Deutsche Zeitschrift für Onkologie 2018; 50(04): 183-187
DOI: 10.1055/a-0790-0653
Praxis – Falldarstellung
© Georg Thieme Verlag KG Stuttgart · New York

Strategiewechsel durch Therapiestratifizierung – Downsizing von primär inoperablen Lebermetastasen bei 3 Patienten mit metastasierendem kolorektalen Karzinom

Change of Therapeutic Strategy – Downsizing of Primarily Inoperable Liver Metastases in 3 Patients with Metastatic Colorectal Carcinoma
Peter Holzhauer
1   Klinik Bad Trissl, Innere Medizin II, Oberaudorf
2   IOZ München, privatärztliche Praxisgemeinschaft
Christina Grosse
3   MVZ InnMed, Radiologie, Oberaudorf
› Author Affiliations
Further Information

Publication History

Publication Date:
07 January 2019 (online)


Durch Fortschritte und Weiterentwicklungen bei diagnostischen Verfahren, Operationstechniken und lokal ablativen sowie strahlentherapeutischen Maßnahmen haben sich die Behandlungsmöglichkeiten für Patienten mit primär nicht resektablen Metastasen von kolorektalen Karzinomen deutlich verbessert. Das gilt besonders für eine begrenzte Metastasierung, die nur ein Organ betrifft. Drei Falldarstellungen.


Advances and further developments in diagnostic, surgical, and local ablative and radiotherapeutic approaches have significantly improved the treatment options for patients with primarily non-resectable metastases. This is especially evident for the situation of limited metastasis, which affects only one organ. Approximately 20% of all patients with colorectal carcinoma have synchronous metastasis at the time of diagnosis. Before metastases in the lungs or skeleton, liver metastases are present in most cases. Therefore, the selection before treatment and the interdisciplinary treatment planning represent a challenging task for this patient group [1]. Depending on the tumor biology and tumor localization as well as the general condition of the patients concerned, very intensive two-fold or three-fold combinations with additional antibody therapy are usually used for systemic treatment [3] [5]. We discuss the curatively intended treatment paths of two male and one female patient with synchronous hepatic metastatic colorectal carcinomas.

  • Literatur

  • 1 Adam R. et al. Patients with initially unresectable colorectal liver metastases: is there a possibility of cure?. J Clin Oncol 2009; 27: 1829-1835 doi:10.1200/JCO.2008.19.9273
  • 2 Douillard JY. et al. Impact of early tumour shrinkage and resection on outcomes in patients with wild-type RAS metastatic colorectal cancer. Eur J Cancer 2015; 51: 1231-1242 doi:10.1016/j.ejca.2015.03.026
  • 3 Falcone A. et al. Phase III trial of infusional fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) compared with infusional fluorouracil, leucovorin, and irinotecan (FOLFIRI) as first-line treatment for metastatic colorectal cancer: the Gruppo Oncologico Nord Ovest. J Clin Oncol 2007; 25: 1670-1676
  • 4 Karoui M. et al. Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg 2006; 243: 1-7
  • 5 Köhne CH. et al. FOLFIRI plus cetuximab in patients with liver-limited or non-liver-limited RAS wild-type metastatic colorectal cancer: A retrospective subgroup analysis of the CRYSTAL study. Eur J Surg Oncol 2016; 42: 1540-1547 doi:10.1016/j.ejso.2016.05.038
  • 6 Primrose J. et al. Systemic chemotherapy with or without cetuximab in patients with resectable colorectal liver metastasis: the New EPOC randomised controlled trial. Lancet Oncol 2014; 15: 601-611 doi:10.1016/S1470-2045(14)70105-6
  • 7 Tirumani SH. et al. Update on the role of imaging in management of metastatic colorectal cancer. Radiographics 2014; 34: 1908-1928 doi:10.1148/rg.347130090
  • 8 van Gijn W. et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 2011; 12: 575-582 doi:10.1016/S1470-2045(11)70097-70093