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Effects of treatment on the abdomen and pelvis
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
The radiologist's approach to imaging toxicity must evolve. It is not only important to recognize the patterns of treatment-related effects on normal tissues and the complications of cancer treatments at the earliest stage, but also to be fully aware of their implications. As a key member of the multidisciplinary team it is the radiologist's role to have a complete understanding of imaging-evident toxicity, be able to use toxicity as a biomarker of treatment response, discuss the effects of toxicity in patients who are candidates for metastasectomy, and be aware of the potential of amplification of toxicity when using combined therapies.
Melanoma-associated emergencies
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Vidya Kharkar, M. R. L. Sujata
Approaches to metastatic melanoma include surgical metastasectomy, immunotherapy, targeted inhibition of the mitogen activated protein kinase (MAPK) pathway, and radiation therapy to symptomatic sites of metastases. Radiation therapy has also proven to be ineffective for treating metastatic melanoma [56]. Thus, metastatic melanomas are medically managed by chemotherapeutics, and dacarbazine has been used for this purpose. Dacarbazine, dimethyltriazeno-imidazolcarboxamide (DTIC), is an alkylating agent. This is the monochemotherapy approved by the U.S. Food and Drug Administration (FDA) for treating melanomas and is the best option for treating metastatic melanoma [56,57].
Treatment of Metastatic Disease
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Jürgen Weitz, Carina Riediger, Annika Stange, Ralf-Thorsten Hoffmann, David Morris
Another question is the technical approach of pulmonary metastasectomy. Most surgeons now perform video-assisted thoracoscopic (VATS) resections. Contrary to this approach there are still those who deem that manual palpation of the lungs is essential to detect all pulmonary lesions as CT often underestimates the number of pulmonary nodules. In a retrospective analysis, intraoperative exploration revealed more pulmonary metastases compared to the preoperative CT scan in 16%–46% of patients. Other trials report about 29%–56% of missed metastases in VATS. However, no difference regarding survival between VATS and thoracotomy for pulmonary metastasectomy have been shown, and missed lesions may always be treated at a later time. As a consequence, many thoracic surgeons perform VATS metastasectomy due to the less invasive nature of the procedure. In the case of synchronous liver and pulmonary metastases, transdiaphragmatic resections is feasible. Whilst authors emphasise the advantage of reduced invasiveness with the transdiaphragmatic approach, there is a higher risk of biliary complications, which can lead to a fatal outcome.
Current status and novel insights into the role of metastasectomy in the era of immunotherapy
Published in Expert Review of Anticancer Therapy, 2023
Efstathia Liatsou, Diamantis I. Tsilimigras, Panagiotis Malandrakis, Maria Gavriatopoulou, Ioannis Ntanasis-Stathopoulos
Metastasectomy in the setting of metastatic disease remains debated. Patient selection for surgery is key in detecting the individuals who are most likely to benefit from surgical intervention in the setting of metastatic disease. In this context, surgery is best suited for patients with oligometastatic disease, ideally limited metastatic deposits in a single organ. Indeed, the volume of the metastatic disease plays a significant role as to which patients will be deemed appropriate candidates for complete resection of metastases. In addition, poor patient performance status and history of poor prior response to chemo-immunotherapy may help inform which patients will derive the least benefit from surgery and, thus, these patients are not frequently offered surgical intervention for their metastatic disease. As such, experiences from retrospective studies suffer from significant selection bias as patients who undergo metastasectomy are more likely to represent a more ‘favorable’ patient group with better performance status, more favorable tumor biology and limited metastases. In turn, safe conclusions from these studies regarding the role of metastasectomy cannot be drawn.
Solitary prostate cancer liver metastasis: an exceptional indication for liver resection
Published in Acta Chirurgica Belgica, 2021
Gilles Tilmans, Julie Navez, Mina Komuta, Thibaud Saussez, Jan Lerut
Routine use of blood PSA level monitoring and of choline PET-CT scan, allows earlier diagnosis and more frequently isolated and oligo-metastatic disease (OM) [9,10]. According to the European Association of Urology-guidelines, LHRH agonists and androgen-deprivation-therapy are the standard treatment for metastatic PC [3]. The term OM, corresponding to a minimal metastatic state, has a distinct natural history as well as an intermediate prognosis between localized and widely spread metastatic disease. This concept is at the basis of the consideration of surgery, also termed “salvage metastasectomy”, in the treatment of metastatic PC. The surgical treatment of a locoregional recurrence or a solitary metastasis mainly aims at postponing androgen-deprivation therapy, a treatment which not only has a limited efficacy but also is responsible for many side effects such as sexual dysfunction, physiologic and biologic osseous (osteoporosis and bone fractures) and body changes [3]. The Rigati et al. series which includes 72 patients, showed a significant benefit of ‘salvage’ pelvic lymphadenectomy (SLA) in patients presenting with PSA values ˂4 ng/ml, (5-years recurrence free survival (RFS) of 48% vs. 11% in non-resected patient (p = .004) [11]. Other series identified PSA level at SLA, presence of LNM at time of radical prostatectomy, and pelvic LNM were associated with clinical relapse [12].
Complete and durable response to immune checkpoint inhibitor in a patient with refractory and metastatic hepatoblastoma
Published in Pediatric Hematology and Oncology, 2021
Hsin-Lien Tsai, Yi-Chen Yeh, Ting-Yen Yu, Chih-Ying Lee, Giun-Yi Hung, Yi-Ting Yeh, Chin-Su Liu, Hsiu-Ju Yen
In children diagnosed with HB, the lungs are the most common site of metastases at both initial diagnosis and recurrence. The presence of pulmonary metastases at diagnosis is a powerful predictor for a poor outcome.1 Distant metastases are generally treated with chemotherapy, and residuals are candidates for metastasectomy. The use of ICG fluorescence has been reported to facilitate precise detection and complete resection of metastatic HB.2,3 In our patient, the AFP level decreased to a normal level after the last ICG-aided metastasectomy. However, lung metastases in HB generally could not have been cured with surgical resection alone, especially in patents who had multiply developed lung metastases after prior metastasectomies. Effective chemotherapy combined with lung metastasectomy was the choice to achieve remission.4,5 In this patient, the longest time (22+ months) to subsequent recurrence achieved by pembrolizumab, as an adjunct to metastasectomies, highlights the effectiveness of immune checkpoint blockade in such patients with refractory HBs.