Metastasectomy In Patients Research Articles

Predictive factors for recurrence after complete metastasectomy in patients with metastatic renal cell carcinoma in the targeted therapy era

ObjectivesComplete metastasectomy is expected to improve the survival of patients with metastatic renal cell carcinoma (mRCC). However, many patients develop re-recurrence, despite achieving complete remission with surgery. We examined recurrence-free survival (RFS) and analyzed predictive factors for recurrence after complete metastasectomy. MethodsFifty-one patients with mRCC who underwent complete metastasectomy between 2008 and 2018 were included in this study. Multivariate Cox regression analyses were performed to identify the prognostic factors for RFS. ResultsOf 51 patients, 6 (12%) had multiple metastatic sites and 45 (88%) had solitary metastasis. The pathological subtype was clear cell in 42 (82%), papillary in 8 (17%), and other subtype in 1 (2%) patient. Sarcomatoid features were found in 2 (4%) patients. The Memorial Sloan Kettering Cancer Center risk category was favorable in 43%, intermediate in 53%, and poor in 4% of patients. The median duration from nephrectomy to metastasectomy was 32 months. Of the total cohort, 39 patients (74%) developed recurrence after complete metastasectomy. The median RFS was 22 months, and the 2- and 5-year RFS rates were 45% and 25%, respectively. Multivariate Cox regression revealed that ≥2 metastatic sites (vs. 1 site; HR = 4.52; P = 0.024) and sarcomatoid features (HR = 11.5; P = 0.0171) were independent predictive factors for recurrence. The 2- and 5-year cancer-specific survival rates were 98% and 82%, respectively. ConclusionThe number of metastatic sites and sarcomatoid features were associated with recurrence after complete metastasectomy, which suggests that careful observation is required for such patients, even after achieving complete remission with metastasectomy.

Stereotactic Body Radiotherapy Versus Metastasectomy in Patients With Pulmonary Metastases From Soft Tissue Sarcoma

The lung is the preferred site of metastasis from soft tissue sarcoma (STS). This systematic review aims to evaluate the outcomes of stereotactic body radiotherapy (SBRT) and metastasectomy (MTS) for the treatment of lung metastases from STS. A systematic review was carried out according to the PRISMA protocol. PubMed, Medline, EMBASE, Cochrane Library, Ovid and Web of Knowledge databases were searched for English-language articles to December 2018 using a predefined strategy. Retrieved studies were independently screened and rated for relevance. Data were extracted by two researchers. In total, there were 1306 patients with STS: 1104 underwent MTS and 202 had SBRT. The mean age ranged from 40 to 55.8 years in the MTS group and from 47.9 to 64 years in the SBRT group. The cumulative death rate was 72% (95% confidence interval 59–85%) in the MTS group and 56% (38–74%) in the SBRT group. The cumulative mean overall survival time was 46.7 months (36.4–57.0%) in the MTS group and 47.6 months (33.7–61.5%) in the SBRT group. The cumulative rate of patients alive with disease was 5% (2–9%) in the MTS group and 15% (6–36%) in the SBRT group. Finally, the cumulative rate of patients alive without disease in the two groups was 19% (9–29%) and 20% (10–50%), respectively. Our study showed that local treatment of pulmonary metastases from STS with SBRT, compared with surgery, was associated with a lower cumulative overall death rate and similar overall survival time and survival rates without disease. By contrast, SBRT was associated with a higher survival rate with disease than MTS. Large randomised trials are necessary to confirm these findings and to establish whether SBRT may be a reliable option for early stage disease.

Ouctomes after Hepatic and Pulmonary Metastasectomies in Patients With Colorectal Cancer Metastasis to Liver and Lungs.

Ouctomes after Hepatic and Pulmonary Metastasectomies in Patients With Colorectal Cancer Metastasis to Liver and Lungs.

FOLFOXIRI in patients with colon cancer and isolated non-resectable liver metastases: phase II prospective non-randomized single-center study

Objective: to assess the frequency of liver resections in patients with metastatic colon cancer and isolated non-resectable liver metastases receiving FOLFOXIRI. Materials and methods. In this single-center non-randomized prospective study, we assessed the frequency of liver resections. According to the statistical hypothesis, the frequency of R0-resections in patients with metastatic colon cancer receiving FOLFOXIRI is between 11 % and 33 % (mean 20 %); to increase it up to 50 % in patients with isolated metastatic lesions in the liver, we had to recruit 20 patients (with β = 0.9 and a = 0.05). We enrolled 20 patients with potentially resectable metastases and 22 patients with non-resectable metastases. The primary endpoint was the frequency of R0 liver resections; secondary endpoints included objective response rate, progression-free survival, overall survival, and tolerability of therapy. Patients receiving targeted therapy (according to the tumor mutation status) were also included in the study.Results. Objective response was observed in 32 out of 42 patients (76 %) (in 17 out of 20 participants (85 %) with potentially resectable metastases), whereas progressive disease was registered in 2 patients (5 %). Radical resection of organs affected by metastasis was performed in 19 out of 42 patients (45 %): 15 out of 20 (75 %) in the group with potentially resectable metastases and 4 out of 22 (18 %) in the group with non-resectable metastasis (р <0.01). At a median follow-up of 11 months (range: 1–32 months), median progression-free survival was 10 months (95 % confidence interval (CI) 8.9–11.1), while median length of life was 34 months (95 % CI 21.3–46.7). Median overall survival was 34 months in patients that had undergone metastasectomy vs 19 months in patients that had no metastasectomy (hazard ratio 0.7; 95 % CI 0.01–0.70; p = 0.02).Conclusions. FOLFOXIRI increased the frequency of metastasectomy in patients with potentially resectable liver metastases from colon cancer, which was associated with a pronounced increase in the length of life.

The Assessment of Prognostic Factors for Lung Metastasectomy in Colorectal Cancer Patients With Previously Resected Liver Metastases

The purpose of this study is to investigate the prognostic factors of lung metastasectomy in patients with previously resected liver metastases. Thirty-three patients underwent complete resection of lung metastases after previous liver metastasectomy from colorectal cancer between January 2004 and December 2013. In univariate analyses, all cumulative survival curves were estimated using the Kaplan-Meier method, and differences in variables were evaluated using the log-rank test. Multivariate analyses were performed using the Cox proportional hazards regression model. The 5-year survival rate of all 33 patients after lung metastasectomy was 31%. Univariate analysis identified 2 significant prognostic factors: preoperative serum carcinoembryonic antigen level (P = 0.035) and maximum tumor size (P = 0.029). Subgroup analysis with a combination of these 2 independent prognostic factors revealed 2-year survival rates of 100%, 92.3%, and 0% for patients with 0, 1, and 2 risk factors, respectively. We identified 2 independent poor prognostic factors for pulmonary metastasectomy in patients with previously resected liver metastases: high serum carcinoembryonic antigen level before lung metastasectomy, and maximum size of lung metastases. When these 2 factors are combined, higher- and lower-risk subgroups can be identified, which may help select patients with previously resected liver metastases who benefit most from lung metastasectomy.

Survival and Complication Rates of Metastasectomy in Patients With Metastatic Renal Cell Carcinoma Treated Exclusively With Targeted Therapy: A Combined Population-based Analysis.

This study analyzed the effect of metastasectomy on overall mortality (OM) and perioperative outcomes in patients with metastatic renal cell carcinoma (mRCC) treated exclusively with targeted therapy. Using the Surveillance, Epidemiology, and End Results (SEER) database (2006-2015), Kaplan-Meier analyses and multivariable Cox regression models tested for OM. Using the National Inpatient Sample (NIS) database (2006-2015), complication rates and in-hospital mortality were evaluated. Within the SEER database, 437 (12.2%) out of 3,654 patients underwent metastasectomy. Metastasectomy was associated with lower OM risk (median survival 11 vs. 9 months, hazard ratio=0.83; p=0.002). Within the NIS database, 351 such patients were identified. Complications and in-hospital mortality were 55.0% and 4.6%, respectively. Metastasectomy in patients with mRCC treated exclusively with targeted therapy is associated with lower OM risk, however, based on short duration of expected survival. Complications and in-hospital mortality rates are not negligible.

Metastasectomy in patients with non-resectable metastatic colorectal cancer receiving chemotherapy and anti-EGFR antibodies: a prospective, non-randomized, multicenter, phase II study

Objective: to analyze the frequency of metastasectomy in general population of patients with RAS wild-type metastatic colorectal cancer who received chemotherapy and anti-EGFR monoclonal antibodies Materials and methods . This prospective, non-randomized, multicenter study was designed to evaluate the frequency of resections of organs affected by metastasis. Our statistical hypothesis was that the addition of anti-EGFR antibodies should increase the frequency of metastasectomy from 5% to 15 %. Sample size calculations showed that to obtain a power of 80 % and an alpha level of 0.05 to detect the difference, we would need to recruit 50 patients. The primary endpoint was the frequency of resections of organs affected by metastasis, whereas the secondary endpoints included objective response rate, progression-free survival, and length of live. Tolerability of the therapy was analyzed separately. Results. Eighteen out of50 (36 %) patients achieved objective response; 32 (64 %) patents achieved stable disease and 18 (36 %) patients had disease progression. Radical resection of organs affected by metastasis was performed in 8 out of 50 patients (16 %): 1 individual had lung resection and 7 individuals had liver resection. Among participants with isolated liver lesions, the frequency of metastasectomy was 24 % (6 out of 25 patients). At a median follow-up of 14 months (between 1 and 34 months), median progression-free survival was 8 months (95 % confidence interval 6.2—9.8) and median length of life was 26 months (95 % confidence interval 19.7—32.2). The estimated 2-year overall survival was 83 % in patients who underwent metastasectomy vs. 51 % in those who had no metastasectomy. Conclusions. The addition of anti-EGFR monoclonal antibodies to standard combination chemotherapy (FOLFOX/FOLFIRI) increases the frequency of metastasectomy in patients with non-resectable metastatic colorectal cancer, which results in an increased length of life.

Is stereotactic radiotherapy equivalent to metastasectomy in patients with pulmonary oligometastases?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether stereotactic body radiotherapy (SBRT) was equivalent to metastasectomy in patients with pulmonary oligometastases arising from solid tumours. Altogether, 1612 papers were found using the reported search, of which 5 cohort studies derived from 4 patient populations represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All 5 studies demonstrated no significant difference in post-treatment overall survival, disease-free survival or local control between SBRT and metastasectomy for pulmonary oligometastases. One of the 5 studies showed a significantly decreased rate of severe complications among the patients treated with SBRT. The other papers reported higher rates of complications in the SBRT groups, invariably due to radiation, but with uncertain clinical significance. The evidence strength of these findings may be largely attenuated due to the small sample size, heterogeneity of SBRT protocols and incomparable follow-up periods between the 2 treatment groups. The selection criteria for the choice of treatment were not stated. We conclude, based on limited evidence, that SBRT has equivalent outcomes to metastasectomy in the treatment of patients with pulmonary oligometastases.

Prognostic factors for survival in stage IV rectal cancer: A Swedish nationwide case–control study

PurposeThe aim was to identify patient-, tumor- and treatment-related prognostic factors for five-year survival in rectal cancer patients with synchronous stage IV disease. Material and methodsThis nationwide case-control study was based on the Swedish Colorectal Cancer Registry with supplementary information from medical records and the Swedish Inpatient Registry during the period 2000–2008. All resected rectal cancer patients with synchronous metastases that survived more than five years were included as cases. The control group consisted of corresponding patients who lived less than five years, matched in a 1:2 based on gender, age, resection of the rectal tumor, and the study period. ResultsA total of 405 patients were identified; 99 long-term survivors (LTS) and 182 short-term survivors (STS). Patient-related factors of symptoms and comorbidity did not differ between LTS and STS. Among the treatment-related factors, multiple site metastases (p = 0.007), bilobar liver metastasis (p = 0.002), and increasing number of liver metastasis (p < 0.001) were associated with STS. Prognostic treatment-related factors were preoperative radiotherapy (p = 0.001), metastasectomy (p < 0.001), and radical resection of the primary tumor (p = 0.014). In the multivariable analysis, the single most important factor for becoming a LTS was a metastasectomy (hazard ratio: 8.474, 95% confidence interval: 4.098–17.543). ConclusionsThe most important prognostic factor for long-term survival in patients with stage IV rectal cancer was metastasectomy, especially liver surgery. With thorough selection of patients for metastasectomy more patients with metastasized rectal cancer may survive beyond five years.

Benefits of repeated resections for liver and lung metastases from colorectal cancer

We aimed to evaluate oncological outcomes after repeat metastasectomies in patients having undergone previous resections for colorectal cancer metastases. We examined 248 patients who underwent metastasectomies for lung and/or liver metastases at our center during a 7-year period, from January 2005 to December 2011. Recurrence-free survival 1 (RFS1) after the metastasectomy for the initial recurrence, recurrence-free survival 2 (RFS2) after the second, and recurrence-free survival 3 (RFS3) after the third repeated resections for recurrence were assessed. The overall survival (OS) rate after the first metastasectomy for the first recurrence (OS) was also assessed. Sites of recurrence of the first metastasectomy were the liver, lung, and liver and lung in 115, 117, and 16 cases, respectively, and 133 patients had a second recurrence (133/248, 53.6%). Twenty-seven patients had a third recurrence (27/52, 51.9%), of whom 14 underwent a third metastasectomy. The 5-year and 10-year OS rates were 74.8% and 57.9%, respectively. The 1-year RFS1, RFS2, and RFS3 rates were 76%, 75%, and 39%, respectively. The hazard ratios for RFS were 1.142 and 2.590 for the first and second repeat surgeries, when compared to the first metastasectomy. The third metastasectomy showed significantly lower RFS than did the second metastasectomy. A second metastasectomy should be considered the optimal treatment for a second recurrence. However, careful considerations should be made before performing a third metastasectomy.

Three risk factors for pulmonary metastasectomy in patients with hepatocellular carcinoma

ObjectiveThe outcomes of surgically treating pulmonary metastases from hepatocellular carcinoma remain unclear. Therefore, we aimed to evaluate patients with hepatocellular carcinoma who underwent pulmonary metastasectomy to assess their survival outcome and prognostic factors.MethodsThis retrospective single-center study included 30 patients who underwent pulmonary metastasectomy for hepatocellular carcinoma between January 1980 and December 2016 at the National Cancer Center Hospital.ResultsThe 1-, 3-, and 5-year overall survival rates after pulmonary metastasectomy were 86.7%, 46.2%, and 33.6%, respectively (median survival time: 25.0 months). The univariate prognostic factors were viral hepatitis (P = 0.019), number of pulmonary metastases (P = 0.002), and other site recurrence before metastasectomy (P = 0.048). Multivariate analysis using a Cox proportional hazards model revealed viral hepatitis (hazard ratio: 3.611, 95% confidence interval: 1.226–10.64; P = 0.02) and ≥ 2 pulmonary metastases (hazard ratio: 4.031, 95% confidence interval: 1.594–10.19; P = 0.003) to be independent prognostic factors. Subgroup analyses of the three risk factors (viral hepatitis, number of pulmonary metastases, and other site recurrence before metastasectomy) revealed that the median survival times after pulmonary metastasectomy were 66.0 and 15.5 months for patients with 0–1 risk factors and those with 2–3 risk factors, respectively (P < 0.001).ConclusionsFor patients who underwent pulmonary metastasectomy for hepatocellular carcinoma, median survival time was 25.0 months and decreased with three risk factors which included viral hepatitis, multiple number of pulmonary metastases, and the presence of other site recurrence before metastasectomy.

Long-term outcomes and prognostic factors of pulmonary metastasectomy for osteosarcoma and soft tissue sarcoma.

The prognostic factors of pulmonary metastasectomy in patients with osteosarcoma and soft tissue sarcoma remain controversial. The purpose of our analysis was to explore the prognostic factors and outcomes of patients with osteosarcoma and soft tissue sarcoma who underwent pulmonary metastasectomy at our institution. We reviewed the data of 44 patients who underwent resection of pulmonary metastases from 1996 to 2016at our institution. The Kaplan-Meier method, log-rank test and multivariate Cox hazard model were used for comparison and survival analyses. There was no perioperative mortality. The median post-metastasectomy overall survival was 24.8 months, and the 5-year overall survival rate of all patients was 43.5%. The 5-year survival rate of the patients who underwent repeat thoracotomies was 60.0%. Incomplete resection, a largest tumor size > 2cm and a disease-free interval < 12months were associated with poor survival in multivariate analyses. Among eight patients, who underwent repeat pulmonary resection, two remain alive with no evidence of disease. These patients had the longest DFI and DFI-2 (time from first pulmonary metastasectomy to the diagnosis of recurrent pulmonary metastasis), respectively. The survival of patients with a relatively long disease-free interval, small tumor size and complete resection was favorable following the treatment of osteosarcoma and soft tissue sarcoma with pulmonary metastasectomy. Repeat pulmonary metastasectomies also provide favorable prognosis in select patients.

Outcomes and prognostic factors after pulmonary metastasectomy in patients with colorectal cancer with previously resected hepatic metastases

ObjectivesOutcomes and prognostic factors remain obscure in patients with colorectal cancer after pulmonary metastasectomy who had previously received a curative hepatic metastasectomy. MethodsWe collected data of 757 patients with pulmonary metastasis from colorectal cancer who underwent curative metastasectomy between 2004 and 2008 from 46 Japanese institutions, from which we extracted data on patients who previously received curative hepatic metastasectomy. Disease-free survival, overall survival, and prognostic factors were analyzed. ResultsThe subjects of this study were 160 patients, of whom 44% had primary rectal tumor, 73% had a single pulmonary metastasis, 11% had a bilateral pulmonary metastasis, and 39% had high (>5 ng/mL) serum carcinoembryonic antigen. Patients' median age was 66 years, and 58% were male. The median follow-up was 64 months. Five-year overall survival and disease-free survival were 65.2% (95% confidence interval, 56.8-72.5) and 33.5% (95% confidence interval, 26.1-41.0), respectively. In multivariable analyses, high prethoracotomy carcinoembryonic antigen level was an independent prognostic factor for overall survival (hazard ratio, 2.01; 95% confidence interval, 1.16-3.47) and disease-free survival (hazard ratio, 2.10; 95% confidence interval, 1.41-3.12). Five-year overall survival and disease-free survival of patients with normal prethoracotomy carcinoembryonic antigen level were 76.4% (95% confidence interval, 66.1-83.9) and 40.7% (95% confidence interval, 30.5-50.5), respectively. ConclusionsAfter pulmonary metastasectomy, approximately two thirds of patients with colorectal cancer with a history of curative hepatic metastasectomy survived for 5 years—half of them disease-free. Our results indicate that patients with colorectal cancer with pulmonary metastasis and a history of curative hepatic metastasectomy may benefit from sequential pulmonary metastasectomy, especially if prethoracotomy serum carcinoembryonic antigen levels are within normal range.

The Role of Biomarkers in Selecting Patients for Metastasectomy

The Role of Biomarkers in Selecting Patients for Metastasectomy

207P A comparison of outcomes of stereotactic body radiotherapy versus metastasectomy in patients with pulmonary metastases

207P A comparison of outcomes of stereotactic body radiotherapy versus metastasectomy in patients with pulmonary metastases

Phase 3, randomized, double-blind trial of pembrolizumab in the adjuvant treatment of renal cell carcinoma (RCC): KEYNOTE-564.

TPS712 Background: Most patients with intermediate- to high-risk advanced renal cell carcinoma (RCC) will progress within 3 years following nephrectomy. Novel treatments in the adjuvant setting are needed to prevent disease recurrence in these higher-risk patients. Upregulation of the programmed death 1 (PD-1) pathway is associated with more aggressive disease and poor prognosis. PD-1 inhibitors have demonstrated activity in metastatic RCC, and PD-1 may represent a novel therapeutic target in the adjuvant setting. Pembrolizumab, a PD-1 inhibitor, blocks the interaction between PD-1 and its ligands, PD-L1 and PD-L2. Methods: KEYNOTE-564 (NCT03142334) is a randomized, double-blind, placebo-controlled phase 3 trial designed to evaluate the efficacy and safety of pembrolizumab as adjuvant therapy in patients with RCC. Eligibility criteria include age ≥18 years; intermediate- to high-risk (T2 grade 4, T3), high-risk (T4, T), or M1 NED RCC with a clear cell component; no prior systemic therapy for advanced RCC; disease free following complete or partial nephrectomy (and metastasectomy in patients with M1 NED) with negative surgical margins; Eastern Cooperative Oncology Group performance status (ECOG PS) 0/1; and provision of a tumor sample for biomarker analyses. Patients will be randomly assigned (1:1) to pembrolizumab 200 mg administered intravenously every 3 weeks or placebo. Randomization will be stratified by metastasis stage (M0 vs M1 NED); within the M0 group, randomization will be further stratified by ECOG PS (0 vs 1) and region (US vs rest of world). Treatment will continue until disease recurrence, unacceptable toxicity, or the completion of 17 cycles (~1 year). Imaging will be performed every 12 weeks. The primary end point is disease-free survival (DFS) per investigator assessment. The key secondary end point is overall survival (OS). Other secondary objectives include safety, disease recurrence-specific survival, DFS and OS according to PD-L1 expression status, and patient-reported outcomes. Biomarkers that may be associated with response will be evaluated as an exploratory objective. Enrollment is ongoing and will continue until ~950 patients are enrolled. Clinical trial information: NCT03142334.

Hepatoblastoma: current understanding, recent advances, and controversies.

Introduction: Hepatoblastoma (HB) is the most common primary malignant liver neoplasm in children. Its increasing survival rate is related to the progress in modern imaging, surgical techniques, and new chemotherapy regimens. Clinical approach: One of the past achievements was the development of the pretreatment extension of disease (PRETEXT) system. Gradually, the HB therapeutic approach has become more individualized with better stratification of patients. Controversies: These include the need for preoperative chemotherapy and its optimal duration; intensity of preoperative chemotherapy required for locally advanced cases (PRETEXT 4); optimal surgical treatment for locally advanced tumors: aggressive hepatic resections versus liver transplantation; the role of postoperative chemotherapy in the post-transplant setting; the timing and role of metastasectomy in patients with disseminated disease who undergo partial liver resection; and the prognostic significance of several HB pathology variants. Hepatoblastoma biology: Beta-catenin mutations and the beta-catenin/Wnt pathway play an important role in HB development. There have been at least two molecular signatures in HB published. Unluckily, all of these findings are based on relatively small clinical series and require confirmation. Conclusion: The treatment of HB started from one and the same therapy for all patients and aimed at increased treatment individualization, but the future seems to lie in biology-driven patient-tailored therapies.

Lung metastasectomy following kidney tumors: outcomes and prognostic factors from a single-center experience.

The lung is one of the sites most frequently affected by metastatic renal cell carcinoma (mRCC). Nonsurgical therapy for mRCC has limited efficacy, while the 5-year survival rates data published in literature after pulmonary surgery for metastasectomy, emphasize the role of surgery as the treatment that guarantees the best effectiveness in pulmonary resectable metastases. From January 2000 to March 2016, 27 patients underwent pulmonary metastasectomy for metastatic renal cancer was retrospectively reviewed. Primary renal cancer was controlled in all patients and there was no other metastatic site in addition to the lung, at the time of metastasectomy. The aim of the study was to identify outcomes and prognostic factors in association with survival after complete pulmonary resection of metastases in a subgroup of patients with isolated pulmonary metastases from RCC. Five- and 10-year overall survival (OS) from first pulmonary metastasectomy was 75% and 59%, respectively. Independent prognostic factor influencing survival were: dimension of pulmonary metastases ≥2 cm (3-year survival: 67% vs. 100%; P=0.014) and disease free interval (DFI) ≥5 years (3-year survival: 94% vs. 28%; P=0.05). The only independent prognostic factors affecting DFI was the dimension of pulmonary metastases ≥2 cm (5-year DFI: 67% vs. 89%; P=0.03) at univariate analysis. Considering the good results based on high long-term efficacy and low morbidity after metastases surgical resection, we always recommend metastasectomy in patients with technically resectable metastases, especially in case of long DFI and reduced dimension of pulmonary lesions.

Impact of Metastasectomy in the Multimodality Approach for BRAF V600E Metastatic Colorectal Cancer: The Mayo Clinic Experience.

BRAF V600E mutations are present in 8%-10% of patients with metastatic colorectal cancer (mCRC) and portend poor prognosis. This study investigated the impact of metastasectomy for patients with BRAF V600E mCRC. Using prospective clinical and molecular data, patients with BRAF V600E mCRC were analyzed for clinical characteristics and survival. Statistical analyses utilized the Kaplan-Meier method, log-rank test, and Cox proportional hazard models. Fifty-two patients were identified between July 1, 2008, and January 4, 2016. Patient characteristics included median age 65 years, 61% female, Eastern Cooperative Oncology Group performance status ≤1, 71% with right-sided tumors, and 28% with liver-limited metastasis. In the first-line setting, 7% (4/52) received fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI)/bevacizumab (BEV) and 81% were treated with doublet chemotherapy consisting of fluoropyrimidine, oxaliplatin, and BEV. Median overall survival (OS) for all 52 patients was 25 months with median progression-free survival (PFS) of 9.3 months. With median follow-up of 18.3 months, 21 patients underwent metastasectomy with longer OS (29.1 months vs. 22.7 months, hazard ratio [HR] = 0.33; confidence interval [CI], 0.12-0.78; p = .01) and PFS (13.6 months vs. 6.2 months, HR = 0.53, CI, 0.28-0.97; p = .03) compared with the non-metastasectomy cohort. In multivariate analysis, metastasectomy remained significant for improved survival outcomes (HR = 0.52; 95% CI, 0.07-1.02; p = .02). Median disease-free survival after metastasectomy was 9.7 months (95% CI, 5.5-19.5). Two patients remain disease-free at the time of last follow-up, with one patient without relapse for greater than 2 years (28.9 months). Multimodality therapy incorporating metastasectomy for BRAF V600E mCRC should be considered and might be associated with improved overall survival in select patients. BRAF V600E metastatic colorectal cancer (mCRC) represents an extremely difficult molecular subset of colorectal cancer to treat. To date, this subset remains refractory to standard chemotherapies, prompting extensive clinical investigation regarding novel treatment approaches and targeted modalities. While the use of metastasectomy for expanded RAS wild-type and RAS mutated mCRC has resulted in improved overall survival for select patients, utilization of metastasectomy in patients with BRAF V600E mCRC remains controversial. This article explores the authors' experience with BRAF V600E mCRC to ascertain whether a multidisciplinary approach incorporating metastasectomy for well-selected patients improves overall survival.

The impact of pulmonary metastasectomy in patients with previously resected colorectal cancer liver metastases

Background40–50% of patients with colorectal cancer (CRC) will develop liver metastases (CRLM) during the course of the disease. One third of these patients will additionally develop pulmonary metastases.Methods137 consecutive patients with CRLM, were analyzed regarding survival data, clinical, histological data and treatment. Results were stratified according to the occurrence of pulmonary metastases and metastases resection.Results39% of all patients with liver resection due to CRLM developed additional lung metastases. 44% of these patients underwent subsequent pulmonary resection. Patients undergoing pulmonary metastasectomy showed a significantly better five-year survival compared to patients not qualified for curative resection (5-year survival 71.2% vs. 28.0%; p = 0.001). Interestingly, the 5-year survival of these patients was even superior to all patients with CRLM, who did not develop pulmonary metastases (77.5% vs. 63.5%; p = 0.015). Patients, whose pulmonary metastases were not resected, were more likely to redevelop liver metastases (50.0% vs 78.6%; p = 0.034). However, the rate of distant metastases did not differ between both groups (54.5 vs.53.6; p = 0.945).ConclusionThe occurrence of colorectal lung metastases after curative liver resection does not impact patient survival if pulmonary metastasectomy is feasible. Those patients clearly benefit from repeated resections of the liver and the lung metastases.