TY - JOUR
T1 - The 'liver-first approach' for patients with locally advanced rectal cancer and synchronous liver metastases
AU - Verhoef, Cornelis
AU - Van Der Pool, Anne E.M.
AU - Nuyttens, Joost J.
AU - Planting, Andre S.T.
AU - Eggermont, Alexander M.M.
AU - De Wilt, Johannes H.W.
PY - 2009/1
Y1 - 2009/1
N2 - PURPOSE: This study was designed to investigate the outcome of ''the liver-first'' approach in patients with locally advanced rectal cancer and synchronous liver metastases. METHODS: Patients with locally advanced rectal cancer and synchronous liver metastases were primarily treated for their liver metastases. If successful, patients underwent treatment for the rectal tumor. RESULTS: Twenty-three patients were included. One patient had liver resection without neoadjuvant chemotherapy followed by chemoradiotherapy. All remaining 22 patients underwent laparotomy after chemotherapy. Eighteen patients underwent partial liver resection and subsequent chemoradiotherapy for the rectal cancer. One patient underwent in one session a partial liver resection and a low anterior resection. Six patients were not treated according to protocol because of extensive disease. Sixteen patients (73 percent) completed the full treatment protocol and all are alive after a median period of 19 (range, 7Y56) months. CONCLUSIONS: This is the first sizable report on the ''liver-first approach'' demonstrating that it may be considered the preferred treatment schedule for patients with locally advanced rectal cancer and synchronous liver metastases. It allows most patients to undergo curative resections of both metastatic and primary disease and can avoid useless rectal surgery in patients with incurable metastatic disease.
AB - PURPOSE: This study was designed to investigate the outcome of ''the liver-first'' approach in patients with locally advanced rectal cancer and synchronous liver metastases. METHODS: Patients with locally advanced rectal cancer and synchronous liver metastases were primarily treated for their liver metastases. If successful, patients underwent treatment for the rectal tumor. RESULTS: Twenty-three patients were included. One patient had liver resection without neoadjuvant chemotherapy followed by chemoradiotherapy. All remaining 22 patients underwent laparotomy after chemotherapy. Eighteen patients underwent partial liver resection and subsequent chemoradiotherapy for the rectal cancer. One patient underwent in one session a partial liver resection and a low anterior resection. Six patients were not treated according to protocol because of extensive disease. Sixteen patients (73 percent) completed the full treatment protocol and all are alive after a median period of 19 (range, 7Y56) months. CONCLUSIONS: This is the first sizable report on the ''liver-first approach'' demonstrating that it may be considered the preferred treatment schedule for patients with locally advanced rectal cancer and synchronous liver metastases. It allows most patients to undergo curative resections of both metastatic and primary disease and can avoid useless rectal surgery in patients with incurable metastatic disease.
KW - Liver-first approach
KW - Locally advanced rectal cancer
KW - Synchronous liver metastases
UR - http://www.scopus.com/inward/record.url?scp=64049090266&partnerID=8YFLogxK
U2 - 10.1007/DCR.0b013e318197939a
DO - 10.1007/DCR.0b013e318197939a
M3 - Article
C2 - 19273952
AN - SCOPUS:64049090266
SN - 0012-3706
VL - 52
SP - 23
EP - 30
JO - Diseases of the Colon and Rectum
JF - Diseases of the Colon and Rectum
IS - 1
ER -