An educational tool to assist in the management of hepatic metastases in patients with colorectal cancer

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Case 14:

Discussant: ALAN VENOOK, MD

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Case Description:

A 65-year-old woman with unknown-stage CRC previously treated by resection of primary lesion without systemic therapy, now presents four years later complaining of abdominal “fullness.” Scan revealed a 6- to 8-cm solitary bilobar liver metastasis, which required shrinkage to obtain adequate margins. She was treated preoperatively with FOLFIRI and bevacizumab, but due to intolerance to irinotecan was switched after one cycle to FOLFOX and bevacizumab. She experienced dramatic tumor response after completing six cycles of systemic therapy. The remaining 3-cm lesion was resected, followed by continued treatment with FOLFOX and bevacizumab. Subsequently, this patient experienced unresectable liver and peritoneal disease recurrence.

Case Discussion:

This was a 65-year-old woman with unknown-stage (T3Nx) CRC previously treated by resection of her primary lesion without systemic therapy. She now presented six years after initial diagnosis complaining of abdominal fullness. PET/CT revealed a potentially convertible 6- to 8-cm solitary bilobar liver metastasis..

The patient was treated with FOLFIRI/bevacizumab, but the patient did not tolerate irinotecan well. She had severe diarrhea after the first cycle. The patient was then switched to FOLFOX/bevacizumab. In total, she received five cycles of FOLFOX and one of FOLFIRI. Her tumor was dramatically reduced to approximately 3-cm in size, and she consequently underwent a complex resection. After surgery, she received additional cycles of FOLFOX and bevacizumab was also added about eight weeks after surgery.

The patient developed recurrent disease elsewhere in the peritoneal cavity, and ultimately succumbed to the cancer.


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