerate come “sistemiche”, e cioè diffuse a tutto il corpo, tanto che un trattamento con la chirurgia non sarebbe stato risolutivo. I migliorati risultati della chirurgia del fegato hanno però portato a riconsiderare l’esecuzione dell’intervento chirurgico per queste pazienti ed oggi l’esecuzione di una resezione epatica per le metastasi epatiche isolate dovrebbe essere considerato nelle possibilità di terapia. Alcune valutazioni di costo efficacia e recenti valutazioni retrospettive multicentriche hanno mostrato risultati migliori per quelle pazienti che eseguivano una resezione epatica piuttosto rispetto a quelle che eseguivano la chemioterapia, a parità di gravità della malattia. Per questo motivo la valutazione nel trattamento delle pazienti con metastasi isolate da tumore della mammella dovrebbe essere eseguito in gruppi multidisciplinari all’interno dei quali dovrebbero esserci chirurghi del fegato.
I pazienti portatori di metastasi epatiche dovrebbero sempre acquisire un parere da un chirurgo esperto nell’esecuzione di interventi di resezioni del fegato per valutare la possibilità di eseguire un intervento chirurgico di asportazione.
Il trapianto di fegato per metastasi
Storicamente le metastasi epatiche sono state una controindicazione assoluta all’indicazione per il trapianto di fegato. Il motivo risiede nel fatto che il trapianto è stato ideato per curare malattie del fegato non trattabili in nessuna altra maniera se non sostituendo l’organo ammalato. Le metastasi sono invece una diffusione “secondaria” al fegato di un tumore nato in un altro organo. Vi è ancora oggi l’idea che il trapianto di fegato non sarebbe in grado di curare in maniera efficace le metastasi.
Nel 2013 un gruppo di chirurghi svedesi ha pubblicato un primo lavoro scientifico dove si riportavano risultati favorevoli ottenuti in pazienti trapiantati di fegato per metastasi epatiche da tumori del colon e del retto non resecabili in maniera convenzionale.
Sette anni dopo, nel 2020, lo stesso gruppo ha pubblicato un secondo lavoro scientifico che riportava risultati ulteriormente migliorati, grazie alla selezione degli ammalati, con il trapianto di fegato per metastasi epatiche.
Alcune considerazioni sono alla base di questi lavori:
- l’introduzione di farmaci antivirali ad azione diretta ha portato e porterà ad una consistente riduzione dei trapianti richiesti per curare le complicanze dell’epatite virale C;
- vi sarà quindi un certo numero di organi donati che sarà disponibile per essere impiegato in indicazioni diverse da quelle tradizionali;
- la chemioterapia per i tumori del colon e del retto è diventata negli anni più efficace nel controllo della malattia;
- la chirurgia oncologica è diventata più sicura e permette di operare più volte lo stesso paziente per rimuovere depositi tumorali che dovessero presentarsi in vari organi.
Questi dati e queste considerazioni hanno portato allo sviluppo di studi clinici prospettici per valutare la reale efficacia del trapianto di fegato nel trattamento di questi pazienti basandosi su popolazioni più numerose ed eseguiti da più centri.
Una prima linea guida sul trapianto di fegato per metastasi colo-rettali non resecabili è stato pubblicato sulla rivista Lancet Gastroenterol Hepatol. il 7 settembre 2021.
Chi cura le metastasi epatiche?
Un tumore al fegato è sempre grave?
Punteggio di Fong
- Ultimo aggiornamento della pagina: 10/12/2023
Linee Guida per la Diagnosi ed il Trattamento delle Metastasi Epatiche
2023
Siriwardena A K; Serrablo A; Fretland Å A; Wigmore S J; Ramia-Angel J M; Malik H Z; Stättner S; Søreide K; Zmora O; Meijerink M; Kartalis N; Lesurtel M; Verhoef C; Balakrishnan A; Gruenberger T; Jonas E; Devar J; Jamdar S; Jones R; Hilal M A; Andersson B; Boudjema K; Mullamitha S; Stassen L; Dasari B V M; Frampton A E; Aldrighetti L; Pellino G; Buchwald P; Gürses B; Wasserberg N; Gruenberger B; Spiers H V M; Jarnagin W; Vauthey J; Kokudo N; Tejpar S; Valdivieso A; Adam R; Lang H; Smith M; deOliveira M L; Adair A; Gilg S; Swijnenburg R; Jaekers J; Jegatheeswaran S; Buis C; Parks R; Bockhorn M; Conroy T; Petras P; Primavesi F; Chan A K C; Cipriani F; Rubbia-Brandt L; Foster L; Abdelaal A; Yaqub S; Rahbari N; Fondevila C; Abradelo M; Kok N FM; Tejedor L; Martinez-Baena D; Azoulay D; Maglione M; Serradilla-Martín M; Azevedo J; Romano F; Line P; Forcén T A; Panis Y; Stylianides N; Bale R; Quaia E; Yassin N; Duque V; Espin-Basany E; Mellenhorst J; Rees A; Adeyeye A; Tuynman J B; Simillis C; Duff S; Wilson R; Nardi P D; Palmer G J; Zakaria A D; Perra T; Porcu A; Tamini N; Kelly M E; Metwally I; Morarasu S; Carbone F; Estaire-Gómez M; Perez E M; Seligmann J; Gollins S; Braun M; Hessheimer A; Alonso V; Radhakrishna G; Alam N; Camposorias C; Barriuoso J; Ross P; Ba-Ssalamah A; Muthu S; Filobbos R; Nadarajah V; Hattab A; Newton C; Barker S; Sibbald J; Hancock J; Carino N L; Deshpande R; Lancellotti F; Paterna S; Gutierrez-Diez M; Artigas C
In: HPB, vol. 25, no 9, pp. 985 – 999, 2023, ISSN: 1365182X, (Cited by: 0; All Open Access, Hybrid Gold Open Access).
@article{Siriwardena2023985,
title = {The multi-societal European consensus on the terminology, diagnosis and management of patients with synchronous colorectal cancer and liver metastases: an E-AHPBA consensus in partnership with ESSO, ESCP, ESGAR, and CIRSE},
author = {Ajith K. Siriwardena and Alejandro Serrablo and Åsmund A. Fretland and Stephen J. Wigmore and Jose M. Ramia-Angel and Hassan Z. Malik and Stefan Stättner and Kjetil Søreide and Oded Zmora and Martijn Meijerink and Nikolaos Kartalis and Mickaël Lesurtel and Cornelis Verhoef and Anita Balakrishnan and Thomas Gruenberger and Eduard Jonas and John Devar and Saurabh Jamdar and Robert Jones and Mohammad A. Hilal and Bodil Andersson and Karim Boudjema and Saifee Mullamitha and Laurents Stassen and Bobby V. M. Dasari and Adam E. Frampton and Luca Aldrighetti and Gianluca Pellino and Pamela Buchwald and Bengi Gürses and Nir Wasserberg and Birgit Gruenberger and Harry V. M. Spiers and William Jarnagin and Jean-Nicholas Vauthey and Norihiro Kokudo and Sabine Tejpar and Andres Valdivieso and René Adam and Hauke Lang and Martin Smith and Michelle L. deOliveira and Anya Adair and Stefan Gilg and Rutger-Jan Swijnenburg and Joris Jaekers and Santhalingam Jegatheeswaran and Carlijn Buis and Rowan Parks and Maximilian Bockhorn and Thierry Conroy and Panagiotis Petras and Florian Primavesi and Anthony K. C. Chan and Federica Cipriani and Laura Rubbia-Brandt and Lucy Foster and Amr Abdelaal and Sheraz Yaqub and Nuh Rahbari and Constantino Fondevila and Manuel Abradelo and Niels FM. Kok and Luis Tejedor and Dario Martinez-Baena and Daniel Azoulay and Manuel Maglione and Mario Serradilla-Martín and José Azevedo and Fabrizio Romano and Pål-Dag Line and Teresa Abadía Forcén and Yves Panis and Nicolas Stylianides and Reto Bale and Emilio Quaia and Nuha Yassin and Victoria Duque and Eloy Espin-Basany and Jarno Mellenhorst and Adam Rees and Ademola Adeyeye and Jurriaan B. Tuynman and Constantinos Simillis and Sarah Duff and Richard Wilson and Paola De Nardi and Gabriella Jansson Palmer and Andee Dzulkarnaen Zakaria and Teresa Perra and Alberto Porcu and Nicolò Tamini and Michael E. Kelly and Islam Metwally and Stefan Morarasu and Fabio Carbone and Mercedes Estaire-Gómez and Elena Martin Perez and Jennifer Seligmann and Simon Gollins and Michael Braun and Amelia Hessheimer and Vincente Alonso and Ganesh Radhakrishna and Noreen Alam and Constantinos Camposorias and Jorge Barriuoso and Paul Ross and Ahmed Ba-Ssalamah and Sivakumar Muthu and Rafik Filobbos and Vinotha Nadarajah and Annas Hattab and Claire Newton and Sharon Barker and Jill Sibbald and Jodie Hancock and Nicola Liguori Carino and Rahul Deshpande and Francesco Lancellotti and Sandra Paterna and Marta Gutierrez-Diez and Consuelo Artigas},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85166950821&doi=10.1016%2fj.hpb.2023.05.360&partnerID=40&md5=2080c720eb9ef9b4d460c8172e6b7cd0},
doi = {10.1016/j.hpb.2023.05.360},
issn = {1365182X},
year = {2023},
date = {2023-01-01},
urldate = {2023-01-01},
journal = {HPB},
volume = {25},
number = {9},
pages = {985 – 999},
publisher = {Elsevier B.V.},
abstract = {Background: Contemporary management of patients with synchronous colorectal cancer and liver metastases is complex. The aim of this project was to provide a practical framework for care of patients with synchronous colorectal cancer and liver metastases with a focus on terminology, diagnosis and management. Methods: This project was a multi-organisational, multidisciplinary consensus. The consensus group produced statements which focused on terminology, diagnosis and management. Statements were refined during an online Delphi process and those with 70% agreement or above were reviewed at a final meeting. Iterations of the report were shared by electronic mail to arrive at a final agreed document comprising twelve key statements. Results: Synchronous liver metastases are those detected at the time of presentation of the primary tumour. The term “early metachronous metastases” applies to those absent at presentation but detected within 12 months of diagnosis of the primary tumour with “late metachronous metastases” applied to those detected after 12 months. Disappearing metastases applies to lesions which are no longer detectable on MR scan after systemic chemotherapy. Guidance was provided on the recommended composition of tumour boards and clinical assessment in emergency and elective settings. The consensus focused on treatment pathways including systemic chemotherapy, synchronous surgery and the staged approach with either colorectal or liver-directed surgery as first step. Management of pulmonary metastases and the role of minimally invasive surgery was discussed. Conclusions: The recommendations of this contemporary consensus provide information of practical value to clinicians managing patients with synchronous colorectal cancer and liver metastases. © 2023 The Author(s)},
note = {Cited by: 0; All Open Access, Hybrid Gold Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2022
Morris V K; Kennedy E B; Baxter N N; Benson A B; Cercek A; Cho M; Ciombor K K; Cremolini C; Davis A; Deming D A; Fakih M G; Gholami S; Hong T S; Jaiyesimi I; Klute K; Lieu C; Sanoff H; Strickler J H; White S; Willis J A; Eng C
Treatment of Metastatic Colorectal Cancer: ASCO Guideline Journal Article
In: Journal of Clinical Oncology, vol. 0, no 0, pp. JCO.22.01690, 2022.
@article{nokey,
title = {Treatment of Metastatic Colorectal Cancer: ASCO Guideline},
author = {Morris, Van K. and Kennedy, Erin B. and Baxter, Nancy N. and Benson, Al B. and Cercek, Andrea and Cho, May and Ciombor, Kristen K. and Cremolini, Chiara and Davis, Anjee and Deming, Dustin A. and Fakih, Marwan G. and Gholami, Sepideh and Hong, Theodore S. and Jaiyesimi, Ishmael and Klute, Kelsey and Lieu, Christopher and Sanoff, Hanna and Strickler, John H. and White, Sarah and Willis, Jason A. and Eng, Cathy},
doi = {https://doi.org/10.1200/JCO.22.01690},
year = {2022},
date = {2022-10-17},
journal = {Journal of Clinical Oncology},
volume = {0},
number = {0},
pages = {JCO.22.01690},
abstract = {PURPOSETo develop recommendations for treatment of patients with metastatic colorectal cancer (mCRC).METHODSASCO convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice.RESULTSFive systematic reviews and 10 randomized controlled trials met the systematic review inclusion criteria.RECOMMENDATIONSDoublet chemotherapy should be offered, or triplet therapy may be offered to patients with previously untreated, initially unresectable mCRC, on the basis of included studies of chemotherapy in combination with anti–vascular endothelial growth factor antibodies. In the first-line setting, pembrolizumab is recommended for patients with mCRC and microsatellite instability-high or deficient mismatch repair tumors; chemotherapy and anti–epidermal growth factor receptor therapy is recommended for microsatellite stable or proficient mismatch repair left-sided treatment-naive RAS wild-type mCRC; chemotherapy and anti–vascular endothelial growth factor therapy is recommended for microsatellite stable or proficient mismatch repair RAS wild-type right-sided mCRC. Encorafenib plus cetuximab is recommended for patients with previously treated BRAF V600E–mutant mCRC that has progressed after at least one previous line of therapy. Cytoreductive surgery plus systemic chemotherapy may be recommended for selected patients with colorectal peritoneal metastases; however, the addition of hyperthermic intraperitoneal chemotherapy is not recommended. Stereotactic body radiation therapy may be recommended following systemic therapy for patients with oligometastases of the liver who are not considered candidates for resection. Selective internal radiation therapy is not routinely recommended for patients with unilobar or bilobar metastases of the liver. Perioperative chemotherapy or surgery alone should be offered to patients with mCRC who are candidates for potentially curative resection of liver metastases. Multidisciplinary team management and shared decision making are recommended. Qualifying statements with further details related to implementation of guideline recommendations are also included.Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2021
Bonney G K; Chew C A; Lodge P; Hubbard J; Halazun K J; Trunecka P; Muiesan P; Mirza D F; Isaac J; Laing R W; Iyer S G; Chee C E; Yong W P; Muthiah M D; Panaro F; Sanabria J; Grothey A; Moodley K; Chau I; Chan A C Y; Wang C C; Menon K; Sapisochin G; Hagness M; Dueland S; Line P; Adam R
In: The Lancet Gastroenterology and Hepatology, vol. 6, no 11, pp. 933 – 946, 2021, ISSN: 24681253, (Cited by: 12).
@article{Bonney2021933,
title = {Liver transplantation for non-resectable colorectal liver metastases: the International Hepato-Pancreato-Biliary Association consensus guidelines},
author = {Glenn K Bonney and Claire Alexandra Chew and Peter Lodge and Joleen Hubbard and Karim J Halazun and Pavel Trunecka and Paolo Muiesan and Darius F Mirza and John Isaac and Richard W Laing and Shridhar Ganpathi Iyer and Cheng Ean Chee and Wei Peng Yong and Mark Dhinesh Muthiah and Fabrizio Panaro and Juan Sanabria and Axel Grothey and Keymanthri Moodley and Ian Chau and Albert C Y Chan and Chih Chi Wang and Krishna Menon and Gonzalo Sapisochin and Morten Hagness and Svein Dueland and Pål-Dag Line and René Adam},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85118286479&doi=10.1016%2fS2468-1253%2821%2900219-3&partnerID=40&md5=9b219dcb9dacf8eff95470bcd6427b88},
doi = {10.1016/S2468-1253(21)00219-3},
issn = {24681253},
year = {2021},
date = {2021-01-01},
urldate = {2021-01-01},
journal = {The Lancet Gastroenterology and Hepatology},
volume = {6},
number = {11},
pages = {933 – 946},
publisher = {Elsevier Ltd},
abstract = {Colorectal cancer is a prevalent disease worldwide, with more than 50% of patients developing metastases to the liver. Despite advances in improving resectability, most patients present with non-resectable colorectal liver metastases requiring palliative systemic therapy and locoregional disease control strategies. There is a growing interest in the use of liver transplantation to treat non-resectable colorectal liver metastases in well selected patients, leading to a surge in the number of studies and prospective trials worldwide, thereby fuelling the emerging field of transplant oncology. The interdisciplinary nature of this field requires domain-specific evidence and expertise to be drawn from multiple clinical specialities and the basic sciences. Importantly, the wider societal implication of liver transplantation for non-resectable colorectal liver metastases, such as the effect on the allocation of resources and national transplant waitlists, should be considered. To address the urgent need for a consensus approach, the International Hepato-Pancreato-Biliary Association commissioned the Liver Transplantation for Colorectal liver Metastases 2021 working group, consisting of international leaders in the areas of hepatobiliary surgery, colorectal oncology, liver transplantation, hepatology, and bioethics. The aim of this study was to standardise nomenclature and define management principles in five key domains: patient selection, evaluation of biological behaviour, graft selection, recipient considerations, and outcomes. An extensive literature review was done within the five domains identified. Between November, 2020, and January, 2021, a three-step modified Delphi consensus process was undertaken by the workgroup, who were further subgrouped into the Scientific Committee, Expert Panel, and Transplant Centre Representatives. A final consensus of 44 statements, standardised nomenclature, and a practical management algorithm is presented. Specific criteria for clinico-patho-radiological assessments with molecular profiling is crucial in this setting. After this, the careful evaluation of biological behaviour with bridging therapy to transplantation with an appropriate assessment of the response is required. The sequencing of treatment in synchronous metastatic disease requires special consideration and is highlighted here. Some ethical dilemmas within organ allocation for malignant indications are discussed and the role for extended criteria grafts, living donor transplantation, and machine perfusion technologies for non-resectable colorectal liver metastases are reviewed. Appropriate immunosuppressive regimens and strategies for the follow-up and treatment of recurrent disease are proposed. This consensus guideline provides a framework by which liver transplantation for non-resectable colorectal liver metastases might be safely instituted and is a meaningful step towards future evidenced-based practice for better patient selection and organ allocation to improve the survival for patients with this disease. © 2021 Elsevier Ltd},
note = {Cited by: 12},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Rocca A; Cipriani F; Belli G; Berti S; Boggi U; Bottino V; Cillo U; Cescon M; Cimino M; Corcione F; Carlis L D; Degiuli M; Paolis P D; Rose A M D; D’Ugo D; Benedetto F D; Elmore U; Ercolani G; Ettorre G M; Ferrero A; Filauro M; Giuliante F; Gruttadauria S; Guglielmi A; Izzo F; Jovine E; Laurenzi A; Marchegiani F; Marini P; Massani M; Mazzaferro V; Mineccia M; Minni F; Muratore A; Nicosia S; Pellicci R; Rosati R; Russolillo N; Spinelli A; Spolverato G; Torzilli G; Vennarecci G; Viganò L; Vincenti L; Delrio P; Calise F; Aldrighetti L
In: Updates in Surgery, vol. 73, no 4, pp. 1247 – 1265, 2021, ISSN: 2038131X, (Cited by: 8).
@article{Rocca20211247,
title = {The Italian Consensus on minimally invasive simultaneous resections for synchronous liver metastasis and primary colorectal cancer: A Delphi methodology},
author = {Aldo Rocca and Federica Cipriani and Giulio Belli and Stefano Berti and Ugo Boggi and Vincenzo Bottino and Umberto Cillo and Matteo Cescon and Matteo Cimino and Francesco Corcione and Luciano De Carlis and Maurizio Degiuli and Paolo De Paolis and Agostino Maria De Rose and Domenico D’Ugo and Fabrizio Di Benedetto and Ugo Elmore and Giorgio Ercolani and Giuseppe M. Ettorre and Alessandro Ferrero and Marco Filauro and Felice Giuliante and Salvatore Gruttadauria and Alfredo Guglielmi and Francesco Izzo and Elio Jovine and Andrea Laurenzi and Francesco Marchegiani and Pierluigi Marini and Marco Massani and Vincenzo Mazzaferro and Michela Mineccia and Francesco Minni and Andrea Muratore and Simone Nicosia and Riccardo Pellicci and Riccardo Rosati and Nadia Russolillo and Antonino Spinelli and Gaya Spolverato and Guido Torzilli and Giovanni Vennarecci and Luca Viganò and Leonardo Vincenti and Paolo Delrio and Fulvio Calise and Luca Aldrighetti},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85107490475&doi=10.1007%2fs13304-021-01100-9&partnerID=40&md5=ceddca9589f92a6e3c8b2ac09a1e442a},
doi = {10.1007/s13304-021-01100-9},
issn = {2038131X},
year = {2021},
date = {2021-01-01},
urldate = {2021-01-01},
journal = {Updates in Surgery},
volume = {73},
number = {4},
pages = {1247 – 1265},
publisher = {Springer Science and Business Media Deutschland GmbH},
abstract = {At the time of diagnosis synchronous colorectal cancer, liver metastases (SCRLM) account for 15–25% of patients. If primary tumour and synchronous liver metastases are resectable, good results may be achieved performing surgical treatment incorporated into the chemotherapy regimen. So far, the possibility of simultaneous minimally invasive (MI) surgery for SCRLM has not been extensively investigated. The Italian surgical community has captured the need and undertaken the effort to establish a National Consensus on this topic. Four main areas of interest have been analysed: patients’ selection, procedures, techniques, and implementations. To establish consensus, an adapted Delphi method was used through as many reiterative rounds were needed. Systematic literature reviews were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses instructions. The Consensus took place between February 2019 and July 2020. Twenty-six Italian centres participated. Eighteen clinically relevant items were identified. After a total of three Delphi rounds, 30-tree recommendations reached expert consensus establishing the herein presented guidelines. The Italian Consensus on MI surgery for SCRLM indicates possible pathways to optimise the treatment for these patients as consensus papers express a trend that is likely to become shortly a standard procedure for clinical pictures still on debate. As matter of fact, no RCT or relevant case series on simultaneous treatment of SCRLM are available in the literature to suggest guidelines. It remains to be investigated whether the MI technique for the simultaneous treatment of SCRLM maintain the already documented benefit of the two separate surgeries. © 2021, Italian Society of Surgery (SIC).},
note = {Cited by: 8},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2020
Karanicolas P; Beecroft R; Cosby R; David E; Kalyvas M; Kennedy E; Sapisochin G; Wong R; K. Zbuk ; the Gastrointestinal Disease Site Group
Regional Therapies for Colorectal Cancer Liver Metastases Bachelor Thesis
2020, (Open Access).
@bachelorthesis{nokey,
title = {Regional Therapies for Colorectal Cancer Liver Metastases},
author = {P. Karanicolas and R. Beecroft and R. Cosby and E. David and M. Kalyvas and E. Kennedy and G. Sapisochin and R. Wong and K. Zbuk, and the Gastrointestinal Disease Site Group},
editor = {Cancer Center Ontario},
url = {https://www.cancercareontario.ca/en/file/53596/download?token=GBIv4RA5},
year = {2020},
date = {2020-03-10},
abstract = {To make recommendations regarding regional therapies for adults with resectable or
unresectable liver metastases from colorectal cancer (CRC) with an emphasis on overall
survival, progression-free survival, time to progression, time to hepatic progression, overall
response rate, and toxicity.
},
note = {Open Access},
keywords = {},
pubstate = {published},
tppubtype = {bachelorthesis}
}
unresectable liver metastases from colorectal cancer (CRC) with an emphasis on overall
survival, progression-free survival, time to progression, time to hepatic progression, overall
response rate, and toxicity.
Vera R; González-Flores E; Rubio C; Urbano J; Camps M V; Ciampi-Dopazo J J; Rincón J O; Macías V M; Braco M A G; Suarez-Artacho G
Multidisciplinary management of liver metastases in patients with colorectal cancer: a consensus of SEOM, AEC, SEOR, SERVEI, and SEMNIM Journal Article
In: Clinical and Translational Oncology, vol. 22, no 5, pp. 647 – 662, 2020, ISSN: 1699048X, (Cited by: 27; All Open Access, Hybrid Gold Open Access).
@article{Vera2020647,
title = {Multidisciplinary management of liver metastases in patients with colorectal cancer: a consensus of SEOM, AEC, SEOR, SERVEI, and SEMNIM},
author = {R. Vera and E. González-Flores and C. Rubio and J. Urbano and M. Valero Camps and J. J. Ciampi-Dopazo and J. Orcajo Rincón and V. Morillo Macías and M. A. Gomez Braco and G. Suarez-Artacho},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85069971361&doi=10.1007%2fs12094-019-02182-z&partnerID=40&md5=2b2cb8d537344d766bd9773b8da6acc7},
doi = {10.1007/s12094-019-02182-z},
issn = {1699048X},
year = {2020},
date = {2020-01-01},
urldate = {2020-01-01},
journal = {Clinical and Translational Oncology},
volume = {22},
number = {5},
pages = {647 – 662},
publisher = {Springer},
abstract = {Colorectal cancer (CRC) has the second-highest tumor incidence and is a leading cause of death by cancer. Nearly 20% of patients with CRC will have metastases at the time of diagnosis, and more than 50% of patients with CRC develop metastatic disease during the course of their disease. A group of experts from the Spanish Society of Medical Oncology, the Spanish Association of Surgeons, the Spanish Society of Radiation Oncology, the Spanish Society of Vascular and Interventional Radiology, and the Spanish Society of Nuclear Medicine and Molecular Imaging met to discuss and provide a multidisciplinary consensus on the management of liver metastases in patients with CRC. The group defined the different scenarios in which the disease can present: fit or unfit patients with resectable liver metastases, patients with potential resectable liver metastases, and patients with unresectable liver metastases. Within each scenario, the different strategies and therapeutic approaches are discussed. © 2019, The Author(s).},
note = {Cited by: 27; All Open Access, Hybrid Gold Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2019
Phelip J M; Tougeron D; Léonard D; Benhaim L; Desolneux G; Dupré A; Michel P; Penna C; Tournigand C; Louvet C; Christou N; Chevallier P; Dohan A; Rousseaux B; Bouché O
In: Digestive and Liver Disease, vol. 51, no 10, pp. 1357 – 1363, 2019, ISSN: 15908658, (Cited by: 53; All Open Access, Green Open Access).
@article{Phelip20191357,
title = {Metastatic colorectal cancer (mCRC): French intergroup clinical practice guidelines for diagnosis, treatments and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, SFR)},
author = {Jean Marc Phelip and David Tougeron and David Léonard and Leonor Benhaim and Grégoire Desolneux and Aurélien Dupré and Pierre Michel and Christophe Penna and Christophe Tournigand and Christophe Louvet and Nikki Christou and Patrick Chevallier and Anthony Dohan and Benoist Rousseaux and Olivier Bouché},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85068756683&doi=10.1016%2fj.dld.2019.05.035&partnerID=40&md5=f2984a0ee0efb731c6b48030a9d3a7a5},
doi = {10.1016/j.dld.2019.05.035},
issn = {15908658},
year = {2019},
date = {2019-01-01},
urldate = {2019-01-01},
journal = {Digestive and Liver Disease},
volume = {51},
number = {10},
pages = {1357 – 1363},
publisher = {Elsevier B.V.},
abstract = {Introduction: This document is a summary of the French intergroup guidelines regarding the management of metastatic colorectal cancer (mCRC) published in January 2019, and available on the French Society of Gastroenterology website (SNFGE) (www.tncd.org). Methods: This collaborative work was realized by all French medical and surgical societies involved in the management of mCRC. Recommendations are graded in three categories (A, B and C), according to the level of evidence found in the literature, up until December 2018. Results: The management of metastatic colorectal cancer has become complex because of increasing available medical, radiological and surgical treatments alone or in combination. The therapeutic strategy should be defined before the first-line treatment, mostly depending on the presentation of the disease (resectability of the metastases, symptomatic and/or threatening disease), of the patient's condition (ECOG PS, comorbidities), and tumor biology (RAS, BRAF, MSI). The sequence of targeted therapies also seems to have an impact on the outcome (angiogenesis inhibition beyond progression). Surgical resection of metastases was the only curative intent treatment to date, joined recently by percutaneous tumor ablation tools (radiofrequency, microwave). Localized therapies such as hepatic intra-arterial infusion, radioembolization and hyperthermic intraperitoneal chemotherapy, also have seen their indications specified (liver-dominant disease and resectable peritoneal carcinomatosis). New treatments have been developed in heavily pretreated patients, increasing overall survival and preserving quality of life (regorafenib and trifluridine/tipiracil). Finally, immune checkpoint inhibitors have demonstrated high efficacy in MSI mCRC. Conclusion: French guidelines for mCRC management are put together to help offer the best personalized therapeutic strategy in daily clinical practice, as the mCRC therapeutic landscape is complexifying. These recommendations are permanently being reviewed and updated. Each individual case must be discussed within a multidisciplinary team (MDT). © 2019 Editrice Gastroenterologica Italiana S.r.l.},
note = {Cited by: 53; All Open Access, Green Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2018
Yoshino T; Arnold D; Taniguchi H; Pentheroudakis G; Yamazaki K; Xu R -H; Kim T W; Ismail F; Tan I B; Yeh K -H; Grothey A; Zhang S; Ahn J B; Mastura M Y; Chong D; Chen L -T; Kopetz S; Eguchi-Nakajima T; Ebi H; Ohtsu A; Cervantes A; Muro K; Tabernero J; Minami H; Ciardiello F; Douillard J -Y
In: Annals of Oncology, vol. 29, no 1, pp. 44 – 70, 2018, ISSN: 09237534, (Cited by: 294; All Open Access, Hybrid Gold Open Access).
@article{Yoshino201844,
title = {Pan-Asian adapted ESMO consensus guidelines for the management of patients with metastatic colorectal cancer: A JSMO-ESMO initiative endorsed by CSCO, KACO, MOS, SSO and TOS},
author = {T. Yoshino and D. Arnold and H. Taniguchi and G. Pentheroudakis and K. Yamazaki and R. -H. Xu and T. W. Kim and F. Ismail and I. B. Tan and K. -H. Yeh and A. Grothey and S. Zhang and J. B. Ahn and M. Y. Mastura and D. Chong and L. -T. Chen and S. Kopetz and T. Eguchi-Nakajima and H. Ebi and A. Ohtsu and A. Cervantes and K. Muro and J. Tabernero and H. Minami and F. Ciardiello and J. -Y. Douillard},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85041205697&doi=10.1093%2fannonc%2fmdx738&partnerID=40&md5=5d637c664b359cc8cd32e8ec1cba1421},
doi = {10.1093/annonc/mdx738},
issn = {09237534},
year = {2018},
date = {2018-01-01},
urldate = {2018-01-01},
journal = {Annals of Oncology},
volume = {29},
number = {1},
pages = {44 – 70},
publisher = {Oxford University Press},
abstract = {The most recent version of the European Society for Medical Oncology (ESMO) consensus guidelines for the treatment of patients with metastatic colorectal cancer (mCRC) was published in 2016, identifying both a more strategic approach to the administration of the available systemic therapy choices, and a greater emphasis on the use of ablative techniques, including surgery. At the 2016 ESMO Asia Meeting, in December 2016, it was decided by both ESMO and the Japanese Society of Medical Oncology (JSMO) to convene a special guidelines meeting, endorsed by both ESMO and JSMO, immediately after the JSMO 2017 Annual Meeting. The aim was to adapt the ESMO consensus guidelines to take into account the ethnic differences relating to the toxicity as well as other aspects of certain systemic treatments in patients of Asian ethnicity. These guidelines represent the consensus opinions reached by experts in the treatment of patients with mCRC identified by the Presidents of the oncological societies of Japan (JSMO), China (Chinese Society of Clinical Oncology), Korea (Korean Association for Clinical Oncology), Malaysia (Malaysian Oncological Society), Singapore (Singapore Society of Oncology) and Taiwan (Taiwan Oncology Society). The voting was based on scientific evidence and was independent of both the current treatment practices and the drug availability and reimbursement situations in the individual participating Asian countries. © The Author(s) 2017. Published by Oxford University Press on behalf of the European Society for Medical Oncology.},
note = {Cited by: 294; All Open Access, Hybrid Gold Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2017
Salvatore L; Aprile G; Arnoldi E; Aschele C; Carnaghi C; Cosimelli M; Maiello E; Normanno N; Sciallero S; Valvo F; Beretta G D
Management of metastatic colorectal cancer patients: Guidelines of the Italian Medical Oncology Association (AIOM) Journal Article
In: ESMO Open, vol. 2, no 1, 2017, ISSN: 20597029, (Cited by: 27; All Open Access, Gold Open Access, Green Open Access).
@article{Salvatore2017,
title = {Management of metastatic colorectal cancer patients: Guidelines of the Italian Medical Oncology Association (AIOM)},
author = {Lisa Salvatore and Giuseppe Aprile and Ermenegildo Arnoldi and Carlo Aschele and Carlo Carnaghi and Maurizio Cosimelli and Evaristo Maiello and Nicola Normanno and Stefania Sciallero and Francesca Valvo and Giordano D. Beretta},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85052655141&doi=10.1136%2fesmoopen-2016-000147&partnerID=40&md5=d7fdc516d361e2364508029bcdcc1e89},
doi = {10.1136/esmoopen-2016-000147},
issn = {20597029},
year = {2017},
date = {2017-01-01},
urldate = {2017-01-01},
journal = {ESMO Open},
volume = {2},
number = {1},
publisher = {BMJ Publishing Group},
abstract = {In the past 15 years, the outcome for patients with metastatic colorectal cancer has substantially improved owing to the availability of new cytotoxic and biological agents along with many significant advances in molecular selection, the use of personalised therapy and locoregional treatment, a more widespread sharing of specific professional experiences (multidisciplinary teams with oncologists, surgeons, radiotherapists, radiologists, biologists and pathologists), and the adoption of patient-centred healthcare strategies. The Italian Medical Oncology Association (AIOM) has developed evidence-based recommendations to help oncologists and all professionals involved in the management of patients with metastatic colorectal cancer in their daily clinical practice. © 2018 Published by the BMJ Publishing Group Limited.},
note = {Cited by: 27; All Open Access, Gold Open Access, Green Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2016
Cutsem E V; Cervantes A; Adam R; Sobrero A; Krieken J H V; Aderka D; Aguilar E A; Bardelli A; Benson A; Bodoky G; Ciardiello F; D'Hoore A; Diaz-Rubio E; Douillard J -Y; Ducreux M; Falcone A; Grothey A; Gruenberger T; Haustermans K; Heinemann V; Hoff P; Köhne C -H; Labianca R; Laurent-Puig P; Ma B; Maughan T; Muro K; Normanno N; österlund P; Oyen W J G; Papamichael D; Pentheroudakis G; Pfeiffer P; Price T J; Punt C; Ricke J; Roth A; Salazar R; Scheithauer W; Schmoll H J; Tabernero J; Taïeb J; Tejpar S; Wasan H; Yoshino T; Zaanan A; Arnold D
ESMO consensus guidelines for the management of patients with metastatic colorectal cancer Journal Article
In: Annals of Oncology, vol. 27, no 8, pp. 1386 – 1422, 2016, ISSN: 09237534, (Cited by: 1877; All Open Access, Bronze Open Access, Green Open Access).
@article{VanCutsem20161386,
title = {ESMO consensus guidelines for the management of patients with metastatic colorectal cancer},
author = {Eric Van Cutsem and A. Cervantes and R. Adam and A. Sobrero and J. H. Van Krieken and D. Aderka and E. Aranda Aguilar and A. Bardelli and A. Benson and G. Bodoky and F. Ciardiello and A. D'Hoore and E. Diaz-Rubio and J. -Y. Douillard and M. Ducreux and A. Falcone and A. Grothey and T. Gruenberger and K. Haustermans and V. Heinemann and P. Hoff and C. -H. Köhne and R. Labianca and P. Laurent-Puig and B. Ma and T. Maughan and K. Muro and N. Normanno and P. österlund and W. J. G. Oyen and D. Papamichael and G. Pentheroudakis and P. Pfeiffer and T. J. Price and C. Punt and J. Ricke and A. Roth and R. Salazar and W. Scheithauer and H. J. Schmoll and J. Tabernero and J. Taïeb and S. Tejpar and H. Wasan and T. Yoshino and A. Zaanan and D. Arnold},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84984985398&doi=10.1093%2fannonc%2fmdw235&partnerID=40&md5=37dbf8c716b4e1b60f3926e653342b08},
doi = {10.1093/annonc/mdw235},
issn = {09237534},
year = {2016},
date = {2016-01-01},
urldate = {2016-01-01},
journal = {Annals of Oncology},
volume = {27},
number = {8},
pages = {1386 – 1422},
publisher = {Oxford University Press},
abstract = {Colorectal cancer (CRC) is one of the most common malignancies in Western countries. Over the last 20 years, and the last decade in particular, the clinical outcome for patients with metastatic CRC (mCRC) has improved greatly due not only to an increase in the number of patients being referred for and undergoing surgical resection of their localised metastatic disease but also to a more strategic approach to the delivery of systemic therapy and an expansion in the use of ablative techniques. This reflects the increase in the number of patients that are being managed within a multidisciplinary team environment and specialist cancer centres, and the emergence over the same time period not only of improved imaging techniques but also prognostic and predictive molecular markers. Treatment decisions for patients with mCRC must be evidence-based. Thus, these ESMO consensus guidelines have been developed based on the current available evidence to provide a series of evidence-based recommendations to assist in the treatment and management of patients with mCRC in this rapidly evolving treatment setting. © The Author 2016. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.},
note = {Cited by: 1877; All Open Access, Bronze Open Access, Green Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2014
Cutsem E V; Cervantes A; Nordlinger B; Arnold D; Group T E G W
Metastatic colorectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up Journal Article
In: Annals of Oncology, vol. 25, pp. iii1 – iii9, 2014, ISSN: 09237534, (Cited by: 775; All Open Access, Bronze Open Access).
@article{VanCutsem2014iii1,
title = {Metastatic colorectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up},
author = {E. Van Cutsem and A. Cervantes and B. Nordlinger and D. Arnold and The ESMO Guidelines Working Group},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84911474269&doi=10.1093%2fannonc%2fmdu260&partnerID=40&md5=9a37923d94a2592fc2da230aac06e7de},
doi = {10.1093/annonc/mdu260},
issn = {09237534},
year = {2014},
date = {2014-01-01},
urldate = {2014-01-01},
journal = {Annals of Oncology},
volume = {25},
pages = {iii1 – iii9},
publisher = {Oxford University Press},
note = {Cited by: 775; All Open Access, Bronze Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2013
Adams R B; Aloia T A; Loyer E; Pawlik T M; Taouli B; Vauthey J
Selection for hepatic resection of colorectal liver metastases: Expert consensus statement Journal Article
In: HPB, vol. 15, no 2, pp. 91 – 103, 2013, ISSN: 1365182X, (Cited by: 218; All Open Access, Bronze Open Access, Green Open Access).
@article{Adams201391,
title = {Selection for hepatic resection of colorectal liver metastases: Expert consensus statement},
author = {Reid B. Adams and Thomas A. Aloia and Evelyne Loyer and Timothy M. Pawlik and Bachir Taouli and Jean-Nicolas Vauthey},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84872185425&doi=10.1111%2fj.1477-2574.2012.00557.x&partnerID=40&md5=bf4f463420a11f6b2f7bb0d549070b2a},
doi = {10.1111/j.1477-2574.2012.00557.x},
issn = {1365182X},
year = {2013},
date = {2013-01-01},
urldate = {2013-01-01},
journal = {HPB},
volume = {15},
number = {2},
pages = {91 – 103},
publisher = {Blackwell Publishing Ltd},
abstract = {Hepatic resection offers a chance of a cure in selected patients with colorectal liver metastases (CLM). To achieve adequate patient selection and curative surgery, (i) precise assessment of the extent of disease, (ii) sensitive criteria for chemotherapy effect, (iii) adequate decision making in surgical indication and (iv) an optimal surgical approach for pre-treated tumours are required. For assessment of the extent of the disease, contrast-enhanced computed tomography (CT) and/or magnetic resonance imaging (MRI) with gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) is recommended depending on the local expertise and availability. Positron emission tomography (PET) and PET/CT may offer additive information in detecting extrahepatic disease. The RECIST criteria are a reasonable method to evaluate the effect of chemotherapy. However, they are imperfect in predicting a pathological response in the era of modern systemic therapy with biological agents. The assessment of radiographical morphological changes is a better surrogate of the pathological response and survival especially in the patients treated with bevacizumab. Resectability of CLM is dependent on both anatomic and oncological factors. To decrease the surgical risk, a sufficient volume of liver remnant with adequate blood perfusion and biliary drainage is required according to the degree of histopathological injury of the underlying liver. Portal vein embolization is sometimes required to decrease the surgical risk in a patient with small future liver remnant volume. As a complete radiological response does not signify a complete pathological response, liver resection should include all the site of a tumour detected prior to systemic treatment. © 2012 International Hepato-Pancreato-Biliary Association.},
note = {Cited by: 218; All Open Access, Bronze Open Access, Green Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2012
Gallinger S; Biagi J J; Fletcher G G; Nhan C; Ruo L; McLeod R S; the Expert Panel
Liver Resection for Colorectal Metastases Working paper
Cancer Care Ontario, 2012.
@workingpaper{nokey,
title = {Liver Resection for Colorectal Metastases},
author = {Steven Gallinger and James J. Biagi and Glenn G. Fletcher and Cindy Nhan and Leyo Ruo and Robin S. McLeod and the Expert Panel},
url = {https://www.cancercareontario.ca/en/file/53281/download?token=IYqP9pPl},
year = {2012},
date = {2012-06-15},
howpublished = {Cancer Care Ontario},
keywords = {},
pubstate = {published},
tppubtype = {workingpaper}
}
2006
Garden O J; Rees M; Poston G J; Mirza D; Saunders M; Ledermann J; Primrose J N; Parks R W
Guidelines for resection of colorectal cancer liver metastases Journal Article
In: Gut, vol. 55, no SUPPL. 3, pp. iii1–iii8, 2006, ISSN: 00175749, (Cited by: 287; All Open Access, Green Open Access).
@article{Garden2006iii1,
title = {Guidelines for resection of colorectal cancer liver metastases},
author = {O. J. Garden and M. Rees and G. J. Poston and D. Mirza and M. Saunders and J. Ledermann and J. N. Primrose and R. W. Parks},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-33746157857&doi=10.1136%2fgut.2006.098053&partnerID=40&md5=ab79f205adc08279253a3890b179eeb2},
doi = {10.1136/gut.2006.098053},
issn = {00175749},
year = {2006},
date = {2006-01-01},
urldate = {2006-01-01},
journal = {Gut},
volume = {55},
number = {SUPPL. 3},
pages = {iii1–iii8},
note = {Cited by: 287; All Open Access, Green Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
