Evaluation of a strategy using pretherapeutic fiducial marker placement to avoid missing liver metastases.
Aftercare
Aged
Antineoplastic Combined Chemotherapy Protocols
/ therapeutic use
Clinical Decision-Making
Colorectal Neoplasms
/ drug therapy
Disease Progression
Female
Fiducial Markers
/ adverse effects
France
/ epidemiology
Hematoma
Hepatectomy
/ methods
Humans
Liver
/ blood supply
Liver Neoplasms
/ diagnostic imaging
Male
Middle Aged
Missed Diagnosis
/ prevention & control
Neoplasm Metastasis
Patient Care Team
Preoperative Care
Radiofrequency Ablation
/ methods
Retrospective Studies
Journal
BJS open
ISSN: 2474-9842
Titre abrégé: BJS Open
Pays: England
ID NLM: 101722685
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
received:
23
07
2018
accepted:
06
12
2018
entrez:
12
6
2019
pubmed:
12
6
2019
medline:
12
6
2019
Statut:
epublish
Résumé
Hepatic surgery is appropriate for selected patients with colorectal liver metastases (CRLM). Advances in chemotherapy have led to modification of management, particularly when metastases disappear. Treatment should address all initial CRLM sites based on pretherapeutic cross-sectional imaging. This study aimed to evaluate pretherapeutic fiducial marker placement to optimize CRLM treatment. This pilot investigation included patients with CRLM who were considered for potentially curative treatment between 2009 and 2016. According to a multidisciplinary team decision, lesions smaller than 25 mm in diameter that were more than 10 mm deep in the hepatic parenchyma and located outside the field of a planned resection were marked. Complication rates and clinicopathological data were analysed. Some 76 metastases were marked in 43 patients among 217 patients with CRLM treated with curative intent. Of these, 23 marked CRLM (30 per cent), with a mean(s.d.) size of 11·0(3·4) mm, disappeared with preoperative chemotherapy. There were four complications associated with marking: two intrahepatic haematomas, one fiducial migration and one misplacement. After a median follow-up of 47·7 (range 18·1-144·9) months, no needle-track seeding was noted. Of four disappearing CRLM that were marked and resected, two presented with persistent active disease. Other missing lesions were treated with thermoablation. Pretherapeutic fiducial marker placement appears useful for the curative management of CRLM.
Sections du résumé
Background
Hepatic surgery is appropriate for selected patients with colorectal liver metastases (CRLM). Advances in chemotherapy have led to modification of management, particularly when metastases disappear. Treatment should address all initial CRLM sites based on pretherapeutic cross-sectional imaging. This study aimed to evaluate pretherapeutic fiducial marker placement to optimize CRLM treatment.
Methods
This pilot investigation included patients with CRLM who were considered for potentially curative treatment between 2009 and 2016. According to a multidisciplinary team decision, lesions smaller than 25 mm in diameter that were more than 10 mm deep in the hepatic parenchyma and located outside the field of a planned resection were marked. Complication rates and clinicopathological data were analysed.
Results
Some 76 metastases were marked in 43 patients among 217 patients with CRLM treated with curative intent. Of these, 23 marked CRLM (30 per cent), with a mean(s.d.) size of 11·0(3·4) mm, disappeared with preoperative chemotherapy. There were four complications associated with marking: two intrahepatic haematomas, one fiducial migration and one misplacement. After a median follow-up of 47·7 (range 18·1-144·9) months, no needle-track seeding was noted. Of four disappearing CRLM that were marked and resected, two presented with persistent active disease. Other missing lesions were treated with thermoablation.
Conclusion
Pretherapeutic fiducial marker placement appears useful for the curative management of CRLM.
Identifiants
pubmed: 31183451
doi: 10.1002/bjs5.50140
pii: BJS550140
pmc: PMC6551408
doi:
Types de publication
Journal Article
Langues
eng
Pagination
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