CASE REPORT: IMPORTANCE OF MULTIMODAL TREATMENT AS A CONVERSION THERAPY IN HIGH VOLUME HEPATIC DISEASE PATIENTS IN COLORRETAL METHASTS

Case Report: We report the case of a 33-year-old female patient, diagnosed in June 2013 with rectal adenocarcinoma, wild kras, with more than 40 liver metastatic nodules. She underwent conversion chemotherapy treatment with FOLFOX + BEV, followed by rectosigmoidectomy + enucleation of 12 and alcoholization of 3 liver lesions in October 2013, and continued systemic treatment. In January 2014, portal vein embolization was performed, and in March of the same year she underwent right hepatic trisegmentectomy, with persistent disease in 3 nodules. Started scheme with FOLFIRI + CETUXIMABE, and in June 2014 radiofrequency performed on 2 remaining lesions, with good response. Continued chemotherapy treatment for 24 cycles, until October 2015 there was progression of disease in the left lung, and the same regimen was resumed. From December 2015 to January 2019, the patient maintained stable disease during chemotherapy, with no evidence of liver injury. Discussion: Surgical resection of colorectal liver metastasis offers a greater chance of cure and long-term survival, therefore being the therapy of choice in resectable metastases. For those with isolated diseases, regional treatment approaches may be considered as an alternative or in combination with systemic chemotherapy. Available regional treatments include regional liver resection, chemoembolization, radioembolization and radiotherapy. Although liver resection was reserved for patients with a maximum of three lesions in the same lobe, if it was possible to reach 1 cm margins and those without lymph node metastases, these rules were modified with advances in surgical technique and systemic therapy. As a result, the criteria for defining which patients are suitable for surgical therapy have evolved, and many surgeons take an aggressive stance in the management of liver metastases. Final comments: The reported case opens the way for discussion of the role of multimodal therapy in cases of high volume liver disease in colorectal metastasis, where with the advancement of surgical techniques and chemotherapy, we can elect patients who are candidates for more aggressive therapy, bringing benefit in quality of life and survival.

Publication History

Article published online:
23 October 2019