[Oligometastasized colorectal cancer-modern treatment strategies]. / Oligometastasierung beim kolorektalen Karzinom ­ moderne Therapiekonzepte.

BACKGROUND: The prognosis of colorectal cancer in UICC stage IV has been improved in the last decades by improvements in interdisciplinary treatment. MATERIAL AND METHODS: Treatment strategies for oligometastasized colorectal cancer are developing more and more into an individualized treatment. An overview of the current literature of modern treatment concepts in oligometastasized colorectal cancer UICC stage IV is given. RESULTS: Surgery still has the supreme mandate in resectable colorectal liver metastases, as neoadjuvant and adjuvant treatment strategies to not provide any benefits for these patients. In marginal or non-resectable stages systemic treatment is superior in these patients depending on the prognostic parameters. Also in curative settings local treatment options should be considered as a reasonable additive tool. An interesting treatment approach for isolated liver metastases and non-resectable colorectal cancer is liver transplantation. CONCLUSION: Irrespective of new developments in treatment strategies for metastasized colorectal cancer, resection of colorectal liver metastases remains the gold standard whenever possible.

Image-guided stereotactic ablative radiotherapy for the liver: a safe and effective treatment.

AIMS: Stereotactic ablative body radiotherapy (SABR) is a non-invasive treatment option for inoperable patients or patients with irresectable liver tumors. Outcome and toxicity were evaluated retrospectively in this single-institution patient cohort. PATIENTS AND METHODS: Between 2010 and 2014, 39 lesions were irradiated in 33 consecutive patients (18 male, 15 female, median age of 68 years). All the lesions were liver metastases (n = 34) or primary hepatocellular carcinomas (n = 5). The patients had undergone four-dimensional respiration-correlated PET-CT for treatment simulation to capture tumor motion. We analyzed local control with a focus on CT-based response at three months, one year and two years after treatment, looking at overall survival and the progression pattern. RESULTS: All patients were treated with hypofractionated image-guided stereotactic radiotherapy. The equivalent dose in 2 Gy fractions varied from 62.5 Gy to 150 Gy, delivered in 3-10 fractions (median dose 93.8 Gy, alpha/beta = 10). The CT-based regression pattern three months after radiotherapy revealed partial regression in 72.7% of patients with a complete remission in 27.3% of the cases. The site of first progression was predominantly distant. One- and two-year overall survival rates were 85.4% and 68.8%, respectively. No toxicity of grade 2 or higher according to the NCI Common Terminology Criteria for Adverse Events v4.0 was observed. CONCLUSION: SABR is a safe and efficient treatment for selected inoperable patients or irresectable tumors of the liver. Future studies should combine SABR with systemic treatment acting in synergy with radiation, such as immunological interventions or hypoxic cell radiosensitizers to prevent distant relapse.

Metronidazole-induced acute pancreatitis.

Three cases of metronidazole-induced acute pancreatitis have been reported recently in three women who were being treated for nonspecific vaginitis. We report the fourth such case in a 63-year-old woman with long-standing Crohn's disease who developed acute pancreatitis that was temporally associated with the initiation of metronidazole therapy for a rectovaginal fistula. No other risk factors for pancreatitis were identified except for possibly Crohn's disease itself. We review the literature with regard to metronidazole-induced acute pancreatitis and suggest a possible mechanism. Metronidazole should be considered as a possible cause of acute pancreatitis, and its use should be discontinued if no other risk factor is found.