RESUMO
Around 20-30% of patients with hepatic metastasis from colorectal cancer can undergo liver resection, but the increased response rate obtained with the addition of monoclonal antibodies to chemotherapy regimens could result in a higher rate of liver surgery. In this report we describe the case of a patient who underwent a liver resection after neoadjuvant treatment with capecitabine, oxaliplatin and bevacizumab and who achieved a complete pathological response of the liver metastasis. A preoperative CT scan demonstrated a partial response to the treatment while 18FDG-PET scan correctly evaluated the complete pathological response in the liver and detected an active interaortocaval lymph node metastasis. New specific studies are required to evaluate the imaging response in metastatic colorectal cancer patients especially after treatment with new, targeted agents.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Colo/patologia , Fluordesoxiglucose F18 , Hepatectomia , Neoplasias Hepáticas/diagnóstico por imagem , Terapia Neoadjuvante/métodos , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais Humanizados , Bevacizumab , Capecitabina , Desoxicitidina/administração & dosagem , Desoxicitidina/análogos & derivados , Fluoruracila/administração & dosagem , Fluoruracila/análogos & derivados , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Metástase Linfática/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Compostos Organoplatínicos/administração & dosagem , Oxaliplatina , Tomografia por Emissão de Pósitrons/métodos , Valor Preditivo dos Testes , Compostos RadiofarmacêuticosRESUMO
The study of prognostic factors in neoplastic rectal surgery is enriched with a new element, namely, the role of the surgeon. The aim of this study was to evaluate whether this was true of our own experience. We selected 118 patients with rectal cancer operated on with a radical intent by two different surgeons and analyzed factors such as sex, age, Dukes' stage, histological type, tumour length, differentiation and type of operation. We studied these factors by univariate and multivariate analysis in relation to local and distant recurrence and survival. We found statistically significant correlations between distant recurrence and tumour stage, differentiation and surgeon, but between local recurrence and tumour stage only. Multivariate analysis showed statistically significant correlations between distant recurrence and tumour stage and differentiation, but between local recurrence and tumour stage only. As regards survival, we found statistically significant differences in relation to stage, histological type, and differentiation. The role of the surgeon appeared to be important when there are differences in experience, training and specialization.