Resection Of Metastases In Patients Research Articles

Resection of metastases in patients with BRAF mutated metastatic colon cancer: results of a multicenter retrospective study

Introduction: local treatment of metastases is an integral part of colon cancer treatment. However, there is not enough data on the efficacy of surgical resection of metastases in patients with a BRAF gene mutation to recom‑mend this approach in routine practice. We initiated a retrospective multicenter study to assess the incidence of BRAF gene mutations in patients with metastatic colon cancer and to study the efficacy of metastasectomy in this group of patients.Materials and methods: we selected all patients who underwent surgical resection of metastases in various sites from the database of patients with BRAF gene mutations created as a result of a multicenter retrospective study with participation of 7 clinics in the Russian Federation. All 57 patients with RAS gene mutations and 43 patients with wild‑type RAS and BRAF genes who also underwent surgical resection of metastases at any stage of treatment were selected from the register of the Chemotherapy Department No. 2 of the NMRC of Oncology named after N. N. Blokhin for comparative analysis. Disease‑free survival and overall survival were used as primary efficacy criteria.Results: we found 26 patients with BRAF gene mutations who underwent surgical resection of metastases. When comparing disease‑free survival, the worst median was achieved in the group of patients with BRAF gene mutations: 7 months versus 14 months in patients with RAS gene mutations (HR 0.4, 94 % CI 0.23–0.7, P = 0.006); median disease‑free survival was not achieved in the wild‑type RAS and BRAF group (HR 0.2, 95 % CI 0.11–0.45, P <0.001).The median overall survival in the BRAF gene mutation group was 26 months versus 38 months in the RAS gene mutations group (HR 0.8, 95 % CI 0.33–1.98, P = 0.6) and 49 months in the wtRAS/wtBRAF group (RR 0.46, 95 % CI 0.17–1.24, P = 0.1). Resection of recurrent tumors in patients with metastases in retroperitoneal lymph nodes was associated with extremely low disease‑free survival (2 months); at the same time, disease‑free survival was 7 months after resection of isolated metastases in the liver and 8 months for metastases in the peritoneum.Conclusion: prognosis of patients with a BRAF gene mutation after surgical resection of metastases is worse than in patients with a different mutation phenotype. Nevertheless, literature data, as well as the results of our study, confirm the possibility of performing metastasectomy with careful selection of patients.

SO-16 Quality of life in Finnish metastatic colorectal cancer patients actively treated with the aim of maximizing resection and/or local ablative therapy (RAXO-study NCT01531595)

Surgical resection of metastases in patients with metastatic colorectal cancer (mCRC) has improved long-term survival, being median (mOS) 80 months in resected vs. 21 months in “systemic therapy only” if no resection was possible (Osterlund et al. TLRHE 2021). The health-related quality of life (HRQoL) data in patients actively treated with the aim of resection is limited.

P16.23 Surgical resection of melanoma brain metastases, a highly effective modality for local control in the era of prolonged survival from stage IV melanoma

Abstract Introduction: Novel systemic therapies targeting the MAP kinase pathway (BRAF inhibitors) or immune checkpoints have significantly improved the overall survival of patients with metastatic melanoma, with a 2 year overall survival now above 50%. The importance of achieving durable local control of brain metastases is therefore reinforced. We sought to determine the local control rate after complete surgical resection of individual brain metastases in patients with stage IV melanoma. Secondary outcome measures were morbidity and mortality associated with these surgeries, frequency of distant recurrence of brain metastases, and overall survival. Additionally, we sought to define patterns of treatment in relation to radiation options and systemic therapies. METHODS: Clinicopathological data was retrospectively collected from 104 consecutive patients recorded in a prospective database who underwent surgical resection of 1 – 4 melanoma brain metastases between May 2008 and December 2014 at Melanoma Institute Australia and Royal Prince Alfred Hospital, Sydney Australia. Group 1 comprised all those treated between May 2008 and May 2011 (before the routine use of effective drug therapies). Group 2 comprised all those treated between June 2011 and December 2014. Given the marked heterogeneity between the treatment the two groups have received, we felt that statistical analyses for direct comparisons would be inappropriate. Results: Group 1 had 46 patients with a total of 78 cerebral melanoma metastatic lesions resected and Group 2 had 58 patients with a total of 106 lesions resected. The local control rate at 24 months was 91% in both Group 1 and Group 2. The median overall survival was higher in Group 2 than Group 1, as reflected by 13.5 months and 11.5 months respectively. The use of whole brain radiation therapy, systemic therapy, stereotactic ­radiosurgery (SRS) to cavity varied between the two groups, with 72%, 35%, 0% in Group 1 and 57%, 34%, 10% in Group 2, respectively. The rates of SRS failure varied between the two groups, with 4% in Group 1 and 34% in Group 2. Peri-operative complications rates and death rate of 4% and 1% respectively was detected in Group 1, and 6% and 2% respectively in Group 2. CONCLUSION: Surgical resection of melanoma brain metastases is a highly effective and safe means of local control for stage IV melanoma patients who now see prolonged survival when treated in a multimodal way by a cohesive multidisciplinary group.

セツキシマブ＋FP併用療法が奏効し根治を目指した手術が可能になった症例

セツキシマブ＋FP併用療法が奏効し根治を目指した手術が可能になった症例

Surgical resection of metastases in patients with urogenital malignancies

Surgical resection of metastases in patients with urogenital malignancies

Outcomes after resection of pulmonary metastases in patients with colorectal cancer.

757 Background: Surgical resection of liver metastases provides a significant survival benefit, and potential for cure, in selected patients with metastatic colorectal cancer. There are very limited data on resection of lung metastases in patients with colorectal lung metastases. We evaluated outcomes after resection of lung metastases in patients with colorectal cancer. Methods: We conducted a retrospective cohort study in patients who underwent resection of pulmonary metastases between 2/2006 and 6/2013 at Cleveland Clinic. Clinical, pathologic, and outcome data were collected by electronic medical records review. Overall survival (OS) as the primary endpoint was summarized by Kaplan-Meier method and analyzed by log-rank tests. Results: The study population comprised 32 patients. Overall, 20 patients were male and median age at diagnosis of lung metastasis was 60.0 years (range 30.4-81.9). All patients had resection of primary tumor. Eleven patients had preoperative chemotherapy and 12 had adjuvant chemotherapy. Patients with unilateral metastases comprised the majority of patients (N = 22, 68.8%); 59% (N = 19) had a solitary metastasis. The median diameter of lung metastases was 20.5 mm (range 7.0 -50.0). Ten patients had concurrent liver metastases, eight of whom had liver resection as well. Overall, 31% (10/32) of patients recurred, with 50% (16/32) of recurrences in the lung, and 28% died. Estimated median OS was 55.0 months. Estimated 5-year OS was 32% ± 17%. Higher CEA level ( ≥ 4.5 ng/mL) at the time of diagnosis of lung metastasis was associated with worsened OS (p = 0.026). Other potential prognostic factors, such as laterality, number of lung metastases, and extrapulmonary lesions, were not associated with overall survival in this study population. Conclusions: Our study showed resection of lung metastases in select patients with colorectal cancer can be associated with prolonged survival in the range seen with resection of liver metastases. Higher CEA level at time of diagnosis of lung metastasis is associated with poorer prognosis. More data are necessary to identify approaches to patient selection in the metastatic colorectal setting.

P-0237 Open and Video-Assisted Thoracoscopic Resection of Solitary Lung Metastases in Patients with Colorectal Cancer: Preliminary Results

ABSTRACT Introduction In patients with colorectal cancer (CRC), the most frequent metastatic site is the liver. In resectable cases liver resection is usually performed, while different treatment modalities including, hepatic arterial infusion chemotherapy, vein embolization, and local destruction with cryotherapy or radiofrequency ablation represent the treatments of choice in unresectable cases. The lung is an uncommon site of metastases from CRC, accounting for 5-10% of cases. In addition, some CRC patients develop pulmonary metastases even when the metastatic sites are considered to be limited to the liver. Unfortunately, untreated stage IV CRC patients have an overall median survival of 6-8 months, and a 5-year survival less than 2-3%. Thus, surgery still remains the sole possible treatment for patients with resectable lung metastases. Pulmonary resection for metastatic CRC has long been reported, although initially this surgical treatment was considered not completely satisfactory. Currently, pulmonary metastasectomy through thoracoscopy appears to be feasible, leading to similar results than that obtained with open surgery, with the advantages of a minimally invasive approach. The aim of this study was to analyze the results of video-assisted thoracoscopic (VATS) pulmonary metastasectomy in patients with CRC. Methods We retrospectively reviewed the results of surgery in a group of 34 patients (26 men, 8 women, median age 64 years) with stage I-II CRC who developed a solitary and small ( Results The mean postoperative follow-up was 49 months (range 6-98 months). The overall 1-year and 3-year survival rate was 85.3% and 67.6%, while the disease-free interval (DFI) rate was 58.8% and 35.3% in Groups A and B, respectively. The 1- and 3-year (Group A vs. B) survival rate was 83.3% vs. 87.5% (95% CI 0.71-4.92, p=0.56), and 61.1% vs. 75.0% (95% CI 0.12-2.29, p=031), while the 1- and 3-year DFI rate was 55.6% vs. 62.5% (95% CI 1.19-2.96, p=0.68), and 33.3% vs. 37.5% (95% CI 0.20-3.41, p=0.56), respectively. Conclusion Better results were obtained in patients who underwent VATS resection, but survival and DFI rates did not differ significantly between Groups. Thus, according to our preliminary reports, in patients with CRC who develop solitary lung metastasis, VATS should be considered the surgical technique of choice.

Surgery for pathological proximal femoral fractures, excluding femoral head and neck fractures

Pathological femoral head and neck fractures are commonly treated by arthroplasty. Treatment options for the trochanteric region or below are not clearly defined. The purpose of this retrospective, comparative, double-centre study was to analyse survival and influences on outcome according to the surgical technique used to treat pathological proximal femoral fractures, excluding fractures of the femoral head and neck. Fifty-nine patients with 64 fractures were operated up on between 1998 and 2004 in two tertiary referral centres and divided into two groups. One group (S, n = 33) consisted of patients who underwent intramedullary nailing alone, and the other group (R, n = 31) consisted of patients treated by metastatic tissue resection and reconstruction by means of different implants. Median survival was 12.6months with no difference between groups. Surgical complications were higher in the R group (n = 7) vs. the S group (n = 3), with no statistically significant difference. Patients with surgery-related complications had a higher survival rate (p = 0.049), as did patients with mechanical implant failure (p = 0.01). Survival scoring systems did not correlate with actual survival. Resection of metastases in patients with pathological fractures of the proximal femur, excluding femoral head and neck fractures, has no influence on survival. Patients with long postoperative survival prognosis are at risk of implant-related complications.

Treatment with 5-Fluorouracil/Folinic Acid, Oxaliplatin, and Irinotecan Enables Surgical Resection of Metastases in Patients With Initially Unresectable Metastatic Colorectal Cancer

The prognosis of unresectable metastatic colorectal cancer might be improved if a radical surgical resection of metastases could be performed after a response to chemotherapy. We treated 74 patients with unresectable metastatic colorectal cancer (not selected for a neoadjuvant approach) with irinotecan, oxaliplatin, and 5-fluorouracil/leucovorin (FOLFOXIRI and simplified FOLFOXIRI). Because of the high activity of these regimens (response rate, 72%), a secondary curative operation could be performed in 19 patients (26%). Four patients underwent an extended hepatectomy, nine patients underwent a right hepatectomy, three patients underwent a left hepatectomy, and three patients had a segmental resection. In five patients, surgical removal of extrahepatic disease was also performed. In seven patients, surgical resection was combined with intraoperative radiofrequency ablation. The median overall survival of the 19 patients who underwent operation is 36.8 months, and the 4-year survival rate is 37%. The median overall survival of the 34 patients who were responsive to chemotherapy, but who did not undergo operation, is 22.2 months (P = .0114). The FOLFOXIRI regimens we studied have significant antitumor activity and allow a radical surgical resection of metastases in patients with initially unresectable metastatic colorectal cancer not selected for a neoadjuvant approach and also those with extrahepatic disease. The median survival of patients with resected disease is promising.

The surgical management of metastatic melanoma.

When deciding whether or not to perform a resection for metastatic melanoma, one should follow general principles that apply to the patient with melanoma as well as to the patient with metastases from other types of primary tumors. When the resection is palliative, the success of surgical treatment will be governed by the presence of identifiable symptoms, the morbidity of the procedure, the course of the disease, and the ability to communicate treatment goals among surgeon, patient, and family. When the resection is performed with curative intent, long-term survival depends on the ability of the surgeon to select patients with a pattern of recurrence suggestive of a less aggressive tumor biology. Regardless of the extent of the operative procedure, resection of metastases in patients whose disease recurs early after the treatment of the primary tumor, in those who present with multiple lesions, and in those who present with disease that cannot be completely resected will only rarely be associated with subsequent long-term survival.

The role of surgery for patients with metastatic melanoma.

When deciding to perform a resection for metastatic melanoma one should first decide whether the intent of the procedure is curative or palliative. When the resection is palliative, the success of surgical treatment will depend on the presence of identifiable symptoms, the morbidity of the procedure, the course of the disease, and the ability to communicate the treatment goals among surgeon, patient, and family. When the resection is curative, survival will depend on the ability of the surgeon to select patients with a pattern of recurrence suggestive of less aggressive tumor biology. Factors generally found predictive of improved survival, and therefore reflective of tumor biology, include longer disease-free interval, fewer numbers of metastases, and the ability to obtain a complete resection. Resection of metastases in patients who recur within one-year, who present with multiple lesions, and who present with disease that cannot be completely resected, will not result in long-term survival.

Metastasectomy – are its benefits chiefly and directly linked to surgery as such, or caused by patient selection and other confounding factors?

Metastasectomy is widely practiced in surgical oncology. Well established examples are the resection of liver metastases in patients with colo-rectal cancer, wedge resections of lung metastases in sarcoma, or the surgical removal of solitary brain metastases derived from solid tumours. The latter example has been tested in randomised phase III trials and found to be an effective mode of treatment compared with radiation therapy alone. In the other fields no such trials are available, and data chiefly stem from retro- and prospective phase II trials. For a variety of reasons, phase II studies are not suitable to separate confounding factors such as selection of good-risk patients, stage migration linked to the improvement of preoperative staging techniques, and improved supportive care, from the direct therapeutic effects of the surgical procedure as such. Although desirable, it is unlikely that surgeons and patients would accept randomised trials to reassess evidence levels in this field. In practice, large prospective studies of case series are likely to provide the highest evidence level achievable, and these limitations of the literature should be taken into account in an appropriate fashion when patients with metastatic cancer are advised about options for surgery.

Resection of hepatic metastases in patients traditionally not considered resection candidiates

Resection of hepatic metastases in patients traditionally not considered resection candidiates