Contemporary Management of Metastatic Colorectal Cancer: A Precision Medicine Approach

Front Matter
Front Matter
Copyright
Dedication
References
Chapter 1 Epidemiology and risk factors for metastatic colorectal disease
	Colorectal cancer incidence and survival
		Risk factors for colorectal cancer
		Screening guidelines
	Summary
	References
Chapter 2 The tumor microenvironment of colorectal cancer liver metastases: Molecular mediators and future therapeutic targets
	Introduction
	The unique immune microenvironment of the liver
		Role of liver sinusoidal endothelial cells
		The natural killer cells of the liver
		Liver dendritic cell functions
		Neutrophils opposing roles in liver metastasis progression
		Myeloid-derived suppressor cells \(MDSCs\) promote liver metasasis by diverse mechanisms
		Role of hepatic stellate cells
		Multiple factors combine to inhibit a cytolytic T cell response to metastatic cancer cells
	The extracellular matrix regulates cancer cell survival and growth in the liver
		The unique extracellular matric \(ECM\) of the liver and liver metastases
		The ECM and cell adhesion molecules
		The effect of ECM stiffness
	Potential strategies for targeting the microenvironment of CRLM and increasing immunotherapy efficacy in patients
	Conclusion
	Acknowledgements
	References
Chapter 3 Pre-operative imaging, response evaluation, and surgical planning ^^e2^^80^^93 CT, PET, radiomics, and FLR measurement
	Introduction
	Role of imaging in CRLM
	Pre-operative imaging of CRLMs
		Initial staging
		Ultrasonography \(US\)
		Computed tomagraphy \(CT\)
		Magnetic resonance imaging \(MRI\)
		Fluorodeoxyglucose-positron emission tomography \(FDG-PET\)
	Assessment of prognosis and surgical candidacy
	Use of imaging for surgical planning
	Pre-operative treatment and response evaluation of CRLM
		Downsizing of initially unresectable lesions
	Increasing future remnant liver volume and volumetric assessment
		Volumetric assessment
		Increasing future remnant liver volume
	Alternative therapies for CRLM
		Ablation
		Hepatic artery infusion \(HAI\) and selective internal radiation therapy \(SIRT\)
	Conclusion
	Bibliography
Chapter 4 Use of molecular markers and other personalized factors in treatment decisions for metastatic colorectal cancer
	Introduction
	Prognostic versus predictive
	Disease characteristics
	Histology
	Pharmacogenetics for conventional cytotoxic chemotherapy
	KRAS
	BRAF
	HER2
	DNA microsatellite instability and immunotherapy
	Tumor sidedness
	Circulating tumor cells and cell free DNA
	Gut microbiome
	Conclusions
	References
Chapter 5 Role of Neoadjuvant therapy in the treatment of patients with colorectal liver metastases
	Introduction
	Rationale for perioperative chemotherapy for colorectal liver metastases
	Preoperative chemotherapy for patients with unresectable liver metastases
	Neoadjuvant chemotherapy for resectable liver metastases
	Safety of neoadjuvant chemotherapy for colorectal liver metastases
	Conclusions
	References
Chapter 6 Management of the disappeared colorectal liver metastasis
	Introduction
	Defining disappearing colorectal liver metastasis \(DLM\)
	Predictors of DLM pathologic response
	Intra-Operative evaluation of DLM
	Surgical resection versus surveillance of DLM
	Summary
	References
Chapter 7 Approach to small liver remnant ^^e2^^80^^93 strategies to increase resectability
	Introduction
	Future liver remnant \(FLR\)
		Calculating FLR
		Optimal future liver volume
	Portal vein embolization \(PVE\)
		Indications and contraindications for PVE
		Portal vein ligation, a historical perspective
		Technical aspects of PVE
		Post-PVE hypertrophy/kinetic growth rate
	Combined portal vein & hepatic vein embolization
	Associating liver partition and portal vein ligation
	Conclusion
	References
Chapter 8 Two-stage versus ALPPS for large intrahepatic burden of colorectal liver metastasis
	FLR hypertrophy and feasibility to complete both stages
	Morbidity and Mortality
	Oncological results
	Conclusion
	References
Chapter 9 Synchronous colorectal liver metastasis ^^e2^^80^^93 simultaneous vs. staged approach
	Introduction
	Sequencing of care for sCRLM
		Perioperative chemotherapy
		Simultaneous approach
		Staged approaches: primary-first
		Staged approaches: liver-first
	Surgical approach summary
	MSK approach
	Case-based learning
	References
Chapter 10 Minimally invasive approaches to colorectal liver metastases
	Introduction
	Laparoscopic liver resection
		Background
		Outcomes
	Robotic liver resection
		Background
		Outcomes
	Laparoscopic radiofrequency ablation
		Background
		Outcomes
	Laparoscopic microwave coagulation
		Background
		Outcomes
	Conclusion
	References
Chapter 11 Hepatic resection of colorectal liver metastasis in the presence of extrahepatic disease
	Incidence of extrahepatic disease
	Diagnosis of extrahepatic disease
	Role of surgery in patients with extrahepatic disease
	Recurrence
	Lung metastases
	Lymph node metastases
	Peritoneal metastases
	Conclusions
	References
Chapter 12 Locoregional approaches to colorectal liver metastasis ^^e2^^80^^93 ablation
	Introduction
	Indications and contraindications
	Radiofrequency vs microwave ablations
	Ablation approaches
	Post-ablation complications
	Surveillance
	Local recurrence rates
	Long-term outcomes
	Long-term outcomes of the multi-modality treatments
	Summary points
	Disclosure statement
	References
Chapter 13 Locoregional approaches to colorectal liver metastasis ^^e2^^80^^93 intra-arterial
	Introduction
	Embolic therapies
		Indications and outcomes
		Summary of embolic therapies
	Transarterial radioembolization \(TARE\)
	Hepatic artery infusion chemotherapy \(HAIC\)
		HAIP: function and insertion
		Indications, contraindications, and other complications
		Summary of hepatic arterial infusion chemotherapy
		HAIC outcomes relative to other intra-arterial therapies
	Conclusions
	Case stem
	References
Chapter 14 Locoregional Approaches to Colorectal Liver Metastasis ^^e2^^80^^93 Radiation Options
	Introduction: external beam radiation therapy \(EBRT\) for colorectal liver metastases
	External beam radiation: rationale for ablative dosing
	External beam radiation: patient selection
	External beam radiation: treatment planning considerations
	External beam radiation: target volume design and treatment objectives
	External beam radiation: outcomes and surveillance considerations
	Future directions
	References
Chapter 15 Immunotherapy and targeted therapies for colorectal liver metastasis
	Targeted therapy in CRC with CLM
	Resectable CLM at diagnosis with no extra-hepatic metastatic disease
	Unresectable CLM at diagnosis with a potential for resection with no extra-hepatic metastatic disease
	CLM with no potential for resection and/or unresectable extra-hepatic disease
		First-line therapy- in combination with chemotherapy
		Subsequent lines of therapy
	Immunotherapy
	References
Chapter 16 Adjuvant therapy following resection of colorectal liver metastases
	Introduction
	Timing of systemic treatment
	Role of adjuvant treatment
	Adjuvant intra-arterial chemotherapy following resection of colorectal liver metastases
	Conclusion
	Clinical case
	References
Chapter 17 Long-term prognosis and surveillance of patients with resected colorectal liver metastasis
	Introduction
	Clinical risk scores
	Other prognostic tools
	Inflammatory and immune predictors of survival
	Predicting recurrence
	Surveillance and recurrence
	Conclusion
	References
Chapter 18 Management of secondary recurrence of intra-hepatic colorectal liver metastasis following initial hepatic resection
	Introduction
	Surveillance following initial hepatectomy
		Frequency of testing
		Length of surveillance
		Testing parameters
	Repeat liver resection
		Technical considerations
		Published experience with repeat hepatectomy
		Early recurrence
	Other treatment modalities
		Systemic therapy
		Ablation therapy
		Ablative radiation
		Transarterial chemoembolization \(TACE\)
		Transarterial radioembolization \(TARE\)
		Hepatic artery infusion chemotherapy \(HAIC\)
		Transplant
	References
Chapter 19 Colorectal liver metastasis: survivorship
	Introduction
	What is a cancer survivor?
	Colorectal cancer survivors with liver metastases
	Surveillance for recurrence and screening for second primary cancers
		Prognosis
		Disparities in metastatic colorectal cancer survival
		Surveillance and screening
	Assessment and management of physical and psychosocial effects of colorectal cancer and treatment
		Methods of assessment
		Post-Diagnosis pain
		Fatigue and physical activity
		Mood/Mental health/depression/fear
		Bowel function
		Ostomy-Specific concerns
		Sexual wellness
		Financial burden
		Specific HRQoL outcomes in patients with colorectal cancer liver metastases
	Routine health promotion needs
	Coordination of care among specialists and primary care clinicians
		Experience with healthcare providers
		Progressive disease
		Palliative care involvement
	Limitations and future directions
		Surveillance for recurrence and screening for second primary cancers
		Assessment and management of physical and psychosocial effects of colorectal cancer and treatment
		Coordination of care among specialists and primary care clinicians
	Summary
	References
Contents
Contributors
Index