A variety of managements, including systemic and local chemotherapy, radiofrequency ablation and others, are used after multidisciplinary team discussion to improve the survival of patients with unresectable liver metastasis, and to enlarge the cohort of patients who can be managed with curative intent. Patients should be divided into different clinical groups according to characteristics of the patient and tumor, and then receive different treatments. For the patients who may be converted to be resectable after chemotherapy, we should choose efficient convertible chemotherapy with short courses to get the best response rate. For KRAS wild-type patients, cetuximab combined with FOLFOX/FOLFIRI, in which 5-fluorouracil is continuously infused, is recommended. In addition, resection of the primary tumor is recommended at the right time for asymptomatic patients with unresectable liver metastases. There is no consensus on the preferred treatment modality for systemic and local therapies.
Colorectal Neoplasms ; drug therapy ; pathology ; surgery ; therapy ; Humans ; Liver Neoplasms ; drug therapy ; secondary ; surgery

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Colorectal Neoplasms ; pathology ; surgery ; Hepatectomy ; methods ; Humans ; Liver Neoplasms ; drug therapy ; secondary ; surgery ; Neoadjuvant Therapy ; Preoperative Care ; Survival Rate

OBJECTIVETo summarize and analyze the diagnosis, clinical features and therapy of primary colorectal non-Hodgkin's lymphoma (NHL).

METHODSThe clinicopathological data of 52 patients with primary colorectal NHL diagnosed and treated in our department from January 2000 to January 2010 were reviewed and analyzed retrospectively in this study.

RESULTSThis group of patients was composed of 45 cases of B cell and 7 T cell lymphomas, including 33 males and 19 females, with a male to female ratio of 1.7:1, and the age at diagnosis was 16 - 74 years old, with a median age of 50 years. The ileocecal region was most frequently involved site, acounted for 48.1%. The common symptoms encountered were abdominal pain (66.7%), diarrhea (15.6%), blood stool (24.4%), and body weight loss (8.9%). All patients were eventually diagnosed by histopathology, and the DLBCL subtype took up 64.4%. Among the 45 cases of B cell subtype, 33 cases (73.3%) were of early stage (IE and IIE confirmed), and the 5-year survival rate was 78.1%, while those of stage IIIE and IVE comprised 26.7%, with a 5-year survival rate of 45.5% (P < 0.05). The 5-year survival rate of all patients was 71.1%. Surgery was employed in 36 cases, and 9 patients received chemotherapy alone. Radical surgery could significantly increase the patients' overall survival rate, as compared with the chemotherapy alone group and palliative surgery group (P < 0.05).

CONCLUSIONSColorectal non-Hodgkin's lymphoma is a rare malignancy of the gastrointestinal tract. B cell type, male predominance and DLBCL subtype are most encountered manifestations in clinics. Multi-modality management with radical surgical resection of the primary lesion followed by standard chemotherapy, affords better local disease control, and a better survival outcome. Early detection and tailored immunotherapy can obviously prolong the long-term survival time.

Adolescent ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Chemotherapy, Adjuvant ; Colorectal Neoplasms ; diagnosis ; drug therapy ; pathology ; surgery ; Cyclophosphamide ; therapeutic use ; Doxorubicin ; therapeutic use ; Female ; Follow-Up Studies ; Humans ; Lymphoma, B-Cell ; diagnosis ; drug therapy ; pathology ; surgery ; Lymphoma, Large B-Cell, Diffuse ; diagnosis ; drug therapy ; pathology ; surgery ; Lymphoma, Non-Hodgkin ; diagnosis ; drug therapy ; pathology ; surgery ; Lymphoma, T-Cell ; diagnosis ; drug therapy ; pathology ; surgery ; Male ; Middle Aged ; Neoplasm Staging ; Prednisone ; therapeutic use ; Retrospective Studies ; Salvage Therapy ; Survival Rate ; Vincristine ; therapeutic use ; Young Adult

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoembryonic Antigen ; blood ; Catheter Ablation ; methods ; Colorectal Neoplasms ; pathology ; Combined Modality Therapy ; Fluorouracil ; therapeutic use ; Humans ; Leucovorin ; therapeutic use ; Liver Neoplasms ; blood ; drug therapy ; secondary ; surgery ; Neoplasm Recurrence, Local ; Organoplatinum Compounds ; therapeutic use

OBJECTIVETo investigate the tumor proliferation and apoptosis changes after preoperative hepatic and regional arterial infusion chemotherapy (PHRAIC) after radical colorectal cancer resection.

METHODSFive hundred and nine patients with stage II or stage III colorectal cancer from June 2001 to June 2007 were randomly assigned to PHRAIC group (n = 256) or control group (n = 253, surgery alone). Tumor proliferation and apoptosis index were evaluated in tumor tissues of the control and PHRAIC group (pre and after intervention). The survival rates were also recorded in the two groups.

RESULTSThere was no significant differences in sex, age, tumor location, tumor size, tumor stage, tumor differentiation and follow-up time for the two groups (P > 0.05). There was no significant differences in all the evaluation factors between the control group and PHRAIC group before intervention (P > 0.05). Before and after intervention for PHRAIC group: stage 3 necrosis rate were 3.1% and 22.7%, stage 4 necrosis rate were 0 and 13.5% (P < 0.05); label index of Ki67 were 48.6 +/- 17.1 and 38.4 +/- 13.3 (P < 0.05); expression rate of Bax, bcl-2 and survivin were 48.0% vs 77.0%, 75.0% vs 43.0%, 52.0% vs 31.6%, respectively (P < 0.05); apoptosis rate were 4.3% +/- 2.2% and 16.7% +/- 6.4%(P < 0.05). In the PHRAIC group, 42.1% +/- 11.2% of the cells in the tumor tissue were in S phase before intervention and the rate fell to 21.8% +/- 10.7% after intervention (P < 0.05); and G0-G1 phase rate of the group pre and post intervention were 35.1% +/- 12.1% and 57.1% +/- 18.1% (P < 0.05). All the patients were followed-up for a mean time of 42 +/- 14 months. For patients with stage III tumor in PHRAIC group and control group, the 5-year liver metastasis rate were 18.9% and 27.3% (P = 0.033), recurrence and metastasis rate were 26.3% and 38.0 (P = 0.024), overall survival rate were 81.0% and 60.4% (P = 0.011), median survival time were 45 and 40 months (P = 0.02); no significant differences of aforementioned factors was found in patients with stage II tumors between the two groups.

CONCLUSIONThe schedule of preoperative hepatic and regional arterial infusion chemotherapy before surgery can restrain proliferation, promote apoptosis and reduce liver metastasis and improve survival rate in stage III colorectal cancer.

Adult ; Aged ; Apoptosis ; drug effects ; Cell Cycle ; drug effects ; Chemotherapy, Adjuvant ; Colorectal Neoplasms ; drug therapy ; pathology ; surgery ; Female ; Follow-Up Studies ; Hepatic Artery ; Humans ; Infusions, Intra-Arterial ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Preoperative Care ; Retrospective Studies

OBJECTIVETo compare the clinical efficacy of postoperative intraperitoneal chemotherapy combined with systemic chemotherapy to systemic chemotherapy alone for serosa-involved colorectal cancer.

METHODSAccording to the criteria of serosa-involving in colorectal cancer, 332 cases were divided into 2 groups prospectively without randomization. Study group(n=166) was treated with intraperitoneal chemotherapy combined with systemic chemotherapy, and control group(n=166) with systemic chemotherapy alone. Incidence of local recurrence, peritoneal metastasis, hepatic metastasis, other distant metastasis and 3-year, 5-year overall survival(OS) rate of two groups were compared.

RESULTS3-year and 5-year OS rates of stage II(B in study group were similar to those in control group(chi(2)=0.612,P=0.434). The above rates of stage III( in study group were higher than those in control group(chi(2)=3.989,P=0.046). Either the study group or the control group, the 3-year and 5-year OS rates of patients undergone laparoscopic surgery or open surgery were similar(P=0.839, P=0.172). Incidences of local recurrence, peritoneal metastasis and hepatic metastasis in study group were 1.9%,3.8% and 3.8% respectively, lower than those in control group(8.2%,9.5% and 10.1%,P<0.05). Distant metastasis rate in study group was similar to that in control group. In study group, intraperitoneal chemotherapy regimen with Oxaliplatin had lower rates of peritoneal metastasis and hepatic metastasis as compared to that with Cisplatin(0.9% vs 8.8%,P=0.019), while the incidences of local recurrence and other distant metastasis were similar.

CONCLUSIONSPostoperative intraperitoneal chemotherapy combined with systemic chemotherapy improves 3-year and 5-year overall survival rates in patients with stage III( serosa-involved colorectal cancer, and decreases local recurrence, peritoneal metastasis and liver metastasis rate, especially when intraperitoneal chemotherapy regimen contains Oxaliplatin. Comparing with open surgery, laparoscopic surgery dose not improve 3-year and 5-year overall survival rates in patients receiving combined chemotherapy or systemic chemotherapy alone.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Chemotherapy, Adjuvant ; Colorectal Neoplasms ; drug therapy ; pathology ; surgery ; Female ; Humans ; Infusions, Intravenous ; Injections, Intraperitoneal ; Male ; Middle Aged ; Neoplasm Staging ; Postoperative Period ; Prospective Studies ; Serous Membrane ; pathology

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Camptothecin ; administration & dosage ; analogs & derivatives ; Chemotherapy, Adjuvant ; methods ; trends ; Colorectal Neoplasms ; pathology ; Fluorouracil ; administration & dosage ; Humans ; Liver Neoplasms ; drug therapy ; secondary ; surgery ; Organoplatinum Compounds ; administration & dosage ; Preoperative Care ; Survival Analysis

OBJECTIVETo investigate the clinical features and prognosis of bone metastases in colorectal cancer patients.

METHODSThe clinical data of 104 cases of colorectal cancer with bone metastasis were collected and retrospectively analyzed.

RESULTSAmong all the 104 patients included, 45 (43.3%) patients had multiple bone metastases, and 59 (56.7%) patients had single bone metastasis. Pelvis (46.1%) was the most common site, followed by thoracic vertebrae (41.3%), lumbar vertebrae (40.4%), sacral vertebrae (29.8%) and ribs (29.8%). One hundred and two patients (98.1%) were complicated with other organ metastases. The median time from colorectal cancer diagnosis to bone metastasis was 16 months, and the median time from bone metastasis to first skeletal-related events (SREs) was 1 month. The most common skeletal-related events (SREs) were the need for radiotherapy (44.2%), severe bone pain (15.4%) and pathologic fracture (9.6%). The median survival time of patients with bone metastases was 10.0 months, and 8.5 months for patients with SREs. ECOG score, systemic chemotherapy and bisphosphonate therapy were prognostic factors by univariate analysis (all P < 0.05). ECOG score and systemic chemotherapy were independent prognostic factors by Cox multivariate analysis.

CONCLUSIONSBone metastasis in colorectal cancer patients has a poor prognosis and the use of chemotherapy and bisphosphonates may have a benefit for their survival.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Bone Density Conservation Agents ; therapeutic use ; Bone Neoplasms ; drug therapy ; radiotherapy ; secondary ; Colorectal Neoplasms ; drug therapy ; pathology ; radiotherapy ; surgery ; Diphosphonates ; therapeutic use ; Female ; Follow-Up Studies ; Fractures, Bone ; etiology ; Humans ; Lumbar Vertebrae ; pathology ; Male ; Middle Aged ; Pain ; etiology ; Pelvic Bones ; pathology ; Prognosis ; Retrospective Studies ; Ribs ; pathology ; Sacrum ; pathology ; Spinal Cord Compression ; etiology ; Spinal Neoplasms ; drug therapy ; radiotherapy ; secondary ; Thoracic Vertebrae ; pathology ; Young Adult

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Camptothecin ; administration & dosage ; analogs & derivatives ; Chemotherapy, Adjuvant ; Colorectal Neoplasms ; drug therapy ; pathology ; surgery ; Disease-Free Survival ; Fluorouracil ; administration & dosage ; Humans ; Leucovorin ; administration & dosage ; Postoperative Care ; Treatment Outcome

The nodal stage of colorectal cancer is based on the number of positive nodes. It is inevitably affected by the number of removed lymph nodes, but lymph node ratio can be unaffected. We investigated the value of lymph node ratio in stage III colorectal cancer in this study. The clinicopathologic factors and follow-up data of 145 cases of stage III colorectal cancer between January 1998 and December 2008 were analyzed retrospectively. The Pearson and Spearman correlation analyses were used to determine the correlation coefficient, the Kaplan-Meier method was used to analyze survival, and the Cox proportional hazard regression model was used for multivariate analysis in forward stepwise regression. We found that lymph node ratio was not correlated with the number of removed lymph nodes (r = -0.154, P = 0.065), but it was positively correlated with the number of positive lymph nodes (r = 0.739, P < 0.001) and N stage (r = 0.695, P < 0.001). Kaplan-Meier survival analysis revealed that tumor configuration, intestinal obstruction, serum carcinoembryonic antigen (CEA) concentration, T stage, N stage, and lymph node ratio were associated with disease-free survival of patients with stage III colorectal cancer (P < 0.05). Multivariate analysis showed that serum CEA concentration, T stage, and lymph node ratio were prognostic factors for disease-free survival (P < 0.05), whereas N stage failed to achieve significance (P = 0.664). We confirmed that lymph node ratio was a prognostic factor in stage III colorectal cancer and had a better prognostic value than did N stage.
Adult ; Aged ; Aged, 80 and over ; Carcinoembryonic Antigen ; blood ; Chemotherapy, Adjuvant ; Colectomy ; Colorectal Neoplasms ; blood ; drug therapy ; pathology ; surgery ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; surgery ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Proportional Hazards Models ; Rectum ; surgery ; Retrospective Studies ; Young Adult