Sigmoid colectomy in an 84 year gentleman stage 3 . Adjuvant chemotherapy six months. Pet scan. On follow up showed adrenal lesion 4 .5 cm size .met. Would you operate or advice palliate chemotherapy
It really depends on his performance status and if he is symptomatic. If his PS is not so good and he is symptomatic, I might consult with radio-oncologist. If he seems to be able to undergo surgery, that would be good. Moderate combination chemotherapy such as bevacizumab+capecitabine or cetuximab+capecitabine would be the good alternation I think.
. N Mourra , C. Guettier, J.-F. Flejou, and E. Tiret, “Adrenalectomy for clinically isolated metastasis from colorectal carcinoma: report of eight cases,” Diseases of the Colon & Rectum, vol. 51, no. 12, pp. 1846–1849, 2008.
median survival 32 months after resection
I would go with palliative metastasectomy every time it could be possible to render a patient disease-free.
Dear prof haray and Dr martins
i feel the same, while there is lot of data on surgery for oligometastic liver and lung disease, oligometastic disease at other sites has not been evaluated extensively
saklani
I would recomend adrenalectomy if patient is suitable for surgery. There are no strong data supporting this advice (solid data are available mainly for liver metastases), but cases series and clinical experience would make me consider it.
In ECOG 0(-1) cut it out if you have a skilled surgeon. If not and the tumor is less than 4cm do it by RFA / HIFU. This may be an alternative anyway.
Dear Dr Avanish
First of all , you should prove the pathology of adrenal preferably with FNA. According NCCN guideline in metastatic colon cancer , it is better to do PET CT scan in order to find other possible mets.
if you only have adrenal mets i suggest metastasectomy.
The PET CT would be something that I would take for granted before starting this debate and this whole discussion is based on the premise that there are no other mets!! However, I would strongly disagree with the suggestion of FNA. Sticking needles into solitary mets can potentially disseminate disease and convert a 'potentially curable' situation to a hopelessly palliative one. Also PET-CTs are very reliable and there are few other adrenal lesions which would be expected to light up similarly.
- Badges
- Science topic
- Similar topics
- Physical Sciences
- Materials Science
- Materials Chemistry
- Polymer Chemistry