From the aDivision of Surgical Oncology, Department of Surgery, and bDepartment of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California.
J Natl Compr Canc Netw. 2013 Sep;11 Suppl 4:S3-8. doi: 10.6004/jnccn.2013.0219.
Colorectal cancer is a common and significant public health concern. The liver is the most common site of metastasis, and colorectal cancer liver metastases (CRLM) may affect up to 60% of patients at some time during the course of their disease. Approximately 25% of patients are found to have synchronous CRLM at the time of diagnosis, and these patients have a worse prognosis than those who develop metastases later in their disease course. In the absence of extrahepatic disease, resection of CRLM with negative margins along with chemotherapy can lead to a 5-year overall survival rate of up to 60%. This report presents the case of a 48-year-old man diagnosed with rectal cancer and synchronous liver metastases that a multidisciplinary tumor board initially deemed to be unresectable because of large size and insufficient future liver remnant. The patient underwent FOLFOX chemotherapy with bevacizumab and experienced conversion to resectable hepatic disease. After neoadjuvant short-course radiation treatment to the rectum, the patient underwent combined low anterior resection of the rectum and a right hepatectomy and was rendered disease-free. The management of the patient's clinical course with correlation to the NCCN Clinical Practice Guidelines in Oncology for Rectal Cancer is presented in this report, including discussion of the role of chemotherapy in the conversion of CRLM to resectable status, the role of surgical metastasectomy, and postoperative surveillance of patients with colorectal cancer.
结直肠癌是一个常见且严重的公共卫生问题。肝脏是最常见的转移部位，结直肠癌肝转移（CRLM）可能在疾病过程中的某个时间影响多达 60%的患者。约 25%的患者在诊断时被发现同时患有 CRLM，这些患者的预后比在疾病后期发生转移的患者差。在没有肝外疾病的情况下，肝切除加化疗可使无肝外疾病的 CRLM 患者的 5 年总生存率高达 60%。本报告介绍了一名 48 岁男性的病例，该患者被诊断为直肠癌和同时性肝转移，多学科肿瘤委员会最初认为由于肿瘤较大且未来剩余肝脏不足，这些肿瘤无法切除。该患者接受了 FOLFOX 化疗联合贝伐珠单抗治疗，并发生了可切除肝疾病的转化。直肠接受新辅助短程放疗后，患者接受了直肠低位前切除术和右半肝切除术，肿瘤被完全切除。本报告介绍了该患者临床病程的管理，并与 NCCN 肿瘤学临床实践指南-直肠癌相关联，包括讨论化疗在 CRLM 可切除状态转化中的作用、手术肝转移切除术的作用以及结直肠癌患者的术后监测。
