Cancer Research and Treatment

Case Report

Hepatic Metastases of Gastric Adenocarcinoma Showing Metabolic Remission on FDG-PET Despite an Increase in Size on CT: So Young Yoon, Sung-Yong Kim, Yo-Han Cho, Hyun Woo Chung, Young So, Hong M Lee; Cancer Res Treat. 2009;41(2):100-103. Published online June 30, 2009; DOI: https://doi.org/10.4143/crt.2009.41.2.100

We report a gastric adenocarcinoma patient with liver metastases. The metastases showed progression on computed tomography (CT), but this was not true progression in terms of metabolic activity according to ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET). Discordance between size criteria and metabolic criteria has been reported in liver gastrointestinal stromal tumors, hepatomas, and renal cell carcinomas after dramatic responses with targeted therapies such as imatinib, sorafenib, and sunitinib (1-6). However, this discordance has been rarely reported in liver metastases of gastric adenocarcinoma when treated with conventional chemotherapy.

Citations

Citations to this article as recorded by

Phase II trial evaluating the efficacy of sorafenib (BAY 43‐9006) and correlating early fluorodeoxyglucose positron emission tomography–CT response to outcome in patients with recurrent and/or metastatic head and neck cancer
Yassine Lalami, Camillo Garcia, Patrick Flamen, Lieveke Ameye, Marianne Paesmans, Ahmad Awada
Head & Neck.2016; 38(3): 347. CrossRef
A Case of Long-Term Complete Remission of Advanced Gastric Adenocarcinoma with Liver Metastasis
Ch'angbum Rim, Jung-Ae Lee, Soojung Gong, Dong Wook Kang, Heebum Yang, Hyun Young Han, Nae Yu Kim
Journal of Gastric Cancer.2016; 16(2): 115. CrossRef
PRELIMINARY EVALUATION OF SERIAL 18FDG‐PET/CT TO ASSESS RESPONSE TO TOCERANIB PHOSPHATE THERAPY IN CANINE CANCER
Amy K. LeBlanc, Ashley N. Miller, Gina D. Galyon, Tamberlyn D. Moyers, Misty J. Long, Alan C. Stuckey, Jonathan S. Wall, Federica Morandi
Veterinary Radiology & Ultrasound.2012; 53(3): 348. CrossRef
Phase II study of sunitinib as second-line treatment for advanced gastric cancer
Yung-Jue Bang, Yoon-Koo Kang, Won K. Kang, Narikazu Boku, Hyun C. Chung, Jen-Shi Chen, Toshihiko Doi, Yan Sun, Lin Shen, Shukui Qin, Wai-Tong Ng, Jennifer M. Tursi, Maria J. Lechuga, Dongrui Ray Lu, Ana Ruiz-Garcia, Alberto Sobrero
Investigational New Drugs.2011; 29(6): 1449. CrossRef

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Original Articles

Radiofrequency Ablation for Metastatic Hepatic Tumor in Colorectal Carcinoma: Jung-Hye Choi, Myung-Ju Ahn, Hyunchul Rhim, Heung Woo Lee, Ho-Suk Oh, Young-Yeul Lee, Il-Young Choi, In-Soon Kim; Cancer Res Treat. 2004;36(2):128-131. Published online April 30, 2004; DOI: https://doi.org/10.4143/crt.2004.36.2.128

Abstract PDF PubReader ePub

Purpose

The purpose of this study was to assess the efficacy and safety of radiofrequency ablation (RFA) to treat hepatic metastasis in patients with colorectal carcinoma.

Materials and Methods

Between May 1999 and July 2002, a total of 45 tumors in 24 patients with colorectal cancer were treated with RFA. Thirteen patients received systemic chemotherapy after the RFA procedure. The ablation was performed percutaneously under ultrasound guidance using cool-tip or expandable electrodes and an RF generator. The medical records as well as the CT scan results taken every 3 months were retrospectively reviewed.

Results

The median follow-up duration of the surviving patients was 11.7 months (4.6~32.2 months). Complete tumor necrosis was achieved in 17 patients (70.8%) on an immediate (<24 hrs) CT scan. The median survival was 17.1 months. The 1- and 2-year survival rates were 80.5 and 25.8%, respectively. In a univariate analysis, complete necrosis, tumor size and post-RFA chemotherapy were significant factors for survival. Nineteen of the 24 patients developed a recurrence or progressed (79.2%). The median progression free survival was 5.5 months. There were no treatment related deaths or serious adverse effects, with the exception of one case of respiratory failure.

Conclusion

These results suggest that RFA is a well-tolerated and effective method to treat hepatic metastasis in colorectal carcinomas.

Citations

Citations to this article as recorded by

Single-centre survival analysis over 10 years after MR-guided radiofrequency ablation of liver metastases from different tumour entities
Susann-Cathrin Olthof, Daniel Wessling, Moritz T. Winkelmann, Hansjörg Rempp, Konstantin Nikolaou, Rüdiger Hoffmann, Stephan Clasen
Insights into Imaging.2022;[Epub] CrossRef
Prognostic factors after ultrasound‐guided percutaneous ablation of colorectal liver metastases: A systematic review
Jeanett Klubien, Andreas P. Kohl, Christian P. Nolsøe, Jacob Rosenberg, Hans‐Christian Pommergaard
Australasian Journal of Ultrasound in Medicine.2018; 21(2): 87. CrossRef
Impact of timing and cycles of systemic chemotherapy on survival outcome of colorectal liver metastases patients treated by percutaneous microwave ablation
Kai Zhang, Jie Yu, Fubo Zhou, Xiaoling Yu, Xin Li, Jianbin Wang, Zhiyu Han, Zhigang Cheng, Ping Liang
International Journal of Hyperthermia.2016; 32(5): 531. CrossRef
Efficacy and safety of thermal ablation in patients with liver metastases
Yingjun Liu, Shengping Li, Xiangbin Wan, Yi Li, Binkui Li, Yaqi Zhang, Yunfei Yuan, Yun Zheng
European Journal of Gastroenterology & Hepatology.2013; 25(4): 442. CrossRef
CT- versus coregistered FDG-PET/CT-based radiation therapy plans for conformal radiotherapy in colorectal liver metastases: a dosimetric comparison
Cem Parlak, Erkan Topkan, Serhat Sonmez, Cem Onal, Mehmet Reyhan
Japanese Journal of Radiology.2012; 30(8): 628. CrossRef

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Effectiveness of Gastrectomy in Stage 4 Gastric Cancer with Hepatic Metastasis: Jeong Hwan Yook, Sung Joon Kwon, Byung Ki Kim, Byung Jae Kim, Sung Kim, Seung Moon Noh, Young Jae Mok, Kyung Kyu Park, Byung Ju Park, Cho Hyun Park, Ho Yoon Bang, Jae Moon Bae, Young Jin Song, Du Hyun Yang, Dae Hyun Yang, Sung Tae Oh, Hyo Yung Yun, Moo Son Lee, Jong Inn Lee, Yong Kwan Cho, Dong Wook Choi, Sang Uk Han; J Korean Cancer Assoc. 1999;31(3):441-447.

Abstract PDF: PURPOSE
The prognosis for patients with stage IV gastric cancer is very poor. However, recently, some studies have reported benefits from a gastric resection for metastatic gastric cancer. This clinical study was performed to evaluate the effectiveness of a noncurative gastrectomy in treating stage IV gastric cancer with hepatic metastasis.
MATERIALS AND METHODS
A retrospective analysis was performed on 98 gastric cancer patients who had undergone gastric resection, in spite of hepatic metastasis, between January 1990 and December 1996 at the Department of Surgery in 11 General Hospitals in Korea.
RESULTS
The average age was 58 years old, and the male-to-female ratio was 69: 29. The laboratory tests were unable to predict hepatic metastasis. In 54 cases, hepatic metastasis was not identified before the surgery. The most common location of gastric cancer was antrum (72 cases). The most common gross type was Bonmann type III (78 cases). The serosa-exposed cases were 80. The peritoneal seeding was combined in 17 cases. A total gastrectomy was performed in 18 cases and a distal gastrectomy in 80. Lymph-node dissection was performed in 23 Dl, and 51 D2 cases. Hepatic resection was performed in 36 cases, The frequent histologic types were moderately differentiated and poorly differentiated tubular adenocarcinoma. Postoperative adjuvant chemotherapy was done in 70 cases. The complication rate (7%) was low. The median survival time was 15 months, with mean survival time of 18 months. The 2-year and 3-year survival rates were 23%, and 7%, respectively. In the univariate analysis, good survival was closely related to limitation of hepatic metastasis to one lobe, a few metastases to both lobes, negativity of peritoneal seeding and lymph node dissection more than D2 (p<0.05), CONCLUSIONS: An aggressive gastric resection for stage IV gastric cancer with hepatic metastasis might be beneficial in lengthening the survival period. A prospective study is needed, especiaUy one with an exact evaluation and analysis of the quality of life between the gastrectomy and nonresection groups.

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Treatment of Hepatic Metastasis of Colorectal Cancer: A Retrospective Analysis of the Outcome in 99 Patients: Jin Cheon Kim, Chang Nam Kim, Chang Sik Yu, Han Il Lee, Sang We Kim, Je Hwan Lee, Woo Kun Kim, Gyeong Hoon Kang, Moon Kyu Lee; J Korean Cancer Assoc. 1998;30(6):1175-1183.

Abstract PDF: PURPOSE
Among various modalities of treatment in hepatic metastasis of colorectal cancer, hepatic resection has been proven to be the most effective treatment. This analysis was intended to determine important prognostic parameters and to understand clinically significant factors during hepatic resection and follow-up period in patients with hepatic metastasis from colorectal cancer.
MATERIALS AND METHODS
Among 1,022 colorectal cancer patients treated at Asan Medical Center from July 1989 to December 1995, 99 patients were found to have liver metastasis at the time of first diagnosis or during follow-up period. These 99 patients were the subject of analysis in this retrospective clinical study. Surgical resection with curative intent was done in 35 patients and chemotherapy in 46 patients. Eighteen patients were with no treatment or misssed during follow-up. Survival rate was analysed according to clinicopathological parameters: sex, age, location of primary tumor, preoperative serum CEA level, TNM staging of primary tumor, number of hepatic metastasis, distribution, synchronous or metachronous lesions, diesase free interval, mode of treatment, type of resection, tumor free resection margin.
RESULTS
Overall survival of the patients with hepatic metastasis was significantly related with numbers of metastasis (<4 vs. >4), distribution (unilobar vs. bilobar), synchronous or metachronous lesions, disease free interval ( < 12 vs. > 12 months), mode of treatment (hepatic resection vs. chemotherapy vs, no treatment, p<0.01. A multivariate analysis showed a significant association of survival with mode of treatment (p<0.01). Survival of patients with hepatic resection was significantly related with resection margin (positive vs. < 1 cm vs. > 1 cm), TNM staging of primary tumor (II vs. III), number of hepatic metastasis (p<0.01), disease free interval (p<0.05). A multivariate analysis showed a significant correlation with survival for tumor free resection margin (p<0.01).
CONCLUSION
An aggressive approach of hepatic resection in the colorectal liver metastasis will improve survival, if the lesion pennits. In patients with hepatic resection, tumor free resection margin was the most important prognostic parameter by the uniand multivariate analysis. Therefore, every effort should be made to ensure that the clear margin be kept at least more than 1 cm during hepatic resection.

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Characteristics and Prognosis in Gastric Cancer with Liver Metastasis: Seung Ki Kim, Sung Hoon Noh, Chang Hak Yoo, Yong Il Kim, Jin Sik Min, Kyong Sik Lee; J Korean Cancer Assoc. 1997;29(6):1085-1093.

Abstract PDF: PURPOSE
Until several years ago, gastric or hepatic resection was seldom indicated for metastatic gastric cancer because of the expected dismal prognosis. Recently, some studies have reported benefits from gastric or hepatic resection for metastatic gastric cancer. We performed this retrospective study to see the prognosis after aggressive surgery in gastric cancer patients with hepatic metastasis.
MATERIALS AND METHODS
A total of 112 gastric cancer patients were confirmed to have liver metastasis at the time of initial surgery or preoperative evaluation during the 8-year period from January, 1987 to December, 1994 at the Department of Surgery, Yonsei University, College of Medicine. Thirty eight cases (33.9%) underwent gastrectomy (total gastrectomy: 15, subtotal gastrectomy: 23). Of these 38 cases, 12 underwent a combined resection of metastatic hepatic tumors (segmentectomy: 7, wedge resection: 3, lobectomy: 1 and enucleation: 1).
RESULTS
The locations of primary lesion were most common in the lower 1/3 of the stomach in all of the nonresected, the gastrectomy only, and the gastrectomy & hepatectomy group. Most of the cancers belonged to Borrmann type III and IV. Histologically, dedifferentiated cancer (poorly differentiated cancer, signet ring cell cancer, mucinous cancer) was more frequent in the nonresected group (67.4%) while differentiated cancer (papillary cancer, well differentiated cancer, moderately differentiated cancer) was more frequent in the resected group (60.9%). The number of metastatic hepatic nodules were less than two in the resected group and the location of metastatic lesions tended to be limited to one lobe. Concerning the prognosis, the mean survival of the resected group was better than the nonresected group (nonresected group: 8.4 months, gastrectomy only group: 18.4 months, gastrectomy & hepatectomy group: 35.5 months). The mean score of QOL (quality of life) according to Spitzer index was better in the resected group (nonresected group: 5.1, gastrectomy only group: 6.0, gastrectomy & hepatectomy group: 7.5).
CONCLUSION
Resection of both the primary gastric lesion and the metastatic hepatic lesion should be considered in selected cases to improve the survival and the quality of life in patients with hepatic metastasis.

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Hepatic Intraarterial Chemotherapy in Unresectable Hepatic Metastases of Colorectal Cancer: Jin Cheon Kim, Han Il Lee, Chang Sik Yu, Hee Won Chung, Sang Wee Kim, Jeong Sin Lee, Kun Choon Park; J Korean Cancer Assoc. 1997;29(2):227-234.

Abstract PDF: PURPOSE
Unresectable hepatic metastases of colorectal cancer does not seem to be amenable to the various treatment modalities. We modified hepatic intraarterial chemotherapy by different installation of port and regimen.
MATERIALS AND METHODS
Between July 1989 to December 1995, 27 patients of colorectal cancer with unresectable liver metastases were randomly allocated into either hepatic intraarterial (HA, 11 patients) or systemic intravenous (IV, 16 patients) chemotherapy after primary tumor resection. Chemo-port was installed with preservation of hepatic arterial flow. One cycle of HA regimen included 5-fluorouracil (5-FU) and mitomycin-C (MMC) with or without leucovorin (LV) for 14 days every month. The IV regimen included 5-FU and LV for 5 days every month. Both HA and IV chemotherapy were continued from 6 to 12 cycles.
RESULTS
The response exceeding partial remission was experienced in six patients (55%) among 11 patients in the HA group, while only two (13%) patients showed response among sixteen patients in the IV group. One year survival was not different between two groups. Although lethal toxicity was not found, patients showed marked increase of the performance scale (ECOG) in both groups.
CONCLUSION
Although survival benefit was not prominent, higher response rate with tolerable complication was found in the HA group. Prudent selection of effective drugs and combination of systemic chemotherapy are needed to improve the survival with minimal complication.

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