161TiP A phase II study of mFOLFOXIRI after metastasectomy in patients with oligometastatic colorectal cancer (FANTASTIC study)
M. IkedaKozo KataokaTakaaki YamadaK. YamazakiK. MoriNobuhisa MatsuhashiManabu ShiozawaMarco DuranteToshie IwaiKeitaro ItoMasaaki YasuiYukio TakiiTaketo SutoYasuyuki TakamizawaNaoto TakaseS. SharmaJoie EnsorA. JurdiM.C. LiuY. Kanemitsu
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We aimed to evaluate oncological outcomes after repeat metastasectomies in patients having undergone previous resections for colorectal cancer metastases.We examined 248 patients who underwent metastasectomies for lung and/or liver metastases at our center during a 7-year period, from January 2005 to December 2011. Recurrence-free survival 1 (RFS1) after the metastasectomy for the initial recurrence, recurrence-free survival 2 (RFS2) after the second, and recurrence-free survival 3 (RFS3) after the third repeated resections for recurrence were assessed. The overall survival (OS) rate after the first metastasectomy for the first recurrence (OS) was also assessed.Sites of recurrence of the first metastasectomy were the liver, lung, and liver and lung in 115, 117, and 16 cases, respectively, and 133 patients had a second recurrence (133/248, 53.6%). Twenty-seven patients had a third recurrence (27/52, 51.9%), of whom 14 underwent a third metastasectomy. The 5-year and 10-year OS rates were 74.8% and 57.9%, respectively. The 1-year RFS1, RFS2, and RFS3 rates were 76%, 75%, and 39%, respectively. The hazard ratios for RFS were 1.142 and 2.590 for the first and second repeat surgeries, when compared to the first metastasectomy. The third metastasectomy showed significantly lower RFS than did the second metastasectomy.A second metastasectomy should be considered the optimal treatment for a second recurrence. However, careful considerations should be made before performing a third metastasectomy.
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14574 Forty eight patients (24 males and 24 females) with colorectal carcinoma and lung or hepatic metastasis who had undergone metastasectomy were evaluated retrospectively. The mean age was 58.12±8.34 years (43–79 years). The mean age of the males was 60.16±8.21 years (47–79 years), while it was 56.08±8.13 years in the females (43–71 years). Among the 48 metastasectomies that were performed, 11 were pulmonary metastases, and 37 were hepatic metastases. The mean time to the hepatic metastasectomy after primary surgery was 324.37±420.04. Among the hepatic metastases, one was located in the caudate lobe, 16 were located in the right lobe, and 20 were located in the left lobe. Thirty of the patients had received postoperative chemotherapy after liver metastasectomy. Twenty two of the patients who underwent liver metastasectomy (59%) had a recurrence. In 14 of these, (38%) the recurrence was in the liver. Overall survival of the patients with liver metastasectomy was 914.19±577.08 days. Survival after metastasectomy was 578.80±331.54 days. On the other hand, the mean time to pulmonary metastasectomy after primary surgery was 811.81±552.06 days. Eight of the lung metastases were located in the right lobe, whereas 3 were located in the left lobe. Three patients had concomittant metastases in the right upper and lower lobes, and one patient had additional liver metastasis. Eight of the patients who underwent pulmonary metastasectomy had received postoperative chemotherapy. Five of the patients who underwent pulmonary metastasectomy (45%) had a recurrence. Two of the patients had recurrence in the lung, while 3 had recurrence elsewhere. Overall survival of the patients who underwent pulmonary metastasectomy after initial surgery was 1341.54±816.21 days. Survival after metastasectomy was 528.81±365.45 days while recurrence-free survival after pulmonary metastasctomy was 342.18±125.71 days. Conclusion: This study suggests that patients with pulmonary metastasectomies have even beter clinical outcomes then hepatic metastasectomies in patients with metastatic coloercatla cencer. Every effort should be made to perform both pulmonary and hepatic metastasectomies in this group of patients. No significant financial relationships to disclose.
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The first, and perhaps most famous, planned pulmonary
metastasectomy in the United States was performed in 1933 by Barney
and Churchill for metastatic renal cell carcinoma. During the
nineteenth century there were sporadic reports of lung resections for
metastatic tumors reported in the European literature. The first one of
these reports was in 1855, by the French surgeon Sedillot, who removed
a chest wall tumor and excised disease extending into the lung.
Almost 30 years later, in 1882, Weinlechner was credited for the
first resection of a true pulmonary metastases.It was not for another 40
years that metastasectomy was performed as a separate procedure by
Divis in Europe. This was followed soon after by similar reports in
the American literature by Torek and Tudor Edwards in the early
twentieth century. These early reports, and others like them, paved the way toward
general acceptance of pulmonary metastasectomy. In 1947 Alexander
and Haight reported the first series of pulmonary metastasectomies.
By the 1950s there were numerous case series with similar accounts.
Today the indications for resection of secondary pulmonary
malignancies have been broadened to include patients not only with
recurrent disease, but those with multiple metastases, bilateral lesions,
and essentially all histologies.
AIMS AND OBJECTIVES :
1. To assess the long term results of pulmonary metastasectomy.
2. To assess prognostic factors which are likely to influence long term outcomes.
3. To find out a favourable subset of prognostic group who may
benefit from pulmonary metastasectomy
METHOD :
Between January 1997 to December 2006 , all patients who
underwent pulmonary metastasectomy were included in this analysis.
Individual patient data were obtained from the case records in the
MMTR which also serves as a HBTR for Cancer Institute (WIA). A total
of 53 patient records were obtained , of that only 42 cases were taken
analysis. Patients who underwent planned sequential or staged
metastasectomies were considered to have single metastasectomy and
redo surgery. Analysis was done using SPSS 11.0.1 statistical package.
Following variables were tested : DFI ,unilateral or bilateral
presentation, number of metastases, histological type and site of primary
tumor, margin status, size of metastases, mediastinal nodes. Survival was
calculated from the time of first metastasectomy to the last date of follow
up by means of Kaplan – Meier estimate.
CONCLUSION :
Pulmonary metastasectomy is a potentially curative treatment that
can be done safely with low mortality or morbidity.
Good prognostic variables like increasing DFI (> 1 year), ability
to do R0 resection, solitary metastasis, size of the lesion less than
1 cm, and absence of mediastinal nodal positivity showed a trend
towards improved survival. Good prognostic group selected on the
basis of the risk factors like completely resected lesions, DFI and
number of metastases show a difference in survival between good
risk and poor risk groups ( 88% and 65% at 36 months). Although
these were not found to be significant in univariate or multivariate
analysis using Cox regression analysis.
There is a need for larger multicenteric analysis of data with larger
duration of follow up, from specialized centres who practice
pulmonary metastasectomy, to arrive at definite conclusions.
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Pulmonary metastasectomy in osteosarcoma can lead to long-term survival, but the role for repeat pulmonary metastasectomy is undefined. To confirm the value of repeat pulmonary resection of recurrent pulmonary metastases, we herein reviewed our institutional experience. Between 1989 and 2007, 25 patients with pulmonary metastases from osteosarcomas of the extremities underwent pulmonary resection, and 14 patients underwent repeat pulmonary metastasectomy. Ten of 14 patients underwent complete resection. Various perioperative variables were investigated retrospectively in these patients to confirm a role for repeat metastasectomy and analyze prognostic factors for overall survival (OS) after repeat pulmonary metastasectomy. OS rate after repeat pulmonary metastasectomy was 43% at two years and 19% at five years. On multivariate analysis, patients with complete resection presented significantly favorable OS (P=0.02). Interestingly enough, survival curve of patients with complete resection after the first pulmonary metastasectomy was almost the same as that of patients with complete resection after the second pulmonary metastasectomy. In conclusion, patients with complete resection for recurrent pulmonary metastasis show a significantly better prognosis after repeat pulmonary metastasectomy. Our data imply that repeat pulmonary metastasectomy might be beneficial because it can salvage a subset of patients with osteosarcoma who retain favorable prognostic determinants.
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Colorectal cancer (CRC) is one of the most common cancers worldwide, with 5%-15% of CRC patients eventually developing lung metastasis (LM).Despite doubts about the role of locoregional therapy in the management of systemic disease, many surgeons have performed pulmonary metastasectomy (PM) for CRC in properly selected patients.However, the use of pulmonary metastasectomy remains controversial due to the lack of randomized controlled studies.This article reviews the results of surgical treatment of pulmonary metastases for CRC, focusing on (1) current treatment guidelines and surgical techniques of PM in patients with LM from CRC; (2) outcomes of PM and its prognostic factors; and (3) controversial issues in PM, focusing on repeated metastasectomy, bilateral multiple metas-
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Purpose . To identify prognostic factors for metastatic osteosarcoma patients and establish indication for repeat metastasectomy. Methods . Data from 37 patients with pulmonary metastasis from osteosarcoma who underwent metastasectomy in our institute from 1979 to 2013 were retrospectively reviewed. Results . Prognostic factors analyzed were age, sex, maximal diameter of the tumor at first pulmonary metastasectomy, total number of resected pulmonary metastases at first metastasectomy, number of surgeries, and disease free interval. In our analysis, characteristics associated with an increased overall survival were age > 15 years and fewer metastases (≤3). Of the 37 patients, 13 underwent repeat metastasectomy after the first metastasectomy. Of the 7 patients that underwent only two metastasectomies, three remained disease-free. In contrast, all six patients that underwent three or more metastasectomies died of relapse. Patients who had five or less lesions at second metastasectomy showed better survival compared to those who had six or more lesions. Conclusion . Age > 15 years and number of metastases at first metastasectomy were independent prognostic factors. Metastasectomy may provide curative treatment even in cases requiring repeat surgery. The number of metastases at second metastasectomy may be a potential predictor of the need for repeat surgery.
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