Clinical practice of MDT in simultaneous hepatic metastasis of rectal cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHENG Bobo ¹ , HU Tao ¹ , DENG Xiangbing ¹ , QIU Meng ² , WANG xin ³ , WU Hong ⁴ , WU Bin ⁵ ,  WANG Ziqiang ¹

1. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Oncology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. Department of Radiotherapy, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
4. Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
5. Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

WANG Ziqiang, Email: wangzqzyh@163.com

Keywords：

MDT; rectal cancer; simultaneous hepatic metastasis

DOI：

10.7507/1007-9424.201712103

Video：

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Objective To develop tailored treatment regimens for a patient with simultaneous liver metastasis of rectal cancer. Methods Considering the patient's specific condition of different teatment stage, the specialists of oncology, imaging, gastroenterology, hepatic surgery, and radiotherapy conduct multidisciplinary consultation. Results After hepatic metastatic tumor was resected, 4 cycles of XELOX chemotherapy combined with radiotherapy, tumor recurrence did not found in the liver. After resection of rectal cancer, the patient received 6 cycles of XELOX. The CEA and the thoracic, abdominal CT and pelvic MRI were reviewed 9 months after operation and no recurrence of the tumor was found. Conclusion The MDT mechanism can provide individualized treatment for patients with advanced rectal cancer and benefit these patients.

Citation： ZHENG Bobo, HU Tao, DENG Xiangbing, QIU Meng, WANG xin, WU Hong, WU Bin, WANG Ziqiang. Clinical practice of MDT in simultaneous hepatic metastasis of rectal cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(3): 342-349. doi: 10.7507/1007-9424.201712103 Copy

1.	American Cancer Society. How many people get colorectal cancer? www.cancer.org. Accessed June 6, 2006.
2.	Yoo PS, Lopez-Soler RI, Longo WE, et al. Liver resection for metastatic colorectal cancer in the age of neoadjuvant chemotherapy and bevacizumab. Clin Colorectal Cancer, 2006, 6(3): 202-207.
3.	Hayashi M, Inoue Y, Komeda K, et al. Clinicopathological analysis of recurrence patterns and prognostic factors for survival after hepatectomy for colorectal liver metastasis. BMC Surg, 2010, 10: 27.
4.	National Comprehensive Cancer Network. NCCN Clinical PracticeGuidelines in Oncology: rectal cancer, V.3. 2017. https://www.nccn.org/store/login/login.aspx?ReturnURL=https://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf.
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6.	Van Cutsem E, Cervantes A, Adam R, et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol, 2016, 27(8): 1386-1422.
7.	Clavien PA, Petrowsky H, DeOliveira ML, et al. Strategies for safer liver surgery and partial liver transplantation. N Engl J Med, 2007, 356(15): 1545-1559.
8.	Zorzi D, Laurent A, Pawlik TM, et al. Chemotherapy-associated hepatotoxicity and surgery for colorectal liver metastases. Br J Surg, 2007, 94(3): 274-286.
9.	Jones RP, Stattner S, Sutton P, et al. Controversies in the oncosurgical management of liver limited stage Ⅳ colorectal cancer. Surg Oncol, 2014, 23(2): 53-60.
10.	Fong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg, 1999, 230(3): 309-318; discussion 318-321.
11.	李进, 张苏展, 蔡三军, 等.中国临床肿瘤学会 (CSCO) 2017 版结直肠癌诊疗指南. http://www.csco.org.cn/cat/148/topic/2368-p1.html.
12.	Mentha G, Roth AD, Terraz S, et al. " Liver first”approach in the treatment of colorectal cancer with synchronous liver metastases. Dig Surg, 2008, 25(6): 430-435.
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14.	Grundmann RT, Hermanek P, Merkel S, et al. Diagnosis and treatment of colorectal liver metastases-workflow. Zentralbl Chir, 2008, 133(3): 267-284.
15.	Kelly ME1, Spolverato G, Lê GN. Synchronous colorectal liver metastasis: a network meta-analysis review comparing classical, combined, and liver-first surgical strategies. J Surg Oncol, 2015, 111(3): 341-351.
16.	Andres A, Toso C, Adam R, et al. A Survival analysis of the liver-first reversed management of advanced simultaneous colorectal liver metastases. Ann Surg, 2012, 256(5): 772-779.
17.	Mayo SC, Pulitano C, Marques H, et al. Surgical management of patients with synchronous colorectal liver metastasis: A multicenter international analysis. J Am Coll Surg, 2013, 216(4): 707-716.
18.	朱峰锋, 司马辉, 宋金超. 结直肠癌肝转移的临床病理特征与术后生存关系分析. 中国普外基础与临床杂志, 2016, 23(7): 781-786.
19.	朱德祥, 任黎, 许剑民. Ⅳ期结直肠癌转移病灶的局部根治性与姑息性处理进展. 中国普外基础与临床杂志, 2017, 11(24): 1306-1310.
20.	MERCURY Study Group. Extramural depth of tumor invasion at thin-section MR in patients with rectal cancer: results of the MERCURY study. Radiology, 2007, 243(1): 132-139.
21.	Poston GJ, Guideline Development Group. Diagnosis and management of colorectal cancer: summary of NICE guidance. BMJ, 2011, 343: d6751.
22.	Butte JM, Gonen M, Ding P, et al. Patterns of failure in patients with early onset (synchronous) resectable liver metastases from rectal cancer. Cancer, 2012, 118(21): 5414-5423.
23.	Chang CY, Kim HC, Park YS, et al. The effect of postoperative pelvic irradiation after complete resection of metastatic rectal cancer. J Surg Oncol, 2012, 105(3): 244-248.
24.	An HJ, Yu CS, Yun SC, et al. Adjuvant chemotherapy with or without pelvic radiotherapy after simultaneous surgical resection of rectal cancer with liver metastases: analysis of prognosis and patterns of recurrence. Int J Radiat Oncol Biol Phys, 2012, 84(1): 73-80.
25.	Lee JH, Jo IY, Lee JH, et al. The role of postoperative pelvic radiation in stage Ⅳ rectal cancer after resection of primary tumor. Radiat Oncol J, 2012, 30(4): 205-212.
26.	Benson AB, D'Angelica MI, Abbott DE, et al. NCCN Guidelines Insights: Hepatobiliary Cancers, Version 1.2017. J Natl Compr Canc Netw, 2017, 15(5): 563-573.
27.	桂安, 陈思羽, 赵师仲. 肝内胆管细胞癌的动态增强多层螺旋 CT 表现. 肝脏, 2013, 18(10): 675-676.
28.	李松年. 现代全身 CT 诊断学. 北京: 中国医药科技出版社, 2002: 720-721.
29.	王屹. 结直肠癌肝转移影像学评估及意义. 中国实用外科杂志, 2016, 36(4): 391-396.
30.	Kim YK, Park G, Kim CS, et al. Diagnostic efficacy of gadoxeticacid-enhanced MRI for the detection and characterisation of liver metastases: comparison with multidetector-row CT. Br J Radiol, 2012, 85(1013): 539-547.
31.	Brännström F, Bjerregaard JK, Winbladh A, et al. Multidisciplinary team conferences promote treatment according to guidelines in rectal cancer. Acta Oncol, 2015, 54(4): 447-453.

1. American Cancer Society. How many people get colorectal cancer? www.cancer.org. Accessed June 6, 2006.
2. Yoo PS, Lopez-Soler RI, Longo WE, et al. Liver resection for metastatic colorectal cancer in the age of neoadjuvant chemotherapy and bevacizumab. Clin Colorectal Cancer, 2006, 6(3): 202-207.
3. Hayashi M, Inoue Y, Komeda K, et al. Clinicopathological analysis of recurrence patterns and prognostic factors for survival after hepatectomy for colorectal liver metastasis. BMC Surg, 2010, 10: 27.
4. National Comprehensive Cancer Network. NCCN Clinical PracticeGuidelines in Oncology: rectal cancer, V.3. 2017. https://www.nccn.org/store/login/login.aspx?ReturnURL=https://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf.
5. Ihnát P, Vávra P, Zonča P. Treatment strategies for colorectal carcinoma with synchronous liver metastases: Which way to go? World J Gastroenterol, 2015, 21(22): 7014-7021.
6. Van Cutsem E, Cervantes A, Adam R, et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol, 2016, 27(8): 1386-1422.
7. Clavien PA, Petrowsky H, DeOliveira ML, et al. Strategies for safer liver surgery and partial liver transplantation. N Engl J Med, 2007, 356(15): 1545-1559.
8. Zorzi D, Laurent A, Pawlik TM, et al. Chemotherapy-associated hepatotoxicity and surgery for colorectal liver metastases. Br J Surg, 2007, 94(3): 274-286.
9. Jones RP, Stattner S, Sutton P, et al. Controversies in the oncosurgical management of liver limited stage Ⅳ colorectal cancer. Surg Oncol, 2014, 23(2): 53-60.
10. Fong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg, 1999, 230(3): 309-318; discussion 318-321.
11. 李进, 张苏展, 蔡三军, 等.中国临床肿瘤学会 (CSCO) 2017 版结直肠癌诊疗指南. http://www.csco.org.cn/cat/148/topic/2368-p1.html.
12. Mentha G, Roth AD, Terraz S, et al. " Liver first”approach in the treatment of colorectal cancer with synchronous liver metastases. Dig Surg, 2008, 25(6): 430-435.
13. Adam R, De Gramont A, Figueras J, et al. The oncosurgery approach to managing liver metastases from colorectal cancer: a multidisciplinary international consensus. Oncologist, 2012, 17(10): 1225-1239.
14. Grundmann RT, Hermanek P, Merkel S, et al. Diagnosis and treatment of colorectal liver metastases-workflow. Zentralbl Chir, 2008, 133(3): 267-284.
15. Kelly ME1, Spolverato G, Lê GN. Synchronous colorectal liver metastasis: a network meta-analysis review comparing classical, combined, and liver-first surgical strategies. J Surg Oncol, 2015, 111(3): 341-351.
16. Andres A, Toso C, Adam R, et al. A Survival analysis of the liver-first reversed management of advanced simultaneous colorectal liver metastases. Ann Surg, 2012, 256(5): 772-779.
17. Mayo SC, Pulitano C, Marques H, et al. Surgical management of patients with synchronous colorectal liver metastasis: A multicenter international analysis. J Am Coll Surg, 2013, 216(4): 707-716.
18. 朱峰锋, 司马辉, 宋金超. 结直肠癌肝转移的临床病理特征与术后生存关系分析. 中国普外基础与临床杂志, 2016, 23(7): 781-786.
19. 朱德祥, 任黎, 许剑民. Ⅳ期结直肠癌转移病灶的局部根治性与姑息性处理进展. 中国普外基础与临床杂志, 2017, 11(24): 1306-1310.
20. MERCURY Study Group. Extramural depth of tumor invasion at thin-section MR in patients with rectal cancer: results of the MERCURY study. Radiology, 2007, 243(1): 132-139.
21. Poston GJ, Guideline Development Group. Diagnosis and management of colorectal cancer: summary of NICE guidance. BMJ, 2011, 343: d6751.
22. Butte JM, Gonen M, Ding P, et al. Patterns of failure in patients with early onset (synchronous) resectable liver metastases from rectal cancer. Cancer, 2012, 118(21): 5414-5423.
23. Chang CY, Kim HC, Park YS, et al. The effect of postoperative pelvic irradiation after complete resection of metastatic rectal cancer. J Surg Oncol, 2012, 105(3): 244-248.
24. An HJ, Yu CS, Yun SC, et al. Adjuvant chemotherapy with or without pelvic radiotherapy after simultaneous surgical resection of rectal cancer with liver metastases: analysis of prognosis and patterns of recurrence. Int J Radiat Oncol Biol Phys, 2012, 84(1): 73-80.
25. Lee JH, Jo IY, Lee JH, et al. The role of postoperative pelvic radiation in stage Ⅳ rectal cancer after resection of primary tumor. Radiat Oncol J, 2012, 30(4): 205-212.
26. Benson AB, D'Angelica MI, Abbott DE, et al. NCCN Guidelines Insights: Hepatobiliary Cancers, Version 1.2017. J Natl Compr Canc Netw, 2017, 15(5): 563-573.
27. 桂安, 陈思羽, 赵师仲. 肝内胆管细胞癌的动态增强多层螺旋 CT 表现. 肝脏, 2013, 18(10): 675-676.
28. 李松年. 现代全身 CT 诊断学. 北京: 中国医药科技出版社, 2002: 720-721.
29. 王屹. 结直肠癌肝转移影像学评估及意义. 中国实用外科杂志, 2016, 36(4): 391-396.
30. Kim YK, Park G, Kim CS, et al. Diagnostic efficacy of gadoxeticacid-enhanced MRI for the detection and characterisation of liver metastases: comparison with multidetector-row CT. Br J Radiol, 2012, 85(1013): 539-547.
31. Brännström F, Bjerregaard JK, Winbladh A, et al. Multidisciplinary team conferences promote treatment according to guidelines in rectal cancer. Acta Oncol, 2015, 54(4): 447-453.

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Clinical practice of MDT in simultaneous hepatic metastasis of rectal cancer

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