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The multidisciplinary management of colorectal cancer: present and future

Prof. Dr. med. Ulrich Güller, MHS, FEBS Medical Oncology, Kantonsspital St. Gallen University Clinic for Visceral Surgery and Medicine, University Berne. The multidisciplinary management of colorectal cancer: present and future. Ueli Güller. No conflicts of interest.

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The multidisciplinary management of colorectal cancer: present and future

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  1. Prof. Dr. med. Ulrich Güller, MHS, FEBS Medical Oncology, Kantonsspital St. Gallen University Clinic for Visceral Surgery and Medicine, University Berne The multidisciplinary management of colorectal cancer: present and future

  2. Ueli Güller

  3. No conflicts of interest.

  4. AcknowlegmentProfessor John Triantafillidis, MD, PhD, MACG

  5. Overview 3 case presentations Current treatment armamentarium in patients with metastatic colorectal cancer Outlook: future treatment strategies Discussion/Questions

  6. Patient 1 58 yo Male IT Specialist • 58 yo male IT-specialist • No relevant past medical history • Unspecific abdominal pain, fatigue

  7. 58 yo Male IT Specialist • Primary care physician: Ultrasound • „Big“ lesion right liver lobe • Computertomographie

  8. Ueli Güller

  9. Computertomographie • 20cm lesion in right liver lobe • Nootherlesions on CT scan • Thikening of sigmoidcolon

  10. Computertomographie • 20cm lesion in right liver lobe • Nootherlesions on CT scan • Thikening of sigmoidcolon => Colonoscopy + biopsy: Adenocarcinoma G2 sigmoidcolon

  11. Computertomographie • 20cm lesion in right liver lobe • Nootherlesions on CT scan • Thikening of sigmoidcolon • Colonoscopy + biopsy: Adenocarcinoma G2 sigmoidcolon • Sigmoidcarcinomawithsynchronoussingularlivermetastasis

  12. Multidisciplinary Tumorboard

  13. Gastroenterology • Medical Oncology • Radiation-Oncology • Surgical Oncology • Radiology • Interventionel Radiol. (TAE, RFA, MWA, IRE) • Patholology • Nuclear Medicine (SIRT) Multidisciplinary Tumorboard

  14. Gastroenterology • Medical Oncology • Radiation-Oncology • Surgical Oncology • Radiology • Interventionel Radiol. (TAE, RFA, MWA, IRE) • Patholology • Nuclear Medicine (SIRT) • => BRAIN POWER!!! Multidisciplinary Tumorboard

  15. Ueli Güller

  16. Systemic disease • Synchronous singule liver metastasis from sigmoid cancer Multidisciplinary Tumorboard

  17. Step 1: Inductionchemotherapy Multidisciplinary Tumorboard

  18. Step 1: Inductionchemotherapy Step 2: Resectionliver (liver-first) Multidisciplinary Tumorboard

  19. Step 1: Inductionchemotherapy Step 2: Resectionliver (liver-first) Step 3: Chemotherapy Multidisciplinary Tumorboard

  20. Step 1: Inductionchemotherapy Step 2: Resectionliver (liver-first) Step 3: Chemotherapy Step 4: Oncologicsigmoid resection Multidisciplinary Tumorboard

  21. OCFL- regime • 3 chemotherapeutic agents (5FU, Oxaliplatin, Irinotecan) • Weekly administration • Port-à-Cath • 3 months of treatment Chemotherapy Roth A et al, Ann Oncol 2005

  22. Prior to Chemotherapy

  23. After 3 Months of Chemotherapy Nach Chemotherapie

  24. Prior After Nach Chemo Vor Chemo

  25. Good partial remission • General conditions improved during chemotx • Relevant decrease of tumormarkers • Ca 19-9: 14`200 => 64 • CEA 3`940 => 16 Chemotherapy

  26. Decision: Right-sidedhemi-hepatectomy MD Tumorboard

  27. Liver Resection

  28. Liver Specimen

  29. Liver Specimen Histology: < 10% vital cancercells!

  30. Chemotherapy: 6 x FOLFOX (5FU und Oxaliplatin) • Oncologicsigmoidcancer resection • ypT3, ypN1a (1/17) ypM1a (HEP) • Patient remains in completeremission 5 years after surgery 58-yo Male IT-Specialist

  31. Excellentcollaborationbetween surgicalandmedicaloncologists! 58-yo Male IT-Specialist

  32. Patient 2 55 yo Female Patient

  33. Fatigue, irondeficiency • Colonoscopy • Cancer ascendingcolon • CT: 6 bilobarhepaticmetastases • 1 lesionseg. II, all otherlesions: right lobe • = > Synchronoushepaticmetastases 55 yo Female Patient

  34. Step 1: Inductionchemotherapy Step 2: Clearing liver (R-lobe plus RFA II) Step 3: Chemotherapy Step 4: Righthemicolectomy MD Tumorboard

  35. FOLFOX 6 infusions (Nordlinger/EORTC) • Very good partial remission 55 yo Female Patient

  36. Prior Post

  37. Prior Post

  38. Tumorboard: Neoadjuvant systemic treatment • FOLFOX 6 infusions • Very good partial remission • 5/2015: Tumorboard: Right hemihepatectomy/RFA metastasis seg. II 55 yo Female Patient

  39. Tumorboard: Neoadjuvant systemic treatment • FOLFOX 6 infusions • Very good partial remission • 5/2015: Tumorboard: Right hemihepatectomy/RFA seg. II • Histology: complete path. remission 55 yo Female Patient

  40. Histology: complete pathologic remission • FOLFOX x 6 infusion • 10/2015: Right hemicolectomy: ypT3N0 (0/16)ypM+ 55 yo Female Patient

  41. 8/2016: PET-CT: solitary pulmonary lesion 55 yo Female Patient

  42. 8/2016: PET-CT: solitary pulmonary lesion 55 yo Female Patient

  43. 8/2016: PET-CT: solitary pulmonary lesion • No other metastases • MRI liver: no liver metastases 55 yo Female Patient

  44. 8/2016: PET-CT: solitary pulmonary lesion • No other metastases • MRI liver: no liver metastases • Microwave ablation 9/2016 (alternative: stereotactic RT) 55 yo Female Patient

  45. 8/2016: PET-CT: solitary pulmonary lesion • No other metastases • MRI liver: no liver metastases • Microwave ablation 9/2016 • Regular restagings: complete remission 55 yo Female Patient

  46. 8/2016: PET-CT: solitary pulmonary lesion • No other metastases • MRI liver: no liver metastases • Microwave ablation 9/2016 • Regular restagings: complete remission • PET-CT May 2018 • Patient in ongoing complete remission 55 yo Female Patient

  47. May 2018

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