No abstract available.
Colorectal Neoplasms* ; Drug Therapy*

No abstract available.
Colorectal Neoplasms* ; Drug Therapy*

PURPOSE: The purpose of this study was to evaluate the clinicopathological significance of responders with metastatic colorectal cancer treated with oxaliplatin chemotherapy. METHODS: A total of 52 patients with unresectable metastatic colorectal cancer were enrolled for treatment between March 2000 and August 2005. Patients received first line chemotherapy consisted of oxaliplatin 85 mg/m2 or 130 mg/m2 as a 2-hour infusion on day 1, concurrently with leucovorin (LV) 20 mg/m2 as a bolus infusion on day 1~5, followed by continuous infusion of 5-fluorouracil (5-FU) 425 mg/m2 on day 1~5. This treatment was repeated in 2 or 3 week intervals. All responses were assessed after 4 cycles of therapy by independent radiologic experts and categorized into two groups: responder (major reduction of tumor) and non-responder group (no change or progression of the tumor. RESULTS: The response rate was 51.9 percent (27/52 patients). There were no significant differences in clinicopathologic parameters between two groups. The decrease of CEA value after chemotherapy was significantly more frequent in the responder group than in the non-responder group. CONCLUSIONS: We could not find any clinical differences between the two groups, but these results suggest that oxaliplatin chemotherapy has a beneficial effect on tumor shrinkage and serum CEA value can be an indicator for tumor response of oxaliplatin in advanced colorectal cancer.
Colorectal Neoplasms* ; Drug Therapy* ; Fluorouracil ; Humans ; Leucovorin

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

Liver metastasis is the leading cause of death in patients with colorectal cancer. Since surgical resection alone has a high postoperative recurrence rate, neoadjuvant therapy as an important means is widely applied in order to reduce recurrence and improve survival. Progress has been achieved in many aspects of neoadjuvant therapy in colorectal cancer liver metastasis, such as eligible patients selection, optimal regimens and courses of chemotherapy. However, controversies still remain regarding the standards of resectability of lesions and the application of targeted drugs. Individualized treatments could be developed based on multidisciplinary teamwork to achieve the goal of 'resources integration and treatment stratification'.
Chemotherapy, Adjuvant ; Colorectal Neoplasms/drug therapy* ; Humans ; Liver Neoplasms/drug therapy* ; Neoadjuvant Therapy ; Neoplasm Recurrence, Local

PURPOSE: This study compared the WHO criteria with the response evaluation criteria in solid tumors (RECIST) in the same patients with metastatic colorectal cancer in order to determine the significance of the RECIST. In addition, this study compared the estimations of medical oncologists with those of a radiologist. MATERIALS AND METHODS: Between 2002 and 2005, a total of 48 patients (male: female ratio, 29: 19; median age, 58 years) with measurable lesions receiving chemotherapy for metastatic colorectal carcinoma were enrolled in this study. Two medical oncologists and one radiologist, who were blinded to the patients' condition, independently reviewed all the CT images. The results were compared using a kappa test. RESULTS: The kappa test for concordance between the WHO and RECIST criteria of the medical oncologists and the radiologist were 0.908 and 0.841, respectively. The level of concordance between the investigators using the WHO and RECIST were 0.722 and 0.753, respectively. CONCLUSIONS: The RECIST criteria are comparable to the WHO criteria in evaluating the response of colorectal carcinoma, but have simple and reproducible guidelines. The use of RECIST is recommended for evaluating the treatment efficacy in clinical trials and practice.
Colorectal Neoplasms* ; Drug Therapy ; Female ; Humans ; Research Personnel ; Treatment Outcome

No abstract available.
Administration, Metronomic ; Aged* ; Capecitabine* ; Colorectal Neoplasms* ; Drug Therapy* ; Humans

PURPOSE: Current neoadjuvant chemotherapy (NAC) may enable therapies such as surgical resection and local ablation of metastases in patients with colorectal liver metastasis (CLM). We evaluated outcomes in CLM patients who underwent resection and/or local treatment after NAC and identified prognostic factors for oncologic outcomes. METHODS: Patients who received NAC followed by resection and/or local treatment of hepatic metastasis from 2013 to 2015 were included. Treatment and tumor-related variables were tabulated. Recurrence-free survival (RFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. Cox regression analysis was used to identify factors associated with RFS and OS. RESULTS: Sixty-eight patients received NAC followed by resection and/or local treatment of hepatic metastases. Targeted therapy was administered in 50% of the patients. RFS was 35.8% at 1 year and 19.4% at 2 years postoperatively. OS was 95.6% at 1 year and 88.2% at 2 years postoperatively. In the multivariable analysis, R1 resection margin (hazard ratio [HR], 3.95; P = 0.008) of the liver metastases and ypN1/ypN2 (HR, 2.356 and 1.983, respectively; P = 0.041) were associated with poor RFS. Both factors were also significantly related to OS. CONCLUSION: Resection margin of the metastatic tumor and ypN status are the only relevant factors for RFS and OS in CLM patients treated with NAC. Despite early and high rates of recurrence, CLM patients treated with NAC who undergo resection and/or local treatment have acceptable OS. Multidisciplinary review of candidates for surgery and cautious planning are crucial for achieving optimal outcomes.
Colorectal Neoplasms ; Drug Therapy ; Humans ; Liver ; Methods ; Neoplasm Metastasis ; Recurrence

Until mid-1990s, fluorouracil was the only chemotherapeutic agent available for the treatment of colorectal cancer. The treatment of advanced colorectal cancer has evolved considerably over the last decade. Considerable improvements in survival as well as quality of life have been achieved with the application of oxaliplatin and irinotecan with fluoropyrimidine as a first and subsequent line therapy for colorectal cancer. Development of oral fluoropyrimidines as an alternative to intravenous administration provides an additional option for combination cytotoxic therapy, which is currently being assessed in phase III trials in advanced settings. The appearance of biologic agents in mid-2000s, namely cetuximab and bevacizumab, and their integration with conventional cytotoxic therapy for the treatment of colorectal cancer has additionally expanded the options for the treatment. Their dramatic success has led to further clinical studies of targeted therapy in colorectal cancer, making it one of the most promising areas of cancer research. Although considerable improvement was achieved by incorporating oxaliplatin in adjuvant chemotherapy for the treatment of colon cancer, there has been no phase III trial incorporating new agents in adjuvant setting for rectal cancer. However, many phase II trials on the efficacy of new agents in the setting of concurrent chemoradiation are in progress. Based on their results, randomized phase III clinical trials evaluating new agents in preoperative or postoperative setting will be carried out.
Antineoplastic Agents/therapeutic use ; Colorectal Neoplasms/drug therapy ; Humans ; Rectal Neoplasms/*drug therapy

PURPOSE: The management of primary tumors in patients with stage IV colorectal cancer remains unclear. This meta-analysis evaluated the survival benefits of primary tumor resection (PTR) in patients with unresectable stage IV colorectal cancer in the era of modern chemotherapy. METHODS: Multiple comprehensive databases were searched for studies comparing survival outcomes in patients with metastatic colorectal cancer who did and did not undergo PTR. Outcome data were pooled, and overall effect size was calculated using random effect models. RESULTS: Seventeen nonrandomized studies involving 18,863 patients met the inclusion criteria. Meta-analysis showed that PTR significantly improved overall survival (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.56–0.71; P < 0.001) and progression free survival (HR, 0.76; 95% CI, 0.67–0.87; P < 0.001). Subgroup analyses and sensitivity analyses, performed by predefined methods, also indicated that PTR improved overall patient survival. CONCLUSION: Palliative resection of the primary tumor may have survival benefits in patients with unresectable stage IV colorectal cancer. Randomized controlled trials are needed to determine the optimal treatment for these patients.
Colorectal Neoplasms* ; Colorectal Surgery ; Disease-Free Survival ; Drug Therapy* ; Humans ; Palliative Care ; Prognosis