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Chi cura le Metastasi al Fegato?
Come trattare le metastasi epatiche
Tutte le metastasi al fegato sono curabili?
Risposta: No.
La possibilità di poter curare le metastasi epatiche dipende da molti fattori:
- dalle condizioni generali dell’ammalato/a e dalla presenza di altre malattie concomitanti (diabete, ipertensione, …..)
- dalla possibilità di poter curare in maniera efficace la sede primitiva del tumore
- dal tipo di tumore da cui le metastasi sono nate;
- dal numero, dalla dimensione e dalla disposizione dei noduli di tumore che sono presenti nel fegato;
- dalla presenza di altri depositi di tumore al di fuori del fegato
I pazienti che presentano una o più di queste caratteristiche sono certamente a rischio di non poter eseguire un intervento chirurgico per rimuovere le metastasi epatiche dal fegato. Quando non si possono applicare terapie ad intento curativo per uno o più di questi motivi, i pazienti possono comunque ricevere trattamenti palliativi.
Questi trattamenti sono in grado di garantire all’ammalato un aumento della sopravvivenza ed una migliore qualità di vita.
Quali sono i trattamenti curativi per le metastasi al fegato?
Risposta: Dipende dal tipo di tumore primitivo e dalle caratteristiche delle metastasi epatiche
Le metastasi che insorgono più frequentemente al fegato sono quelle che provengono dai tumori del colon e del retto.
Per questo tipo di metastasi l’unico trattamento curativo ad oggi è la chirurgia (riferimento bibliografica): l’esecuzione cioè di interventi di resezione epatica che asportino dal fegato i noduli tumorali metastatici. La possibilità che l’intervento chirurgico porti alla guarigione della malattia è di circa il 20% e varia in base alle caratteristiche delle metastasi stesse, essendo più basso per alcuni tipi e più alto per altri tipi.
La possibilità che la chemioterapia da sola faccia scomparire completamente ed in maniera duratura le metastasi epatiche da tumore del colon e del retto è molto bassa. Uno dei pochi lavori della letteratura scientifica che riporta questo dato indica che questa possibilità è inferiore all’1% (riferimento bibliografico).
Risulta quindi evidente quanto sia importante che i pazienti eseguano nel corso della loro malattia una consulenza per valutare la possibilità di eseguire un intervento chirurgico.
I risultati ottenibili con la resezione epatica possono essere valutati con il punteggio di Fong, pubblicato nel settembre 1999, che valuta la sopravvivenza dei pazienti operati in base a 5 semplici variabili cliniche.
Per le pazienti che hanno metastasi epatiche isolate da tumore da mammella la situazione è più controversa, perché non vi sono studi che confermino l’utilità di eseguire questo tipo di intervento con risultati certi, anche se vi sono crescenti evidenze che anche per queste pazienti la resezione epatica sia meglio della chemioterapia (scarica l’articolo completo). Una recente valutazione di più centri Europei pubblicata nel 2018 confermerebbe che per il gruppo particolare di pazienti con metastasi isolate al fegato da tumore della mammella la resezione epatica migliorerebbe la sopravvivenza (riferimento bibliografico).
Per metastasi che provengono da altri tipi di tumore la situazione varia da caso a caso e deve essere valutata nel contesto della storia della malattia del singolo paziente.
Chi deve decidere se un paziente può eseguire un intervento chirurgico?
Risposta: il chirurgo, in particolare quello che si occupa di fare interventi sul fegato.
Non vi è oggi alcun dubbio che l’unico medico deputato ad esprimere un parere sulla possibile esecuzione di un intervento chirurgico in un paziente che ha delle metastasi epatiche, ed in particolare quelle del colon-retto e della mammella, sia il chirurgo epato-biliare.
Studi pubblicati nella letteratura scientifica hanno dimostrato che la possibilità di un paziente di essere operato diminuiscono se la situazione del paziente stesso non viene valutata da gruppi multispecialistici che includano la presenza di un chirurgo del fegato (riferimento bibliografico).
I medici specialisti in oncologia tendono a sottovalutare la possibilità di resecare le metastasi epatiche nei pazienti che hanno un cancro del colon o del retto e pertanto spesso non riescono a fare valutare per l’intervento pazienti che invece ne avrebbero l’indicazione. (tratto da The Asco Post)
Risultati di una valutazione sulla possibilità di operare metastasi epatiche da tumore del colon retto in 52 pazienti che non avevano ricevuto un parere da un chirurgo del fegato.
Ogni barra rappresenta un paziente. Il parere è stato richiesto a chirurghi del fegato. E’ rappresentato in rosso la percentuale di intervistati che hanno ritenuto che il paziente non potesse mai essere operato ed i blu quelli che ritenevano che il paziente potesse essere operato. In 33 casi (63%), la maggior parte degli intervistati riteneva invece che il paziente avesse una malattia suscettibile di intervento chirurgico.
Fonte: Jones RP, Vauthey JN, Adam R, et al. Effect of specialist decision-making on treatment strategies for colorectal liver metastases. Br J Surg. 2012;99(9):1263‐1269. doi:10.1002/bjs.8835
Cosa deve fare allora un paziente che ha delle metastasi al fegato?
Risposta: 1) deve affidarsi ad un ospedale dove siano presenti gruppi multidisciplinari di discussione che includono un chirurgo del fegato
2) deve sempre verificare che nella documentazione che riguarda la sua malattia sia presente un referto scritto di un chirurgo del fegato che abbia valutato la sua situazione.
La scelta di dove farsi trattare una malattia tumorale è sempre molto delicata.
I pazienti nei quali le metastasi epatiche vengono rilevate dopo il trattamento del tumore primario hanno frequentemente già iniziato un percorso di terapia con il gruppo di medici che lo ha seguito per questa malattia. Questo gruppo potrebbe non comprendere un chirurgo esperto nell’esecuzione di resezione epatica.
La valutazione della possibilità di eseguire un intervento chirurgico di resezione epatica è invece molto specialistica e potrebbe non essere disponibile nell’ospedale dove si viene trattati. Il paziente può sempre chiedere ai propri medici curanti una valutazione aggiuntiva per valutare le possibilità di essere trattato, anche chirurgicamente.
E' sempre necessario fare la chemioterapia prima di una resezione epatica per metastasi al fegato?
Risposta: No.
Non vi sono dati certi che indichino che sia sempre necessario eseguire una chemioterapia prima dell’intervento chirurgico di resezione epatica per rimuovere le metastasi, in particolare per quelle che derivano da tumori del colon e del retto. L’idea di intraprendere la chemioterapia prima della resezione epatica nasce dalla pubblicazione di un importante lavoro collaborativo europeo che dimostrava risultati migliori dopo la resezione epatica per i pazienti che facevano la chemioterapia prima e dopo l’intervento (referenza bibliografica). In realtà l’aggiornamento dei dati dello stesso studio pubblicati nel 2013 riportava che non vi erano differenze nei risultati fra chi aveva eseguito la chemioterapia prima e dopo l’intervento rispetto a chi aveva eseguito solo l’intervento chirurgico (referenza bibliografica).
Numerosi studi hanno comunque dimostrato che la chemioterapia può essere utile per ridurre le dimensioni delle metastasi epatiche da tumori del colon e del retto, raggiungendo due possibili scopi:
- rendere operabili pazienti che inizialmente non lo erano;
- rendere più semplici interventi chirurgici di resezione epatica quando il paziente aveva metastasi molto grandi o difficili da asportare dal punto di vista tecnico.
Per questo motivo non è mai sbagliato iniziare la chemioterapia sistemica, in particolare per le metastasi da tumori del colon e del retto. Bisogna però che la situazione del paziente venga rivalutata periodicamente, e anche più di una volta, per verificare sempre la possibilità di poter eseguire l’intervento chirurgico di resezione epatica.
Le metastasi al fegato
Il Tumore al Fegato è sempre una malattia grave?
Punteggio di Fong
- Ultimo aggiornamento della pagina: 09/06/2023
Linee Guida per la Diagnosi ed il Trattamento delle Metastasi Epatiche
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.},
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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}
}
