Colorectal metastase

Turler and coworkers81 (Germany) examined the effectiveness of ECT, in colorectal metastases established in BDIX rats by injection of colon cancer cells under the liver capsule. The tumors thus induced in the liver were subjected to low current level ECT applied via five platinum electrodes (Figure 10). Four different applications were used ... 

Tot T. Identifying colorectal metastases in liver biopsies the novel CDX2 antibody is less specific than the cytokeratin 20+/7-phenotype. Med Set Monit. 2004 10 BR139-BR143. 

Kennedy AS, Coldwell D, Nutting C et al (2004) Y-micro-spheres in the treatment of colorectal metastases USA experience. In Khayat D, Hortobagyi GN (eds) Fifteenth International Congress on Anti-Cancer Treatment, Paris, France, T.C.O., p 285... 

Two devices are commercially available. Thera-Sphere (glass microsphere MDS Nordion, Kana-ta, Canada) was approved in 1999 by the Food and Drug Administration (FDA) under a Humanitarian Device Exemption (HDE) for the treatment of unresectable hepatocellular carcinoma (HCC) in patients who can have appropriately positioned hepatic arterial catheters with or without portal vein thrombosis [1]. SIR-Spheres (resin microsphere Sirtex Medical, Lane Cove, Australia) were granted full pre-marketing approval in 2002 by the FDA for the treatment of colorectal metastases in conjunction with intra-hepatic FUDR [2]. Both devices have European approval for liver neoplasia and approvals in various Asian countries. 

Given the encouraging safety and therapeutic benefit of °Y in both primary and metastatic liver disease, there is an opportunity to explore its application in combination with other available therapies. Studies to assess the potential synergistic therapeutic benefit of °Y and known radio-sensitizers in both metastatic breast and colorectal cancer are warranted. Combination capecitabine and Y present a low toxicity option for breast cancer patients. The potential to improve hepatic tumor response via the synergistic action of selective uptake of 5-FU in the presence of radiation warrants further investigation. °Y in combination with 5-FU, FUDR and capecitabine in colorectal metastases to the liver require further study. Given the potential for super irradiation of liver parenchyma in the presence of these agents, carefully controlled Phase I dose escalation studies are required. 

Another possible area of investigation includes the prophylactic radioemboiization of remnant liver tissue in patients undergoing hepatic resection for HCC or colorectal metastases. Although initially attractive, this approach may hinder and limit the ability for future Y to the prophylactically radio-embolized lobe. Furthermore, the blood supply to small metastases is derived from the portal vein, not the hepatic artery, bringing into question whether prophylactic treatment would yield any radiation effect to microscopic metastases [59]. Therefore, if such a study is undertaken, since imaging of micro-metastases is not possible, improved survival or decreased time to disease recurrence would represent possible endpoints. It is clear that further research is needed to address possible treatment options for advanced stage HCC. Any studies in this patient population require careful consideration of the risk of therapy induced liver failure vs. the benefit of lesion stabilization. 

LA. Infusion For the treatment of colorectal metastases to liver, systemic 5- fluorouracil (5FU) yielded a 20% response rate. FUDR infused through a catheter placed surgically or percutaneously into the hepatic artery, had response rates ranging from 32% to 88% depending upon the criteria utilized. Despite effective control of hepatic disease, extrahepatic metastases were usually the major cause of death. At MDACC, the intraarterial infusion of FUDR (100 mg/m /day-h5) and mitomycin C (10 mg/m ) yielded a response rate of 61% in previously untreated patients, and 45% in patients who failed to respond to previous intravenous 5FU. A response rate of 52% was found with the intraarterial infusion of FUDR and cisplatin (100 mg/m ). The median survival time for the responders was 16 months. 

Lang EK, Brown CL (1993) Colorectal metastases to the liver selective chemoembolization. Radiology 189 417-422 Lee W, Kim S (1998) Renal angiomyolipomas embolotherapy with a mixture of alcohol and iodized oil. J Vase Intervent Radiol 9 255-261... 

Lang EK, Brown CL Jr (1993) Colorectal metastases to the liver selective chemoembolization. Radiology 189 417-422... 

Indication for use Hepatocellular carcinoma Hepatocellular carcinoma, colorectal metastases... 

In the study by Curley (Curley 2003) alocal relapse in only about 7% of the patients was shown after RFA of colorectal metastases, however, 80% of the local recurrences developed in the periphery of tumors larger than 5 cm in diameter. 

McCormack PM, Ginsberg RJ (1998) Current management of colorectal metastases to lung. Chest Surg Clin N Am 8(1) 119-126... 

The liver is the most frequent site of metastases, primarily due to the spread of cancer cells through the portal circulation. Approximately 60% of patients diagnosed with colorectal carcinoma will eventually experience liver disease as the predominant site. As with hepatocellular carcinoma (HCC), surgical resection of colorectal metastases offers the only chance for cure. However, this option is only available to a small percentage of patients. Many patients with other primaries such as breast, lung, and neuroendocrine will develop liver metastases during the course of the dis-... 

Stubbs RS, Cannan RJ, Mitchell AW (2001) Selective Internal Radiation therapy with Yttrium-90 microspheres for extensive colorectal metastases. J Gastrointest Surg 5 294-302... 

Adam R, Lucidi V, Bismuth H (2004) Hepatic colorectal metastases methods of improving resectability. Surg Clin North Am 84 659-671... 

Kokudo N, Tada K, Seki M et al. (2001) Proliferative activity of intrahepatic colorectal metastases after preoperative hemihepatic portal vein embolization. Hepatology 34267-272... 

Carter R, Hemingway D, Cooke TG, et al (1996) A prospective study of six methods for detection of hepatic colorectal metastases. Ann R Coll Surg Engl 78 27-30... 

Bradley AL, Chapman WC, Wright JK (1999) Surgical experience with hepatic colorectal metastases. Am J Surg 65 560-566... 

Lencioni R, Crocetti L, Cioni D, et al (2004b) Percutaneous radiofrequency ablation of hepatic colorectal metastases technique, indications, results, and new promises. Invest Radiol (in press)... 

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