Peritoneal metastases from colorectal cancer managed by stereotactic body radiation therapy: presentation of a clinical case and review of literature
Notice bibliographique
Résumé
Abstract Peritoneal metastasis (PM, or peritoneal carcinomatosis) is often associated with dismal prognosis. The treatment of peritoneal metastasis depends on several factors, including the type of primary cancer, the extent of metastasis and the patient’s overall health condition. Apart from systemic chemotherapy and cytoreductive surgery (CRS), locoregional therapies such as hyperthermic intraperitoneal chemotherapy (HIPEC) or pressurized intraperitoneal aerosol chemotherapy (PIPAC) may improve tumour control. CRS is a complex procedure with high morbidity, performed only in approximately 25% of all eligible patients and the efficiency of other non-surgical therapies is not well known. The place of radiation therapy needs to be defined. A 62-year-old woman was referred for surgery for a few days’ history of large bowel obstruction. A previous abdominopelvic CT showed an obstructive 3-cm mass in the proximal ascending colon, associated with small bowel dilatation. Right hemi-colectomy was performed. Work-up demonstrated on MRI (magnetic resonance imaging) sub-centimetric secondary liver lesions. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) ruled out other metastatic lesions. After multidisciplinary discussion, peri-operative systemic therapy based on FOLFOX-Bevacizumab was offered and was associated with stable disease for 7 months. Unfortunately, peritoneal progression was detected on PET/CT imaging. FOLFIRI-Bevacizumab was offered as second line systemic therapy followed by resection of residual masses. The patient was considered in remission for 5 months thereafter. A second isolated peritoneal relapse occurred involving the same 2 distinct sites. Second line chemotherapy was re-challenged. The oligorecurrent PM lesions were considered as non-operable. After multidisciplinary team discussion, stereotactic body radiation therapy (SBRT) was decided. The relapse sites were treated with 48 Gy, delivered in 6 fractions of 8 Gy given every other day. At the 22-month follow-up, the patient showed no signs of relapse on CT imaging and no treatment-related toxicities. Isolated peritoneal oligometastatic metastases are associated with poor prognosis. Cytoreductive surgery remains the historical standard of care treatment but represents a minority of all eligible patients. Our case and few other reports suggest that SBRT is a safe, reasonable, and non-invasive treatment option.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».