title: Successful Multidisciplinary Treatment with Secondary Metastatic Liver Resection after Downsizing by Palliative Second-Line Treatment of Colorectal Cancer: A Curative Option.
abstract: BACKGROUND
  The prognostic outcome following progression after palliative first-line treatment for patients suffering from metastatic colorectal adenocarcinoma is generally poor. Long-term relapse-free survival with palliative second-line treatment may be achieved in only a limited number of individual cases.
  
  
  METHODS
  A 37-year-old patient presented with bilobar liver metastases of colon cancer confirmed by histology with wild-type K-RAS (exon 2). Due to progressive disease after eight cycles of first-line therapy with FOLFIRI plus cetuximab, second-line chemotherapy with modified FOLFOX4 (mFOLFOX4) plus bevacizumab was initiated. During four cycles of mFOLFOX4 plus bevacizumab (2 months), no higher-grade toxicity occurred. Liver MRI with contrast medium revealed downsizing of the segment II/III metastases, as well as regressive, small, faint, hardly definable lesions in segments VI and IVb. The interdisciplinary tumor board of the University of Erlangen thus decided to perform resection of the liver metastases. Segments II and III were resected, and the liver metastases in segments IVa and VI were excised (R0). Histopathology confirmed three of the R0-resected metastases to be completely necrotic, with residual scarring. As perioperative therapy, four additional cycles of mFOLFOX4 plus bevacizumab were administered postoperatively. No higher-grade toxicity was observed. Three years after the initial diagnosis, the patient is relapse free, professionally fully reintegrated, and has an excellent performance status.
  
  
  CONCLUSIONS
  Patients suffering from metastatic colorectal cancer may benefit from multidisciplinary treatment with secondary metastatic liver resection after downsizing by palliative second-line treatment. In individual cases, patients may even have a curative treatment option, provided that close interdisciplinary collaboration exists.
authors.affiliation: Department of Internal Medicine 1 - Gastroenterology, Pulmonology and Endocrinology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Wein
authors.affiliation: Department of Internal Medicine 1 - Gastroenterology, Pulmonology and Endocrinology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Siebler
authors.affiliation: Department of Internal Medicine 1 - Gastroenterology, Pulmonology and Endocrinology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Ruediger
authors.initials: R
authors.lastname: Goertz
authors.affiliation: Department of Internal Medicine 1 - Gastroenterology, Pulmonology and Endocrinology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Wolff
authors.affiliation: Department of Internal Medicine 1 - Gastroenterology, Pulmonology and Endocrinology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Nicola
authors.initials: N
authors.lastname: Ostermeier
authors.affiliation: Department of Internal Medicine 1 - Gastroenterology, Pulmonology and Endocrinology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Busse
authors.affiliation: Department of Internal Medicine 1 - Gastroenterology, Pulmonology and Endocrinology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Andreas E
authors.initials: AE
authors.lastname: Kremer
authors.affiliation: Department of Internal Medicine 1 - Gastroenterology, Pulmonology and Endocrinology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Franz
authors.initials: F
authors.lastname: Koch
authors.affiliation: Department of Internal Medicine 1 - Gastroenterology, Pulmonology and Endocrinology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Hagel
authors.affiliation: Practice of Gastroenterology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Farnbacher
authors.affiliation: Department of Radiology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Ferdinand J
authors.initials: FJ
authors.lastname: Kammerer
authors.affiliation: Department of Internal Medicine 1 - Gastroenterology, Pulmonology and Endocrinology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Markus F
authors.initials: MF
authors.lastname: Neurath
authors.affiliation: Department of Surgery, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Gruetzmann
keywords: Colorectal cancer; Curative option; Second-line chemotherapy; Secondary liver metastasis resection