Isolated Liver Metastases Research Articles

Barriers for access to isolated liver metastasis treatment in colon cancer in the United States.

833 Background: Multidisciplinary treatment of stage IV colon cancer with isolated hepatic metastases implies patient’s access to quality healthcare. Here, we evaluate barriers for access to hepatic metastasectomy in the United States. Methods: The National Cancer Database was queried for stage IV colon cancer patients with isolated liver metastasis diagnosed from 2010-2014. Patient demographics, T and N staging, laterality and surgery were among the variables of interest. Pearson Chi square test was used for statistical analysis Results: A total of 3145 patients were identified for analysis. Moderately differentiated, T3 and N1 tumors were the most frequent tumors to be treated with perioperative and neoadjuvant chemotherapy. Neoadjuvant and perioperative chemotherapy correlated with age (p<0.0001) and year of diagnosis (p=0.0289). Left sided tumors were more likely to receive perioperative and neoadjuvant chemotherapy compared to right sided or transverse tumors (p<0.0001). Conclusions: With various degrees of utilization of perioperative and neoadjuvant chemotherapy based on demographic and clinical variables, there exists a great need to close the gap in access to chemotherapy and surgery for colorectal cancer isolated liver metastases. [Table: see text]

Clinical correlates and prognostic value of different metastatic sites in metastatic renal cell carcinoma.

Aim: Real life data on the clinical correlates and prognostic value of metastatic sites in metastatic renal cell carcinoma (RCC) are needed. This parameter was assessed in RCC patients registered within the surveillance, epidemiology and end results (SEER) database. Methods: Data were obtained from the National Cancer Institute-SEER database spanning 2010-2013; and it has been accessed through SEER*Stat program to determine the clinical correlates and prognosis of RCC patients with distant metastases according to the site of metastasis. Multivariate analyses were performed using Cox regression analysis to determine factors associated with improved overall and cancer-specific survival. Kaplan-Meier curves and log-rank tests were used to calculate and compare survival estimates. Results: A total of 5992patients with metastatic RCC were identified in the period from 2010 to 2013. Patients with isolated liver metastases have worse survival outcomes compared with patients with other single organ sites of metastases. Pairwise p-values for cancer-specific survival: bone metastasis versus liver metastasis: p < 0.0001; lung metastasis versus liver metastasis: p =0.002; distant lymph nodes versus liver metastasis: p =0.006. Multivariate analysis revealed that younger age at diagnosis (p <0.0001), single organ site of metastatic disease (p =0.046), male gender (p =0.001), earlier T stage (p <0.0001), node negative status (p <0.0001), clear cell histology (p =0.001), local treatment to the primary tumor (p <0.0001) and surgery to the metastatic disease (p <0.0001) were associated with better overall survival. The same factors (except age) were associated with better cancer-specific survival. Conclusion: Metastatic RCC patients with liver metastases seem to have worse outcomes compared with patients with other sites of metastases.

Stage IV colorectal cancer: An NCDB analysis of the surgical treatment of peritoneal carcinomatosis versus liver metastases.

e15067 Background: Traditionally, peritoneal carcinomatosis (PC) secondary to colorectal cancer (CRC) was perceived as a terminal disease, for which the only palliation was offered. With the emergence of new surgical approaches such as cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), surgical intervention in select patients with ‘curative’ intent was made possible. In this study, we compared the outcomes of the surgical intervention on stage IV CRC patients with isolated liver metastases (LM) to those with PC only. Methods: The National Cancer Database (NCDB) for CRC was analyzed excluding patients with PMP. Patients with isolated LM or with PC were identified, then divided into 2 treatment groups per the current treatment of each scenario: LM patients treated with surgery±chemotherapy (LM group), and PC patients treated with surgery+chemo±HIPEC (PC group). Results: 21,829 patients were identified; 18,932 fell in the LM group, and 2,897 in the PC group. Mean age in the LM and PC groups was 62.94±13.54 vs. 59.59±13.73. No significant difference was noted in the 30-day readmission rates (6.0% vs. 6.6%; p = 0.103). LM group had higher rates of 30- and 90-day mortality (4.3% vs. 0.3% and 8.6% vs. 1.8%, respectively; p &lt; 0.0001), but a slightly shorter hospitalization (7.70±8.64 vs. 7.92±7.07; p = 0.024) Median overall survival was not different between the groups (27.3 vs. 25.36 months; p = 0.214). Conclusions: Surgery with systemic and IP chemotherapy can be a viable treatment option in stage IV CRC patients with PC with comparable short-term and survival outcomes to the widely accepted liver resection in patients with isolated LM.

Cytoreductive surgery for relapsed ovarian sarcoma

Ovarian sarcomas represent a subgroup of ovarian malignancies associated with a poorer outcome when compared to ovarian adenocarcinomas in similar stages. This fact is usually related to a more aggressive biological behavior and a higher risk of recurrence even if the principles of complete cytoreduction are respected. We present the case of a 72 year old patient who was initially diagnosed with a stage IIIC ovarian cancer. At that moment a total hysterectomy, bilateral adnexectomy, pelvic and para-aortic lymph node dissection, total omentectomy, pelvic and parietal peritonectomy were performed, an R0 resection being achieved. The histopathological studies revealed the presence of an ovarian leiomyosarcoma. Postoperatively the patient was submitted to adjuvant oncologic treatment for six months. Six years later the patient was diagnosed with an isolated liver metastasis so she was re-submitted to surgery. An atypical hepatectomy was performed, the histopathological studies confirming the sarcomatous origin of the lesion which was resected with negative margins. At two year follow up the patient is free of any recurrent disease.

452. Prognostic factors related to surgical resection of isolated liver metastasis from breast cancer

Background: Isolated liver metastases (LM) from breast cancer (BC) occur in only 1–5% of cases. Resection of isolated LM improves survival. We examined the prognostic factors for time to LM development, disease free survival (DFS) and overall survival (OS) after LM resection.

Radioembolization as a Treatment Strategy for Metastatic Colorectal Cancer to the Liver: What Can We Learn from the SIRFLOX Trial?

In the setting of liver metastases from colorectal cancer (CRC), radioembolization with yttrium-90 has been used to treat chemotherapy refractory disease with a growing interest to establish its efficacy in prospective trials combined with first- and second-line chemotherapy. SIRFLOX is an ongoing, multi-center, phase 3 randomized trial comparing first-line chemotherapy alone or in combination with yttrium-90 radioembolization in patients with CRC who have isolated liver metastases or liver-dominant metastases. Preliminary results from SIRFLOX demonstrate that radioembolization combined with first-line chemotherapy is safe and feasible. There was no significant difference in median overall progression-free survival (PFS) between the combined radioembolization-chemotherapy and chemotherapy-only arms (10.7 versus 10.2months). Although the trial did not meet its primary endpoint of improved median PFS, there was a significant increase in the median hepatic PFS (20.5 versus 12.6months; p = 0.02) favoring the combination arm. Thus, combining radioembolization with chemotherapy in the first-line setting may be most effective for liver-limited metastatic CRC. Since radioembolization targets liver disease, it is plausible that the trial failed to achieve an improvement in PFS given that 40% of the SIRFLOX population had extra-hepatic disease. It is also possible that the overall median PFS may be a poor surrogate endpoint, and other endpoints like overall survival still needs to be delineated in this setting. In addition, it is crucial to document improvement or delay in time to deterioration in quality of life symptom endpoints in this population. SIRFLOX is the first of three prospective studies that assess the efficacy of adding radioembolization to first-line chemotherapy, and the combined data from these trials will provide the necessary power for an overall survival analysis. The final results of SIRFLOX will be eagerly awaited to determine if the increased hepatic PFS in preliminary data will translate to increased overall survival benefit.

Isolated hepatic perfusion for choroidal melanoma metastases: A treatment option on isolated liver metastases

Isolated hepatic perfusion for choroidal melanoma metastases: A treatment option on isolated liver metastases

Use and impact of bevacizumab in patients undergoing liver resection for metastatic colorectal cancer in routine clinical practice.

698 Background: In metastatic colorectal cancer (mCRC) patients with isolated liver metastases, surgical resection offers the greatest likelihood of cure. Whilst for mCRC patients treated with palliative intent the addition of bevacizumab to the chemotherapy backbone is of proven benefit, whether to use bevacizumab in the resectable or potentially resectable population is a clinical dilemma. Methods: Consecutive patients who underwent resection of liver metastases were identified from a prospective Australian mCRC registry that captures comprehensive data on patient and tumor characteristics (including resectability), treatment and outcome. The use of bevacizumab in this setting was examined and the impact on outcomes was explored. Results: From a total mCRC population of 1,700 patients, 543 patients with liver-only mCRC were identified, of which 217 patients (40%) underwent liver resection. Perioperative chemotherapy was administered to 185 patients (85.3%), with bevacizumab added to chemotherapy in 73 (39.5%) patients. There was a trend for bevacizumab treated patients to be younger (median age 60.4 vs 65.1 years, p = 0.07) and fitter (mean Charlson score 2.22 vs 2.64, p = 0.054). Patients that received bevacizumab with perioperative chemotherapy were considerably less likely to have disease regarded as resectable at diagnosis (39 of 73 (53.4%) vs 95 of 112 (84.8%), p =&lt;.01). At 5 years, overall survival was similar for bevacizumab treated and non-treated patients (61.4% vs. 59.2%, HR 0.83, p=0.52). There were no deaths within 30 days of surgery in any patients. Conclusions: Despite limited evidence to support the use of bevacizumab in patients with resectable or potentially resectable liver-only mCRC, clinicians are not infrequently utilising this approach, particularly in younger and fitter patients and those not considered to have resectable disease at diagnosis. The addition of bevacizumab did not appear to impact survival outcomes. A multivariate analysis is underway to better define the impact of bevacizumab on survival outcomes.

Colorectal liver metastases management in the Veterans Health Administration: Geographic disparity.

694 Background: Multidisciplinary management including surgical resection of Colorectal Liver Metastases (CLM) offers the greatest chance of long-term survival. We aimed to study surgical intervention types, rates and factors affecting the decision making in the Veterans Health Administration. Methods: The Veterans Affairs Central Cancer Registry (VACCR) and VA Informatics &amp; Computing Infrastructure (VINCI) were queried and linked to retrospectively analyze stage IV CLM from 10/01/2004-12/31/2012. Cohort construction and statistical analyses were performed utilizing SQL Server, SAS software, version 9.4 (SAS Institute Inc., Cary, NC) and Microsoft Excel. Results: We identified 118 VA stations and 1245 subjects meeting the inclusion criteria. Hemicolectomy was identified in 79%, (637) and 21 % (168) liver metastatectomy. Open versus laparoscopic hemicolectomy was 87.96% and 12.04% respectively. Follow-up imaging post metastatic disease diagnosis was carried in 88.9% (1,108) subjects. Immense variation in the percentage of surgeries conducted and the sites of surgery when stratified by geographic location. The percentage of patients receiving surgery at the colon remained high across almost all the stations. In 53 stations, hemicolectomy and hepatectomy were attempted in at least 15% of subjects with stage IV colorectal cancer and isolated liver metastases. Of the high volume stations, only 52% had a 15% or higher percentage of hemicolectomy and hepatectomy. Subjects receiving hepatectomy only were the least frequent and occurred in only three stations. Age at diagnosis, gender, Charlson comorbidity scores and the performance status at diagnosis did not differ significantly among surgery versus no-surgery groups. Conclusions: Geographic disparity emerged as a factor affecting metastatectomy decisions. Ongoing analysis to identify and analyze the differences amongst various stations is underway. Additional characterization of the liver metastases including size, number, and specific hepatic lobe and the surgical expertise is underway.

Transarterial chemoembolization for patients with metastatic uveal melanoma in the liver

Objective: to evaluate the safety and efficacy of transarterial chemoembolization method (TACE) in the treatment of inoperable patients with uveal melanoma with isolated liver metastases with cured the primary focus. Material and methods. In N.N. Blokhin RCRC since 2000, 31 patients received treatment with metastatic uveal melanoma in the liver. Among them: men – 13 (42%), women – 18 (58%). The average age of 45.12 ± 13.22 years, range 23–71 years. Time detection of liver metastases after treatment of the primary tumor ranged from 2 to 180 months, median – 23 months. Liver lesion volume to 25% was in 11 patients, to 50% in 13, to 75% in 7 patients. Total 62 TACE intervention was performed. As used embolizing materials: Lipiodol 10 ml in 45 cases, microspheres – in 11 cases (particle sizes ranged from 100 to 500 microns), combinations presented embolizing materials have been used in 6 patients. As the chemotherapy Doxorubicin performed at a dosage of 100 mg, or Gemzar 1–2 g, or Carboplatin 450 mg. Results. 100% of the TACE was technically successful. Complications related to the technical implementation not observed. Local response was observed in 21 (67.7%) patients with metastatic uveal melanoma. Duration of monitoring of patients after TACE was held from 2 to 60 months. Median follow-up in this case was 10 months. Overall survival in this group of patients was calculated by Kaplan–Meier. 1-year was 51.0 ± 9.5%, 2-year 34.0 ± 15.2%. The median survival – 12.9 months. 20 patients were alive at the time of the study, 11 died from progression. Conclusion. In this study transarterial chemoembolization in patients with metastatic uveal melanoma in the liver has established itself as an effective and well-tolerated treatment. Objective response or stabilization process in the liver was observed in 68% of patients. A median overall survival was comparable to that provided in the literature.

A Rare Case of Single, Isolated Liver Metastases from Spermatic Cord Leiomyosarcoma

A 54-year-old man presents with a left scrotal mass with abdominal pain. The investigation18F-FDG PET/CT reveals hypermetabolic heterogenous enhanced mass at leftspermatic cord but non 18F-FDG avid hypodensitic mass at left lobe of the liver isobserved. Left orchiectomy with high ligation of the left spermatic cord and lefthepatectomy were performed. The pathological fi nding reveals leiomyosarcomaarising from spermatic cord with liver metastasis. Follow-up at 6 months shows noevidence of recurrence by 18F-FDG PET/CT examination.

Metastatic spread pattern after curative colorectal cancer surgery. A retrospective, longitudinal analysis

ObjectiveThe most common sites of colorectal cancer (CRC) recurrence are the local tissues, liver or lungs. The objective was to identify risk factors associated with the primary CRC tumor and cancer recurrence in these anatomical sites. MethodsRetrospective, longitudinal analyses of data on CRC survivors. Multivariable Cox regression analysis was performed to examine the association between possible cofounders with recurrence to various anatomical sites. ResultsData for 10,398CRC survivors (tumor location right colon=3870, left colon=2898, high rectum=2569, low rectum=1061) were analyzed; follow up time was up to five years. Mean age at curative surgery was 71.5 (SD 11.8) years, 20.2% received radio-chemotherapy, stage T3 (64.4%) and N0 (65.1%) were most common. Overall 1632 (15.7%) had cancer recurrence (Isolated liver n=412, 3,8%; isolated lung n=252, 2,4%; isolated local n=223, 2.1%). Risk factors associated with recurrent CRC were identified, i.e. isolated liver metastases (male: Adjusted Hazard Ratio (AHR) 1,45; colon left: AHR 1,63; N2 disease: AHR 3,35; T2 disease: AHR 2,82), isolated lung metastases (colon left: AHR 1,53; rectum high: AHR 2,48; rectum low: AHR 2,65; N2 disease 3,76), and local recurrence (glands examined<12: AHR 1,51; CRM <3mm: AHR 1,60; rectum high: AHR 2,15; N2 disease: AHR 2,58) (all p values <0001). ConclusionOur study finds that the site of the primary CRC tumor is associated with location of subsequent metastasis. Left sided colon cancers have increased risk of metastatic spread to the liver, whereas rectal cancers have increased risk of local recurrence and metastatic spread to the lungs. These results, in combination with other risk factors for CRC recurrence, should be taken into consideration when designing risk adapted post-treatment CRC surveillance programs.

The Prognostic Value of Patient-Reported Outcome Data in Patients With Colorectal Hepatic Metastases Who Underwent Surgery

IntroductionPatient-reported outcomes (PROs) are critical to evaluate clinically effective treatments and evidence suggests that PROs might predict survival. The prognostic value of PROs in patients with isolated liver metastases from colorectal cancer (CRC) who undergo surgery is unclear. In this study we investigated whether baseline PROs are prognostic in this patient group. Patients and MethodsFrom April 2004 to May 2007, consecutive patients who underwent curative resection of CRC liver metastases completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ)-C30 and QLQ-LMC21 questionnaires before surgery. Patients were followed until death or data were censored on April 9, 2012. Cox proportional hazards models were used to assess the effect of PROs on survival controlling for predefined clinical covariates. Models were simplified using a backwards stepwise approach and model utility appraised using the Harrell C and Somers D statistics and bootstrap methods. ResultsTwo hundred thirty-two patients underwent liver resection and 101 (43.5%) survived 5 years. Multivariate analysis controlling for relevant clinical covariates showed that a 10-point improvement in baseline global quality of life scores was associated with a 54% improvement in survival (hazard ratio [HR], 0.46; 95% confidence interval [CI], 0.33-0.63; P < .001), and a clinically significant weight loss was associated with 75% worse survival (HR, 1.75; 95% CI, 1.20-2.55; P = .004). Smaller effects were noted for worsening abdominal pain, taste problems, and fatigue (30%-38% poorer survival). Results of bootstrap resampling suggested that global health and weight loss most reliably predicted survival. ConclusionResults of this study demonstrated that patients who reported worse baseline global quality of life and increased weight loss before liver resection for CRC liver metastases had significantly poorer survival. These findings if externally validated might be used to inform patients, and could also influence treatment planning and advise follow-up strategies and supportive care.

Prognostic factors for longer disease free survival and overall survival after surgical resection of isolated liver metastasis from breast cancer.

e12062 Background: Isolated liver metastases (LMs) from breast cancer (BC) occur in only 1-3% of the cases. Resection of isolated LMs improves survival. We examined the prognostic factors for time to LM development, disease free survival (DFS) and overall survival (OS) after BCLM resection. Methods: From 2006 to 2009, 32 patients underwent LM resection. All of them had breast cancer surgery for their primary tumor and developed resectable LMs as the first and only site of disease progression. Results: LMs developed after a median of 25 months. With a median follow up of 37 months (range 7-66) after metastases resection, median DFS and OS (with 95% CI) were 22.5 (12-40) and 37 ( ≥ 23) months, respectively. Tumor size ≥ 3 vs < 3 cm and adjuvant chemotherapy vs no adjuvant chemotherapy correlated with shorter time to LM development (p < 0.01 for both parameters). These parameters and BC negative estrogen (ER)/ progesterone receptors (PR) (ER?/PR? vs other) were related with shorter DFS. Positive (vs negative) axillary lymph nodes and BC negative ER/ PR (ER?/PR? vs other) status correlated with shorter OS (p < 0.01 for both parameters). A period to metastases development ≥ 24 months (vs ≤ 24) and single (vs multiple) metastases were related with longer DFS and OS (p < 0.01 for both conditions). Conclusions: Despite the relatively small number of patients in this study, we believe that positive ER/PR status for both BC and LMs, negative axillary lymph nodes, time to liver metastases development > 24 months and single liver metastases predict longer DFS and OS after LM resection.

Tu1955 FOLFIRINOX ± Chemo-Radiation in Locally Advanced Pancreatic Cancer and Isolated Liver Metastasis: A Single Center Experience

Background/Aim: FOLFIRINOX as neoadjuvant therapy for locally advanced pancreatic cancer has shown encouraging R0 resection and response rates. We report our experience for the overall response rate, R0 resection rate, progression free survival of FOLFIRINOX and chemoradiation in patients with) borderline resectable, locally advanced pancreatic cancer (LAPC) and LAPC with isolated liver metastasis.Methods: Retrospectively, 15 consecutive patients were given neoadjuvant FOLFIRINOX between 11/2011 and 8/2014. Radiographic review was used to allocate the patients into 3 groups (5 patients in each) based on National Comprehensive Cancer Network Criteria. Endpoints were objective response rates as per Response Evaluation Criteria in Solid Tumors Criteria, R0 resection rate and progression free survival. Results: All patients' characteristics are summarized in Table1. Out of 15, 5 were borderline resectable (Grp 1), 5 were locally advanced (Grp 2), and 5 had locally advanced disease with isolated liver metastases (Grp 3). Following neoadjuvant FOLFIRINOX the overall R0 resection rate was 27% (20% in Grp 1 and 2, 40% in Grp 3). The ORR was 26.7%. Median follow-up was 14 months. The progression free survival (PFS) and overall survival (OS) in surgical and non-surgical patient's seen in graphs 1 and 2. Conclusion: FOLFIRINOX possesses activity in patients with borderline-resectable and LAPC. The use of FOLFIRINOX was associated with conversion to R0 resectability in 40% of our patients, 27% after FOLFIRINOX alone and 13% after additional treatment with radiation. Despite having locally advanced disease with isolated liver metastasis, 40% of patients were able to proceed to R0 resection. There was also a survival benefit in patients getting neoadjuvant therapy with FOLFIRINOX and then resection. Prospective studies are advised to evaluate the true benefit of this treatment and survival rate.

Tu1956 CCL20 Is a Critical NFκB/RelA Target Gene in Pancreatic Carcinoma Conferring TRAIL Induced Immune Cell Recruitment and Immunce Cell Mediated Apoptosis Resistance of Pancreatic Cancer Cells

Background/Aim: FOLFIRINOX as neoadjuvant therapy for locally advanced pancreatic cancer has shown encouraging R0 resection and response rates. We report our experience for the overall response rate, R0 resection rate, progression free survival of FOLFIRINOX and chemoradiation in patients with) borderline resectable, locally advanced pancreatic cancer (LAPC) and LAPC with isolated liver metastasis.Methods: Retrospectively, 15 consecutive patients were given neoadjuvant FOLFIRINOX between 11/2011 and 8/2014. Radiographic review was used to allocate the patients into 3 groups (5 patients in each) based on National Comprehensive Cancer Network Criteria. Endpoints were objective response rates as per Response Evaluation Criteria in Solid Tumors Criteria, R0 resection rate and progression free survival. Results: All patients' characteristics are summarized in Table1. Out of 15, 5 were borderline resectable (Grp 1), 5 were locally advanced (Grp 2), and 5 had locally advanced disease with isolated liver metastases (Grp 3). Following neoadjuvant FOLFIRINOX the overall R0 resection rate was 27% (20% in Grp 1 and 2, 40% in Grp 3). The ORR was 26.7%. Median follow-up was 14 months. The progression free survival (PFS) and overall survival (OS) in surgical and non-surgical patient's seen in graphs 1 and 2. Conclusion: FOLFIRINOX possesses activity in patients with borderline-resectable and LAPC. The use of FOLFIRINOX was associated with conversion to R0 resectability in 40% of our patients, 27% after FOLFIRINOX alone and 13% after additional treatment with radiation. Despite having locally advanced disease with isolated liver metastasis, 40% of patients were able to proceed to R0 resection. There was also a survival benefit in patients getting neoadjuvant therapy with FOLFIRINOX and then resection. Prospective studies are advised to evaluate the true benefit of this treatment and survival rate.

Isolated hepatic perfusion with oxaliplatin combined with 100 mg melphalan in patients with metastases confined to the liver: A phase I study

AimTo improve isolated hepatic perfusion (IHP), we performed a phase I dose-escalation study to determine the optimal oxaliplatin dose in combination with a fixed melphalan dose. MethodsBetween June 2007 and July 2008, 11 patients, comprising of 8 colorectal cancer and 3 uveal melanoma patients and all with isolated liver metastases, were treated with a one hour IHP with escalating doses of oxaliplatin combined with 100 mg melphalan. Samples of blood and perfusate were taken during IHP treatment for pharmacokinetic analysis of both drugs and patients were monitored for toxicity, response and survival. ResultsDose limiting sinusoidal obstruction syndrome (SOS) occurred at 150 mg oxaliplatin. The areas under the concentration–time curves (AUC) of oxaliplatin at the maximal tolerated dose (MTD) of 100 mg oxaliplatin ranged from 11.9 mg/L h to 16.5 mg/L h. All 4 patients treated at the MTD showed progressive disease 3 months after IHP. ConclusionsIn view of similar and even higher doses of oxaliplatin applied in both systemic treatment and hepatic artery infusion (HAI), applying this dose in IHP is not expected to improve treatment results in patients with isolated hepatic metastases.

Management of colorectal hepatic metastases in the Veterans Affairs medical system: Opportunities for curative intent surgery.

e14541 Background: Surgical resection of isolated liver metastases in colon cancer offers the greatest chance of long-term survival. An initial 15-20% of patients are resectable with an additional ...

High survival in patients operated for small isolated liver metastases from gastric cancer: a multi-institutional study.

Although several studies have reported the outcomes of surgery for the treatment of liver metastases of gastric cancer (GLM), indications for liver resection for gastric metastases remain controversial. This study was designed to identify prognostic determinants that identify operable hepatic metastases from gastric cancer and to evaluate the actual targets of surgical therapy. Retrospective analysis was performed on outcomes for 24 consecutive patients at five institutions who underwent gastrectomy for gastric cancer followed by curative hepatectomy for GLM between 2000 and June 2012. Overall 5-year survival and median survival were 40.1 % and 22.3 months, respectively. Uni- and multivariate analyses showed that liver metastatic tumour size less than 5 cm was the most important predictor of overall survival (OS, p = 0.03). Four patients survived >5 years. Repeat hepatectomy was performed in three patients. Two of these patients have remained disease-free since the repeat hepatectomy. GLM patients with metastatic tumour diameter less than 5 cm maximum are the best candidates for hepatectomy. Hepatic resection should be considered as an option for gastric cancer patients with liver metastases.

Outcome Analysis of a Decade-Long Experience of Isolated Hepatic Perfusion for Unresectable Liver Metastases at a Single Institution

To evaluate outcomes of isolated hepatic perfusion (IHP) on isolated liver metastases (LMs). Isolated unresectable LMs are often the main determinant of overall survival (OS) for colorectal cancer (CRC) and other solid malignancies. We hypothesized that IHP can be performed safely and yield impressive responses for a variety of solid tumor pathology, using different perfusion agents. Retrospective review of a prospectively collected database of patients undergoing IHP for unresectable solid tumor LM. Between 2003 and 2012, IHP was completed in 91 patients. Primary tumor pathology was CRC = 54, non-CRC = 37 (ocular/cutaneous melanoma = 32, cholangiocarcinoma = 3, appendiceal = 1, and breast = 1). IHP employed Melphalan (n = 69) (CRC = 32, non-CRC = 37), Oxaliplatin (n = 10) (CRC), or Oxaliplatin + 5FU (n = 12) (CRC). Hepatic arterial infusion (HAI) pumps were placed in all CRC patients. There were 3(3.3%) perioperative deaths. Response rates for CRC, melanoma, and cholangiocarcinoma were 68.2%, 57.1%, and 100% respectively. Response rates for CRC patients using 5FU + Oxaliplatin, Oxaliplatin, or Melphalan were 83.3%, 66.7%, and 60.9%, respectively. Median OS for the CRC patients (from IHP date) was 23 months (95% confidence interval: 15-28 months). On univariate analysis, receipt of HAI-FUDR (floxuridine) within 1 year of IHP was the only factor associated with improved OS (P = 0.043) in CRC patients. IHP results in excellent response rates for patients with unresectable liver metastasis from solid tumors. Improved local control for CRC patients undergoing IHP-HAI may improve survival.