24 Journal of Practical Oncology Vol. 31 No. 1 2016 MDT 1 MDT * MDT 310009 1 9 / / / / R735. 7 R730. 56 DOI:10.13267/j.cnki.syzlzz.2016.01.007 A 1001-1692 2016 01-0024-06 MDT diagnosis and treatment of colonic cancer with synchronous liver metastases A case review Li Jun Wang Liuhong Wang Jianwei et al The Multidisciplinary Team of Colorectal Cancer Cancer Center The Second Affiliated Hospital of Zhejiang University Medical School Hangzhou 310009 China Abstract The history of multidisciplinary team MDT treatment of a colonic cancer patient with synchronous multiple liver metastases was described. Liver metastases were unresectable at initial diagnosis. The patient received chemotherapy combined with targeted therapy after MDT discussion. The patient attained occasional partial response PR and received hepatectomy and colectomy. The hepatic recurrence was confirmed 9 months after surgery. PR was achieved again by chemotherapy combined with targeted therapy. The case indicated that MDT discussion was key to improve the prognosis of patients with liver metastases of colorectal cancer. Treatment aim should be dynamically adjusted according to the tolerance and treatment response of patients. MDT should be stable and specialized to achieve patients' maximum benefit. Key words liver neoplasms /secondary liver neoplasms /surgery colonic neoplasms /surgery diagnosis drug therapy antibodies monoclonal /therapeutic use 1 66 3 21. 9 kg /m 2 1 activities of daily living ADL Ⅰ ECOG 0 2 2014 4 18 3 150 /85 mmhg 1 mmhg = 0. 133 2 kpa 2 6 cm 2 kg 10 carcinoembryonic 2016-01-08 1978-. + * E-mail zrsj@ zju. edu. cn body mass index BMI antigen CEA 365 μg /L 131 g 1
2016 31 1 25 RAS Kras MRI 2 3 4 Nras 2 3 4 1B CT 1 Ⅳa 2 1 A CT Ⅰ A CT B MRI 1 2 2. 1 1 multidisciplinary team MDT 2. 1. 1 1 MDT 2014 4 22 2. 1. 1. 1 2014 4 CT MRI < 30% 2 > 30% CT 3. 6 cm 2. 1. 1. 2 T4a N N0 MRI Ⅱ Ⅲ Ⅳ Ⅴ Ⅵ Ⅶ Ⅷ Ⅳa Ⅵ 7 cm CT 2. 1. 1. 3 ct4an0m1a RAS PS 0 mfolfox6 + + 1 FOLFIRI + + 2 2. 1. 1. 4 Ⅰ
26 Journal of Practical Oncology Vol. 31 No. 1 2016 RAS 4 mfolfox6 FOLFIRI g 3. 5 g + 600 mg + MDT 700 mg 2014 7 MRI RECIST1. 1 1 2. 1. 2 partial response PR 2014 4 25-2014 6 14 FOL- FIRI 4 2014 4 25 2014 5 14 2014 5 30 2014 6 14 280 mg + 0. 5 4 2014 9 MRI 2 2 2. 2 2 MDT 2. 2. 1 2 MDT 2014 9 16 2014 9 MRI 2. 2. 1. 1 2014 9 MRI FOLFIRI 8 Ⅵ PR 2. 8 cm Ⅵ FOLFIRI CT 8 RECIST1. 1 1 PR PR R0 R0 4 2. 2. 1. 3 > 40% FOLFIRI > 10 Ⅳ 2 1 1 2. 2. 1. 2 R0 CEA > 200 μg /L 2. 2. 2 Ⅳ Ⅳ 2014 9 23-2014 10 19 Ⅱ Ⅲ Ⅵ
2016 31 1 27 + 1 2 3 7 + B Ⅳ + Ⅳ 3. 0 cm 2. 0 cm Ⅳ 2 A B B 3A ~ 0 /2 2 9 3 HE 40 FOLFIRI 4 3. 0 cm 2. 0 cm 1 3B 2. 5 cm 2. 0 cm MRI 2015 7 16 2 CT 2015 7 24 MRI 0 /19 ypt4an0m1a 2014 12 17 3 2. 3 3 MDT 2. 3. 1 3 MDT 2015 7 28 4 4 2015 7 24 9 MRI 2. 3. 1. 1 MRI 8 Ⅳ 3. 1 cm stable disease CT SD PR CT overall survival OS RECIST pro- gressive disease PD 8 3. 1 cm 2. 3. 1. 2 DFS 9 9 6 6 FOLFIRI mfolfox6 4 disease free survival DFS 9
28 Journal of Practical Oncology Vol. 31 No. 1 2016 mfolfox6 130 mg d1 + 0. 625 g 3. 5 g + 600 mg d1 + 400 mg d1 8 2. 3. 1. 3 DFS 9 8 5 CEA CEA 6 mfolfox6 4 2016 1 7 2. 3. 2 2015 8 2-2015 12 15 8 2 PR 2015 11 27 MRI PS 1 6 3 5 2015 11 27 mfolfox6 + 6 MRI PR MDT R0 MDT 2015 3 12 MDT MDT 1 RAS MDT 8 FOLFI- RI > 2 1 B DFS 9 MDT PR MDT MDT 1 ESMO 2-3 Group
2016 31 1 29 DMAS PERK NSCLC PC9 /GR 1 2* 3 1. 310053 2. 310006 3. 310006 β β'- β dimethylacryl shikonin DMAS PKR ER PKR-like ER kinase PERK PC9 /GR DMAS PC9 /GR CCK-8 Western blot 78 glucose regulated protein 78 GRP78 C /EBP C /EBP homologous protein CHOP unfolded protein response UPR PERK GSK2606414 Annexin-V-PI Western blot caspase-3 caspase-8 caspase-9 poly ADP-ribose polymerase PARP DMAS 0 5 10 15 μmol /L PC9 /GR P < 0. 05 DMAS PC9 /GR caspase-3 caspase-8 caspase-9 PARP P < 0. 05 GRP78 CHOP 0 2 4 8 P < 0. 05 PERK 2 eukaryotic initiation factor-2α eif2α 4 activating transcription factor 4 ATF4 P < 0. 05 UPR 1α inositol-requiring enzyme 1α IRE1α X 1 X-box binding protein 1 spliced XBP1s ATF6 P > 0. 05 DMAS GSK2606414 P < 0. 05 PERK P < 0. 05 caspase-3 caspase-8 caspase-9 PARP P < 0. 05 PERK-eIF2α DMAS PC9 /GR / / R734. 2 R730. 53 2015-08-11 81303114 1990-. * E-mail alexisczh@ sohu. com 檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭檭 0 1 2 3 4 2015 ESMO NED no evidence of disease 3 States National Cancer Institute of Canada J. J Natl Cancer Inst 2000 92 3 205-216. A 1001-1692 2016 01-0029-06 1 Therasse P Arbuck SG Eisenhauer EA et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer National Cancer Institute of the United 2 Suarez J. Analysis of clinical and economic implications 2 MDT of Esmo 2014 Clinical Practice Guidelines for metastatic 4 MDT colorectal cancer treatment J. Value Health 2015 18 3 MDT 7 A446. 3 Van Cutsem E Cervantes A Nordlinger B et al. Metastatic colorectal cancer ESMO Clinical Practice Guide- lines for diagnosis treatment and follow-up J. Ann On- col 2014 25 Suppl 3 iii1-9. 4. J. 2014 17 11 1060-1061.