Maitham A Moslim1, Amir L Bastawrous2, D Rohan Jeyarajah3,4. 1. Methodist Richardson Medical Center, 2805 E. President George Bush Highway, Richardson, TX, USA. 2. Swedish Medical Center, Seattle, WA, USA. 3. Methodist Richardson Medical Center, 2805 E. President George Bush Highway, Richardson, TX, USA. rohanjeyarajah@gmail.com. 4. TCU/UNTHSC School of Medicine, Fort Worth, TX, USA. rohanjeyarajah@gmail.com.
Abstract
BACKGROUND: The use of neoadjuvant pelvic radiotherapy was a major advance in oncologic care for locally advanced rectal cancer in the twentieth century. The extrapolation of the care of locally advanced rectal cancer to the management of rectal cancer with treatable liver metastases is controversial. The aim of this review is to examine the available data on the role of pelvic radiotherapy and chemoradiation in the setting of treatable metastatic liver disease. METHODS: A systematic search of MEDLINE was performed to report the landmark randomized controlled trials between 1993 and 2021. RESULTS: Attaining liver clearance and total mesorectal excision with R0 margin remains the mainstay of cure. There is uncertainty regarding the sequencing of treatment. The literature lacks randomized clinical trials comparing the rectal first, liver first, interval strategy, and simultaneous surgical approaches. A multidisciplinary discussion regarding the utility of radiotherapy is emphasized to achieve the goals of treatment. Short-course radiotherapy has proved comparable disease-control outcomes to long-course chemoradiation with a significantly improved cost-performance. The implementation of short-course radiotherapy in the interval strategy and simultaneous surgical approach is promising. Neoadjuvant pelvic radiotherapy can be omitted in patients with metastatic rectal cancer if adequate margin clearance is achievable. CONCLUSION: The use of radiotherapy in metastatic rectal cancer is popular but is based on limited data. Treatment should be tailored to the local extent of rectal cancer and priority of liver metastasis management. The optimal treatment strategy in patients with rectal cancer and synchronous liver metastatic disease needs to be studied in randomized trials.
BACKGROUND: The use of neoadjuvant pelvic radiotherapy was a major advance in oncologic care for locally advanced rectal cancer in the twentieth century. The extrapolation of the care of locally advanced rectal cancer to the management of rectal cancer with treatable liver metastases is controversial. The aim of this review is to examine the available data on the role of pelvic radiotherapy and chemoradiation in the setting of treatable metastatic liver disease. METHODS: A systematic search of MEDLINE was performed to report the landmark randomized controlled trials between 1993 and 2021. RESULTS: Attaining liver clearance and total mesorectal excision with R0 margin remains the mainstay of cure. There is uncertainty regarding the sequencing of treatment. The literature lacks randomized clinical trials comparing the rectal first, liver first, interval strategy, and simultaneous surgical approaches. A multidisciplinary discussion regarding the utility of radiotherapy is emphasized to achieve the goals of treatment. Short-course radiotherapy has proved comparable disease-control outcomes to long-course chemoradiation with a significantly improved cost-performance. The implementation of short-course radiotherapy in the interval strategy and simultaneous surgical approach is promising. Neoadjuvant pelvic radiotherapy can be omitted in patients with metastatic rectal cancer if adequate margin clearance is achievable. CONCLUSION: The use of radiotherapy in metastatic rectal cancer is popular but is based on limited data. Treatment should be tailored to the local extent of rectal cancer and priority of liver metastasis management. The optimal treatment strategy in patients with rectal cancer and synchronous liver metastatic disease needs to be studied in randomized trials.
Authors: M Ychou; W Hohenberger; S Thezenas; M Navarro; J Maurel; C Bokemeyer; E Shacham-Shmueli; F Rivera; C Kwok-Keung Choi; A Santoro Journal: Ann Oncol Date: 2009-06-30 Impact factor: 32.976
Authors: John M Creasy; Eran Sadot; Bas Groot Koerkamp; Joanne F Chou; Mithat Gonen; Nancy E Kemeny; Vinod P Balachandran; T Peter Kingham; Ronald P DeMatteo; Peter J Allen; Leslie H Blumgart; William R Jarnagin; Michael I D'Angelica Journal: Surgery Date: 2018-02-15 Impact factor: 3.982
Authors: Marzieh Araghi; Melina Arnold; Mark J Rutherford; Marianne Grønlie Guren; Citadel J Cabasag; Aude Bardot; Jacques Ferlay; Hanna Tervonen; Lorraine Shack; Ryan R Woods; Nathalie Saint-Jacques; Prithwish De; Carol McClure; Gerda Engholm; Anna T Gavin; Eileen Morgan; Paul M Walsh; Christopher Jackson; Geoff Porter; Bjorn Møller; Oliver Bucher; Michael Eden; Dianne L O'Connell; Freddie Bray; Isabelle Soerjomataram Journal: Gut Date: 2020-06-01 Impact factor: 23.059
Authors: D Rohan Jeyarajah; Maria B Majella Doyle; N Joseph Espat; Paul D Hansen; David A Iannitti; Joseph Kim; Thavam Thambi-Pillai; Brendan C Visser Journal: J Gastrointest Oncol Date: 2020-04
Authors: Yoshikuni Kawaguchi; Mario De Bellis; Elena Panettieri; Gregor Duwe; Jean-Nicolas Vauthey Journal: Surg Oncol Clin N Am Date: 2020-10-27 Impact factor: 3.495
Authors: Alan I Valderrama-Treviño; Baltazar Barrera-Mera; Jesús C Ceballos-Villalva; Eduardo E Montalvo-Javé Journal: Euroasian J Hepatogastroenterol Date: 2017-09-29
Authors: John A Bridgewater; Siân A Pugh; Tom Maishman; Zina Eminton; Jane Mellor; Amy Whitehead; Louise Stanton; Michael Radford; Andrea Corkhill; Gareth O Griffiths; Stephen Falk; Juan W Valle; Derek O'Reilly; Ajith K Siriwardena; Joanne Hornbuckle; Myrddin Rees; Timothy J Iveson; Tamas Hickish; O James Garden; David Cunningham; Timothy S Maughan; John N Primrose Journal: Lancet Oncol Date: 2020-01-31 Impact factor: 41.316