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Oligometastasierung beim kolorektalen Karzinom – moderne Therapiekonzepte

Oligometastasized colorectal cancer—modern treatment strategies

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coloproctology Aims and scope

Zusammenfassung

Hintergrund

Die Prognose des kolorektalen Karzinoms (KRK) im UICC-Stadium IV hat sich durch die Verbesserungen der interdisziplinären Therapie in den letzten Jahrzehnten deutlich verbessert.

Material und Methoden

Behandlungsstrategien des oligometastasierten kolorektalen Karzinoms entwickeln sich zunehmend hin zu einer individualisierten Therapie. Es soll eine Übersicht der aktuellen Literatur zu modernen Therapiekonzepten in der Oligometastasierung beim KRK im Stadium IV gegeben werden.

Ergebnisse

Oberstes Mandat bei resektablen kolorektalen Lebermetastasen hat weiterhin die Chirurgie, neoadjuvante und adjuvante Therapiekonzepte sind ohne onkologischen Vorteil. Bei marginal oder nichtresektablen Stadien steht eine systemische Therapie, abhängig von der prognostischen Einstufung der Patienten im Vordergrund. Auch in der kurativen Situation sind lokale Therapieverfahren sinnvoll additiv einsetzbar. Ein interessanter Therapieansatz bei isoliert hepatisch metastasierten, nichtresektablen KRK ist die Lebertransplantation.

Schlussfolgerung

Unabhängig von neuen Entwicklungen in der Behandlung des metastasierten kolorektalen Karzinoms bleibt die Resektion kolorektaler Lebermetastasen der Goldstandard der onkologischen Therapie wann immer möglich.

Abstract

Background

The prognosis of colorectal cancer in UICC stage IV has been improved in the last decades by improvements in interdisciplinary treatment.

Material and methods

Treatment strategies for oligometastasized colorectal cancer are developing more and more into an individualized treatment. An overview of the current literature of modern treatment concepts in oligometastasized colorectal cancer UICC stage IV is given.

Results

Surgery still has the supreme mandate in resectable colorectal liver metastases, as neoadjuvant and adjuvant treatment strategies to not provide any benefits for these patients. In marginal or non-resectable stages systemic treatment is superior in these patients depending on the prognostic parameters. Also in curative settings local treatment options should be considered as a reasonable additive tool. An interesting treatment approach for isolated liver metastases and non-resectable colorectal cancer is liver transplantation.

Conclusion

Irrespective of new developments in treatment strategies for metastasized colorectal cancer, resection of colorectal liver metastases remains the gold standard whenever possible.

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Literatur

  1. Van CE, Cervantes A, Adam R et al (2016) ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol 27:1386–1422

    Article  Google Scholar 

  2. Hwang M, Jayakrishnan TT, Green DE et al (2014) Systematic review of outcomes of patients undergoing resection for colorectal liver metastases in the setting of extra hepatic disease. Eur J Cancer 50:1747–1757

    Article  Google Scholar 

  3. Grundmann RT, Hermanek P, Merkel S et al (2008) Diagnosis and treatment of colorectal liver metastases – workflow. Zentralbl Chir 133:267–284

    Article  CAS  Google Scholar 

  4. Schoening WN, Denecke T, Neumann UP (2015) Preoperative imaging/operation planning for liver surgery. Chirurg 86:1167–1179

    Article  CAS  Google Scholar 

  5. McCormack L, Petrowsky H, Jochum W et al (2007) Hepatic steatosis is a risk factor for postoperative complications after major hepatectomy: a matched case-control study. Ann Surg 245:923–930

    Article  Google Scholar 

  6. Nakano H, Oussoultzoglou E, Rosso E et al (2008) Sinusoidal injury increases morbidity after major hepatectomy in patients with colorectal liver metastases receiving preoperative chemotherapy. Ann Surg 247:118–124

    Article  Google Scholar 

  7. Costa ML, Lima-Junior RC, Aragao KS et al (2014) Chemotherapy-associated steatohepatitis induced by irinotecan: a novel animal model. Cancer Chemother Pharmacol 74:711–720

    Article  CAS  Google Scholar 

  8. Clavien PA, Petrowsky H, DeOliveira ML, Graf R (2007) Strategies for safer liver surgery and partial liver transplantation. N Engl J Med 356:1545–1559

    Article  Google Scholar 

  9. Stockmann M, Lock JF, Malinowski M et al (2010) The LiMAx test: a new liver function test for predicting postoperative outcome in liver surgery. HPB (Oxford) 12:139–146

    Article  Google Scholar 

  10. Geisel D, Malinowski M, Powerski MJ et al (2014) Improved hypertrophy of future remnant liver after portal vein embolization with plugs, coils and particles. Cardiovasc Intervent Radiol 37:1251–1258

    Article  Google Scholar 

  11. Pandanaboyana S, Bell R, Hidalgo E et al (2015) A systematic review and meta-analysis of portal vein ligation versus portal vein embolization for elective liver resection. Surgery 157:690–698

    Article  Google Scholar 

  12. Garlipp B, de Damm T, Irmscher R et al (1873) Left-liver hypertrophy after therapeutic right-liver radioembolization is substantial but less than after portal vein embolization. Hepatology 59(1864):2014

    Google Scholar 

  13. Tomlinson JS, Jarnagin WR, DeMatteo RP et al (2007) Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol 25:4575–4580

    Article  Google Scholar 

  14. Gruenberger T, Bridgewater J, Chau I et al (2015) Bevacizumab plus mFOLFOX-6 or FOLFOXIRI in patients with initially unresectable liver metastases from colorectal cancer: the OLIVIA multinational randomised phase II trial. Ann Oncol 26:702–708

    Article  CAS  Google Scholar 

  15. Venook AP, Niedzwiecki D, Lenz HJ et al (2017) Effect of first-line chemotherapy combined with cetuximab or bevacizumab on overall survival in patients with KRAS wild-type advanced or metastatic colorectal cancer: a randomized clinical trial. JAMA 317:2392–2401

    Article  CAS  Google Scholar 

  16. Folprecht G, Gruenberger T, Bechstein WO et al (2010) Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomised phase 2 trial. Lancet Oncol 11:38–47

    Article  CAS  Google Scholar 

  17. Vigano L, Darwish SS, Rimassa L et al (2018) Progression of colorectal liver metastases from the end of chemotherapy to resection: a new contraindication to surgery? Ann Surg Oncol 25(6):1676–1685. https://doi.org/10.1245/s10434-018-6387-8

    Article  PubMed  Google Scholar 

  18. Pathak S, Jones R, Tang JM et al (2011) Ablative therapies for colorectal liver metastases: a systematic review. Colorectal Dis 13:e252–e265

    Article  CAS  Google Scholar 

  19. Wright AS, Sampson LA, Warner TF et al (2005) Radiofrequency versus microwave ablation in a hepatic porcine model. Radiology 236:132–139

    Article  Google Scholar 

  20. Jiang HC, Liu LX, Piao DX et al (2002) Clinical short-term results of radiofrequency ablation in liver cancers. World J Gastroenterol 8:624–630

    Article  Google Scholar 

  21. Tanis E, Nordlinger B, Mauer M et al (2014) Local recurrence rates after radiofrequency ablation or resection of colorectal liver metastases. Analysis of the European Organisation for Research and Treatment of Cancer #40004 and #40983. Eur J Cancer 50:912–919

    Article  CAS  Google Scholar 

  22. Stattner S, Jones RP, Yip VS et al (2013) Microwave ablation with or without resection for colorectal liver metastases. Eur J Surg Oncol 39:844–849

    Article  CAS  Google Scholar 

  23. Fiorentini G, Aliberti C, Tilli M et al (2012) Intra-arterial infusion of irinotecan-loaded drug-eluting beads (DEBIRI) versus intravenous therapy (FOLFIRI) for hepatic metastases from colorectal cancer: final results of a phase III study. Anticancer Res 32:1387–1395

    CAS  PubMed  Google Scholar 

  24. Xing M, Kooby DA, El-Rayes BF et al (2014) Locoregional therapies for metastatic colorectal carcinoma to the liver—an evidence-based review. J Surg Oncol 110:182–196

    Article  Google Scholar 

  25. Petersen C, Gauer T (2017) Local ablative radiotherapy of oligometastatic colorectal cancer. Radiologe 57:105–110

    Article  CAS  Google Scholar 

  26. Sterzing F, Brunner TB, Ernst I et al (2014) Stereotactic body radiotherapy for liver tumors: principles and practical guidelines of the DEGRO Working Group on Stereotactic Radiotherapy. Strahlenther Onkol 190:872–881

    Article  Google Scholar 

  27. Andratschke N, Alheid H, Allgauer M et al (2018) The SBRT database initiative of the German Society for Radiation Oncology (DEGRO): patterns of care and outcome analysis of stereotactic body radiotherapy (SBRT) for liver oligometastases in 474 patients with 623 metastases. BMC Cancer 18:283

    Article  CAS  Google Scholar 

  28. Rusthoven KE, Kavanagh BD, Cardenes H et al (2009) Multi-institutional phase I/II trial of stereotactic body radiation therapy for liver metastases. J Clin Oncol 27:1572–1578

    Article  Google Scholar 

  29. Figueras J, Valls C, Rafecas A et al (2001) Resection rate and effect of postoperative chemotherapy on survival after surgery for colorectal liver metastases. Br J Surg 88:980–985

    Article  CAS  Google Scholar 

  30. Huh JW, Cho CK, Kim HR, Kim YJ (2010) Impact of resection for primary colorectal cancer on outcomes in patients with synchronous colorectal liver metastases. J Gastrointest Surg 14:1258–1264

    Article  Google Scholar 

  31. Allard MA, Cunha AS, Gayet B et al (2015) Early and long-term oncological outcomes after laparoscopic resection for colorectal liver metastases: a propensity score-based analysis. Ann Surg 262:794–802

    Article  Google Scholar 

  32. Schiffman SC, Kim KH, Tsung A et al (2015) Laparoscopic versus open liver resection for metastatic colorectal cancer: a metaanalysis of 610 patients. Surgery 157:211–222

    Article  Google Scholar 

  33. Fretland AA, Sokolov A, Postriganova N et al (2015) Inflammatory response after laparoscopic versus open resection of colorectal liver metastases: data from the Oslo-CoMet Trial. Medicine (Baltimore) 94:e1786

    Article  CAS  Google Scholar 

  34. Schadde E, Raptis DA, Schnitzbauer AA et al (2015) Prediction of mortality after ALPPS stage-1: an analysis of 320 patients from the international ALPPS registry. Ann Surg 262:780–785

    Article  Google Scholar 

  35. Ahmad A, Chen SL, Bilchik AJ (2007) Role of repeated hepatectomy in the multimodal treatment of hepatic colorectal metastases. Arch Surg 142:526–531

    Article  Google Scholar 

  36. Heise D, Bayings W, Tuinhof A et al (2017) Long-term outcome and quality of life after initial and repeat resection of colorectal liver metastasis: a retrospective analysis. Int J Surg 48:281–285

    Article  CAS  Google Scholar 

  37. Dueland S, Guren TK, Hagness M et al (2015) Chemotherapy or liver transplantation for nonresectable liver metastases from colorectal cancer? Ann Surg 261:956–960

    Article  Google Scholar 

  38. Tveit KM, Guren T, Glimelius B et al (2012) Phase III trial of cetuximab with continuous or intermittent fluorouracil, leucovorin, and oxaliplatin (Nordic FLOX) versus FLOX alone in first-line treatment of metastatic colorectal cancer: the NORDIC-VII study. J Clin Oncol 30:1755–1762

    Article  CAS  Google Scholar 

  39. Line PD, Hagness M, Berstad AE et al (2015) A novel concept for partial liver transplantation in nonresectable colorectal liver metastases: the RAPID concept. Ann Surg 262:e5–e9

    Article  Google Scholar 

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Correspondence to U. P. Neumann.

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Interessenkonflikt

M. Binnebösel, A. Lambertz, K. Dejong und U.P. Neumann geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Diese Beitrag wurde erstpubliziert in Der Chirurg (2018) 89:497-504. https://doi.org/10.1007/s00104-018-0661-y

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Binnebösel, M., Lambertz, A., Dejong, K. et al. Oligometastasierung beim kolorektalen Karzinom – moderne Therapiekonzepte. coloproctology 41, 194–201 (2019). https://doi.org/10.1007/s00053-018-0312-2

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