Intensive locoregional therapy before liver transplantation for colorectal cancer liver metastasis: A novel pretransplant protocol

Liver Transplantation, Journal Year: 2024, Volume and Issue: 30(12), P. 1238 - 1249

Published: June 4, 2024

We describe a novel pre-liver transplant (LT) approach in colorectal liver metastasis, allowing for improved monitoring of tumor biology and reduction disease burden before committing patient to transplantation. Patients undergoing LT metastasis at Cleveland Clinic were included. The described protocol involves intensive locoregional therapy with systemic chemotherapy, aiming reach minimal revealed by positron emission tomography scan carcinoembryonic Ag. no detectable or irreversible treatment-induced injury undergo transplant. Nine patients received out 27 who evaluated (33.3%). median follow-up was 700 days. Seven (77.8%) living donor LT. Five had disease, 4 cirrhosis. Pretransplant management included chemotherapy (n = 9) +/− bevacizumab 6) and/or anti-EGFR 6). number pre-LT cycles 16 (range 10–40). Liver-directed Yttrium-90 5), ablation 4), resection hepatic artery infusion pump 3). Three recurred after Actuarial 1- 2-year recurrence-free survival 75% 6/8) 60% 3/5). Recurrence occurred the lungs 1), graft lungs+para-aortic nodes 1). reduced RFS ( p 0.04). All recurrence histologically viable tumors explant. treated our 16) demonstrated versus those not candidates 11) regardless status 0.01). A defined aggressive pretransplant liver-directed treatment undetectable may help prevent recurrence.

Language: Английский

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Circulating Tumor DNA Profiling in Liver Transplant for Hepatocellular Carcinoma, Cholangiocarcinoma, and Colorectal Liver Metastases: A Programmatic Proof of Concept

Cancers, Journal Year: 2024, Volume and Issue: 16(5), P. 927 - 927

Published: Feb. 25, 2024

Circulating tumor DNA (ctDNA) is emerging as a promising, non-invasive diagnostic and surveillance biomarker in solid organ malignancy. However, its utility before after liver transplant (LT) for patients with primary secondary cancers still underexplored.

Language: Английский

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PET-Assessed Metabolic Tumor Volume Across the Spectrum of Solid-Organ Malignancies: A Review of the Literature

Biomedicines, Journal Year: 2025, Volume and Issue: 13(1), P. 123 - 123

Published: Jan. 7, 2025

Solid-organ malignancies represent a significant disease burden and remain one of the leading causes death globally. In past few decades, rapid evolution imaging modalities has shifted paradigm towards image-based precision medicine, especially in care patients with solid-organ malignancies. Metabolic tumor volume (MTV) is such semi-quantitative parameter obtained from positron emission tomography (PET) 18F-fluorodeoxyglucose (FDG) that been shown to have implications clinical oncology setting. Across various solid malignancies, including lung cancer, head neck breast esophageal colorectal current literature demonstrated an association between MTV outcomes. may be used conjunction several existing established parameters help inform risk stratification treatment strategies predict outcomes cancer. Optimizing volumetric paramount for advancing efforts advance cancer our patients. While advancements are made, it important investigate address limitations MTV, variability terms measurement methods, lack standardized cut-off values, impact inherent heterogeneity. Despite these limitations, which can precipitate challenges standardization, as prognostic factor great potential opens avenue future integration technology into medicine model This article serves narrative review explores utility PET-MTV settings malignancy.

Language: Английский

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Histotripsy of Liver Tumors: Patient Selection, Ethical Discussions, and How We Do It

Cancers, Journal Year: 2025, Volume and Issue: 17(7), P. 1100 - 1100

Published: March 25, 2025

Liver malignancies, both primary and metastatic tumors, are a major cause of cancer-related mortality. Colorectal cancer alone results in liver metastases nearly 50% patients, with approximately 85% presenting unresectable disease. Similarly, hepatocellular carcinoma intrahepatic cholangiocarcinoma frequently present at advanced stages, limiting curative options. Systemic therapies provide modest survival benefits, underscoring the need for alternative treatments. Locoregional approaches, such as thermal ablation chemoembolization, while effective, have notable limitations, including invasiveness, peri-procedural risks, requirement to interrupt systemic Histotripsy is novel, non-invasive method that uses focused ultrasound-induced cavitation enable precise tumor without heat or radiation. Our institution utilizes multidisciplinary board approach evaluate patients histotripsy, particularly cases involving disease, complex surgical candidacy, palliative intent related disease control symptom management, bridging therapy transplantation. Early results, preclinical data THERESA #HOPE4LIVER trials, highlight its efficacy treating tumors minimal complications. This review outlines institutional protocols covering pre- post-procedural along ethical considerations current treatment paradigms. As patient-centered approach, histotripsy offers novel option favorable safety profile compatibility therapies.

Language: Английский

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Circulating Tumor DNA and Management of Colorectal Cancer

Cancers, Journal Year: 2023, Volume and Issue: 16(1), P. 21 - 21

Published: Dec. 19, 2023

Although the incidence of colorectal cancer (CRC) has decreased as a result increased screening and awareness, it still remains major cause cancer-related death. Additionally, early detection CRC recurrence by conventional means such CT, endoscopy, CEA not translated into an improvement in survival. Liquid biopsies, circulating tumor DNA (ctDNA), have been investigated biomarker for patients with terms prognosis recurrence, well their use to guide therapy. In this manuscript, we provide overview ctDNA its utility providing prognostic information, using therapy, monitoring CRC. addition, discuss influence site disease may on ability detect metastatic

Language: Английский

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Liver transplantation for tumor entities

Current Opinion in Organ Transplantation, Journal Year: 2024, Volume and Issue: 29(4), P. 255 - 265

Published: May 8, 2024

Purpose of review Tumor entities represent an increasing indication for liver transplantation (LT). This addresses the most contentious indications LT in transplant oncology. Recent findings Patient selection based on tumor biology colorectal cancer metastases (CRLM) demonstrated promising long-term outcomes and preserved quality life despite high recurrence rates. In selected cases, intrahepatic cholangiocarcinoma (iCCA) is feasible, with acceptable survival even high-burden cases responsive to chemotherapy. following a strict neoadjuvant protocol perihilar (pCCA) resulted consistently surpassing benchmark values, potentially outperforming resection. Summary While preliminary results are promising, prospective trials crucial define applications routine clinical practice. Molecular profiling targeted therapies pave way personalized approaches, requiring evolving allocation systems equitable access.

Language: Английский

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Update to ‘A Contemporary Systematic Review on Liver Transplantation for Unresectable Liver Metastasis of Colorectal Cancer’

Annals of Surgical Oncology, Journal Year: 2023, Volume and Issue: 31(2), P. 697 - 700

Published: Nov. 23, 2023

Language: Английский

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Transplantation for colorectal liver metastasis

Current Opinion in Organ Transplantation, Journal Year: 2023, Volume and Issue: 29(1), P. 23 - 29

Published: Nov. 23, 2023

Liver transplantation has emerged as a possible treatment for selected patients with nonresectable colorectal liver metastasis, but controversy still exists regarding optimal selection criteria and acceptable outcomes.

Language: Английский

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The Impact of Biliary Injury on the Recurrence of Biliary Cancer and Benign Disease after Liver Transplantation: Risk Factors and Mechanisms

Cancers, Journal Year: 2024, Volume and Issue: 16(16), P. 2789 - 2789

Published: Aug. 7, 2024

Liver transplantation is known to generate significant inflammation in the entire organ based on metabolic profile and tissue's ability recover from ischemia-reperfusion injury (IRI). This cascade contributes post-transplant complications, affecting both synthetic liver function (immediate) scar development biliary tree. The new occurrence of strictures, recurrence malignant benign diseases, such as cholangiocarcinoma (CCA) primary sclerosing cholangitis (PSC), are direct consequences linked this inflammation. accumulation toxic metabolites, succinate, causes undirected electron flows, triggering releases reactive oxygen species (ROS) a severely dysfunctional mitochondrial complex 1. initiates inflammatory IRI cascade, with subsequent ischemic stricturing, upregulation pro-tumorigenic signaling. Such local systemic, promoting an immunocompromised status that can lead underlying disease, nature. traditional treatment for CCA was resection, when possible, followed by cytotoxic chemotherapy. transplant oncology increasingly recognized potentially curative approach patients intrahepatic (iCCA) perihilar (pCCA) cholangiocarcinoma. link between disease hepatocellular carcinoma. However, smaller numbers have prevented similar analyses CCA. mechanistic may be even more critical most profound damage bile ducts. article reviews mechanisms associated pathology after transplantation. One main focus transplant-related IRI-associated diseases Risk factors protective strategies highlighted.

Language: Английский

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The role of living donor liver transplantation in colorectal cancer liver metastases

Current Opinion in Organ Transplantation, Journal Year: 2024, Volume and Issue: unknown

Published: Nov. 28, 2024

Purpose of review Despite technical and therapeutic advances, only 20–40% patients with colorectal liver metastases (CRLM) have resectable disease. Historically, the remaining unresectable, liver-only CRLM would receive palliative chemotherapy, a median survival 8 months. Recent findings Liver transplantation has emerged as viable option for selected CRLM. This advancement stems from improved understanding tumour genomics biology better patient selection criteria. The results recent prospective clinical trials further ignited enthusiasm option. Living donor (LDLT) offers several advantages over deceased (DDLT) this disease, including reduced wait-time optimized timing coordination oncologic therapy. On-going LDLT demonstrated favourable outcomes compared other indications. However, there is no established consensus or standardization in implementation CRLM, beyond centre-specific protocols. Summary an excellent highly Refining prognostic factors criteria will help to optimize utility broaden acceptance

Language: Английский

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