XXXX metastases: surgical indications and multimodal approach.

@entity1 @entity3 @entity5 @entity14
BACKGROUND/AIMS: The therapeutic plan to follow in @entity1 affected by hepatic and pulmonary metastases from @entity14 is based on prognostic factors and staging. METHODOLOGY: Our experience from January 1980 to January 2002 underlines the effectiveness of combined multimodal therapy in the treatment of advanced metastatic stages. A total of 224 @entity1 with metastases from @entity14 have been treated. Among these @entity1 160 underwent surgery (4 pulmonary and 156 hepatic resections), 17 have been reoperated for metastatic relapse, 14 with multiple metastases underwent locoregional therapy, while 33, deemed not resectable initially, have been treated with neoadjuvant chemo- and radio-therapy. RESULTS: For the operated @entity1 group the 5-year actuarial survival was 22% with an operative morbidity of 17.5% and mortality of 3.8%. The 17 @entity1 reoperated for metastatic relapse had a 5-year actuarial survival of 21% with an operative morbidity of 11.6% and mortality of 5.8%. The 14 @entity1 treated with locoregional therapy had a median survival of 6 months whereas the 33 @entity1 treated with combined multimodal treatment in two different periods had a response rate of 57.57%. Five @entity1 had a complete response and 4 are presently alive: 3 are disease free and 1 with disease. 1 died of pulmonary primitive @entity5 24 months later. CONCLUSIONS: Surgical resection is presently the best known treatment for @entity3 . In advanced, but not yet disseminated, stages in which there is no indication to surgery on metastases (II-III stages according to Gennari's classification), a neoadjuvant treatment is proposed, if the @entity5 has already been completely resected. This therapeutic strategy, called combined multimodal therapy, has the aim to obtain the disease regression and to offer the chance of disease re-staging.
