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Wein A, Siebler J, Goertz R, et al. Successful Multidisciplinary Treatment with Secondary Metastatic Liver Resection after Downsizing by Palliative Second-Line Treatment of Colorectal Cancer: A Curative Option. Case Rep Oncol. 2016;9(2):379-86doi: 10.1159/000445677.
Wein, A., Siebler, J., Goertz, R., Wolff, K., Ostermeier, N., Busse, D., Kremer, A. E., Koch, F., Hagel, A., Farnbacher, M., Kammerer, F. J., Neurath, M. F., & Gruetzmann, R. (2016). Successful Multidisciplinary Treatment with Secondary Metastatic Liver Resection after Downsizing by Palliative Second-Line Treatment of Colorectal Cancer: A Curative Option. Case reports in oncology, 9(2), 379-86. https://doi.org/10.1159/000445677
Wein, Axel, et al. "Successful Multidisciplinary Treatment with Secondary Metastatic Liver Resection after Downsizing by Palliative Second-Line Treatment of Colorectal Cancer: A Curative Option." Case reports in oncology vol. 9,2 (2016): 379-86. doi: https://doi.org/10.1159/000445677
Wein A, Siebler J, Goertz R, Wolff K, Ostermeier N, Busse D, Kremer AE, Koch F, Hagel A, Farnbacher M, Kammerer FJ, Neurath MF, Gruetzmann R. Successful Multidisciplinary Treatment with Secondary Metastatic Liver Resection after Downsizing by Palliative Second-Line Treatment of Colorectal Cancer: A Curative Option. Case Rep Oncol. 2016 Jul 09;9(2):379-86. doi: 10.1159/000445677. eCollection 2016. PMID: 27489542; PMCID: PMC4960360.
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Case Rep Oncol. 2016 Jul 09;9(2):379-86. doi: 10.1159/000445677. eCollection 2016.

Successful Multidisciplinary Treatment with Secondary Metastatic Liver Resection after Downsizing by Palliative Second-Line Treatment of Colorectal Cancer: A Curative Option.

Case reports in oncology

Axel Wein, Jürgen Siebler, Ruediger Goertz, Kerstin Wolff, Nicola Ostermeier, Dagmar Busse, Andreas E Kremer, Franz Koch, Alexander Hagel, Michael Farnbacher, Ferdinand J Kammerer, Markus F Neurath, Robert Gruetzmann

Affiliations

  1. Department of Internal Medicine 1 - Gastroenterology, Pulmonology and Endocrinology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
  2. Practice of Gastroenterology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
  3. Department of Radiology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
  4. Department of Surgery, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.

PMID: 27489542 PMCID: PMC4960360 DOI: 10.1159/000445677

Abstract

INTRODUCTION: The prognostic outcome following progression after palliative first-line treatment for patients suffering from metastatic colorectal adenocarcinoma is generally poor. Long-term relapse-free survival with palliative second-line treatment may be achieved in only a limited number of individual cases.

CASE REPORT: A 37-year-old patient presented with bilobar liver metastases of colon cancer confirmed by histology with wild-type K-RAS (exon 2). Due to progressive disease after eight cycles of first-line therapy with FOLFIRI plus cetuximab, second-line chemotherapy with modified FOLFOX4 (mFOLFOX4) plus bevacizumab was initiated. During four cycles of mFOLFOX4 plus bevacizumab (2 months), no higher-grade toxicity occurred. Liver MRI with contrast medium revealed downsizing of the segment II/III metastases, as well as regressive, small, faint, hardly definable lesions in segments VI and IVb. The interdisciplinary tumor board of the University of Erlangen thus decided to perform resection of the liver metastases. Segments II and III were resected, and the liver metastases in segments IVa and VI were excised (R0). Histopathology confirmed three of the R0-resected metastases to be completely necrotic, with residual scarring. As perioperative therapy, four additional cycles of mFOLFOX4 plus bevacizumab were administered postoperatively. No higher-grade toxicity was observed. Three years after the initial diagnosis, the patient is relapse free, professionally fully reintegrated, and has an excellent performance status.

CONCLUSION: Patients suffering from metastatic colorectal cancer may benefit from multidisciplinary treatment with secondary metastatic liver resection after downsizing by palliative second-line treatment. In individual cases, patients may even have a curative treatment option, provided that close interdisciplinary collaboration exists.

Keywords: Colorectal cancer; Curative option; Second-line chemotherapy; Secondary liver metastasis resection

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