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Long-term outcome of adrenalectomy for metastasis resulting from colorectal cancer with other metastatic sites: A report of 3 cases

View Article: PubMed Central - PubMed

ABSTRACT

Metastasis to the adrenal glands is a relatively frequent observation at autopsy of patients that have succumbed to cancer. Long-term disease-free survival has been reported in patients following the resection of solitary adrenal metastasis resulting from colorectal cancer. In addition, following primary resection for colorectal cancer, solitary metastasis to the adrenal glands is rare, even in outpatients at routine follow-ups. Therefore, adrenal metastasis is usually detected in combination with multiple synchronous metastases at other sites in the terminal stages of cancer. Between 1998 and 2002, 3 patients with adrenal metastasis and other synchronous metastatic sites underwent surgery for adrenal metastasis at the Department of Gastroenterological Surgery at Osaka University. The other synchronous metastatic sites observed in the 3 patients consisted of lung and para-aortic lymph nodes. In total, 2 out of the 3 patients experienced long-term disease-free survival for >5 years following surgery and 1 patient underwent curative resection for recurrence of metastases in the liver and right adrenal gland 79 months subsequent to the initial resection for adrenal metastasis. All 3 patients survived for >90 months. In conclusion, aggressive surgical resection for adrenal metastasis and other metastatic sites resulting from colorectal cancer may result in a survival benefit in selected patients.

No MeSH data available.


Related in: MedlinePlus

Patient 3. (A) Abdominal CT of an enlarged right adrenal gland, indicated by an arrow. (B) Abdominal CT of para-aortic lymph node swelling, indicated by an arrow. (C) Abdominal PET-CT with FDG uptake of right adrenal gland, indicated by an arrow. (D) Abdominal PET-CT of the para-aortic lymph node with FDG uptake, indicated by an arrow. (E) Alterations in the serum CEA levels of the patient. CT, computed tomography; PET, positron emission tomography; FDG, [18F]-2-fluoro-2-deoxy-D-glucose; CEA, serum carcinoembryonic antigen; UFT, tegaful/uracil; CPT-11, camptothecin-11; mFOLFOX6, modified FOLFOX6 regimen (5-fluorouracil with leucovorin and oxaliplatin).
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f3-ol-0-0-4897: Patient 3. (A) Abdominal CT of an enlarged right adrenal gland, indicated by an arrow. (B) Abdominal CT of para-aortic lymph node swelling, indicated by an arrow. (C) Abdominal PET-CT with FDG uptake of right adrenal gland, indicated by an arrow. (D) Abdominal PET-CT of the para-aortic lymph node with FDG uptake, indicated by an arrow. (E) Alterations in the serum CEA levels of the patient. CT, computed tomography; PET, positron emission tomography; FDG, [18F]-2-fluoro-2-deoxy-D-glucose; CEA, serum carcinoembryonic antigen; UFT, tegaful/uracil; CPT-11, camptothecin-11; mFOLFOX6, modified FOLFOX6 regimen (5-fluorouracil with leucovorin and oxaliplatin).

Mentions: A 57-year-old woman underwent a sigmoidectomy in January 2002 for CRC. According to the TNM classification (26,27), the pathological staging of the tumor was II (moderately-differentiated adenocarcinoma; pT3pN0M0; R0). Eleven months after sigmoidectomy, abdominal CT (Discovery CT750 HD; GE Healthcare) revealed liver metastasis [segment (S) 2 and S7], and 4 cycles of chemotherapy (400 mg UFT with 240 mg CPT-11) were administered to the patient for 5 months. After 4 cycles of chemotherapy, the liver metastasis decreased in size and new lesions were not detected. A partial liver resection (S2 and S7) was performed in July 2003, and 3 additional cycles of chemotherapy (400 mg UFT with 180 mg CPT-11) were administered. Forty months subsequent to the second surgery, PET-CT (HEADTOME/set. 2400W; Shimadzu Co.) revealed the presence of adrenal metastasis and para-aortic lymph node recurrences (Fig. 3A-D). In total, 4 cycles of the modified folinic acid, 5-FU and oxaliplatin (mFOLFOX6) regimen (5-FU with LV and oxaliplatin) were administered to the patient as pre-operative chemotherapy. In each course, there were no cycles, but simply one rapid infusion and one continuous infusion for 46 h. The adrenal metastasis and lymph node recurrence decreased in size, and a right adrenalectomy and para-aortic lymph node dissection was performed in July 2007. A pathological examination of the adrenal gland confirmed the diagnosis of moderately-differentiated adenocarcinoma consistent with metastatic CRC. Metastasis was detected in 1 out of 13 dissected para-aortic lymph nodes. mFOLFOX6 was administered as post-operative chemotherapy for 4 cycles following the third surgery. Subsequently, the CEA level of the patient was elevated to 8 ng/ml and PET-CT revealed a local recurrence in the right adrenal gland. Therefore, mFOLFOX6 with bevacizumab was administered to the patient for 23 cycles and discontinued following the development of adverse reactions, including peripheral neuropathy (grade 2), general fatigue and nausea. Following mFOLFOX and bevacizumab treatment for the local adrenal recurrence, the patient was well and no evidence of an additional recurrence was observed using PET-CT (Fig. 3E). However, 79 months subsequent to the initial resection of adrenal metastasis, the patient underwent a curative resection for recurrence of liver metastases and recurrence in the right adrenal gland. At the last follow-up in February 2015, the patient was alive and no evidence of metastasis was observed using PET-CT and the patient had a normal CEA level for 12 months following the second surgical resection of adrenal and liver metastases.


Long-term outcome of adrenalectomy for metastasis resulting from colorectal cancer with other metastatic sites: A report of 3 cases
Patient 3. (A) Abdominal CT of an enlarged right adrenal gland, indicated by an arrow. (B) Abdominal CT of para-aortic lymph node swelling, indicated by an arrow. (C) Abdominal PET-CT with FDG uptake of right adrenal gland, indicated by an arrow. (D) Abdominal PET-CT of the para-aortic lymph node with FDG uptake, indicated by an arrow. (E) Alterations in the serum CEA levels of the patient. CT, computed tomography; PET, positron emission tomography; FDG, [18F]-2-fluoro-2-deoxy-D-glucose; CEA, serum carcinoembryonic antigen; UFT, tegaful/uracil; CPT-11, camptothecin-11; mFOLFOX6, modified FOLFOX6 regimen (5-fluorouracil with leucovorin and oxaliplatin).
© Copyright Policy - open-access
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4998229&req=5

f3-ol-0-0-4897: Patient 3. (A) Abdominal CT of an enlarged right adrenal gland, indicated by an arrow. (B) Abdominal CT of para-aortic lymph node swelling, indicated by an arrow. (C) Abdominal PET-CT with FDG uptake of right adrenal gland, indicated by an arrow. (D) Abdominal PET-CT of the para-aortic lymph node with FDG uptake, indicated by an arrow. (E) Alterations in the serum CEA levels of the patient. CT, computed tomography; PET, positron emission tomography; FDG, [18F]-2-fluoro-2-deoxy-D-glucose; CEA, serum carcinoembryonic antigen; UFT, tegaful/uracil; CPT-11, camptothecin-11; mFOLFOX6, modified FOLFOX6 regimen (5-fluorouracil with leucovorin and oxaliplatin).
Mentions: A 57-year-old woman underwent a sigmoidectomy in January 2002 for CRC. According to the TNM classification (26,27), the pathological staging of the tumor was II (moderately-differentiated adenocarcinoma; pT3pN0M0; R0). Eleven months after sigmoidectomy, abdominal CT (Discovery CT750 HD; GE Healthcare) revealed liver metastasis [segment (S) 2 and S7], and 4 cycles of chemotherapy (400 mg UFT with 240 mg CPT-11) were administered to the patient for 5 months. After 4 cycles of chemotherapy, the liver metastasis decreased in size and new lesions were not detected. A partial liver resection (S2 and S7) was performed in July 2003, and 3 additional cycles of chemotherapy (400 mg UFT with 180 mg CPT-11) were administered. Forty months subsequent to the second surgery, PET-CT (HEADTOME/set. 2400W; Shimadzu Co.) revealed the presence of adrenal metastasis and para-aortic lymph node recurrences (Fig. 3A-D). In total, 4 cycles of the modified folinic acid, 5-FU and oxaliplatin (mFOLFOX6) regimen (5-FU with LV and oxaliplatin) were administered to the patient as pre-operative chemotherapy. In each course, there were no cycles, but simply one rapid infusion and one continuous infusion for 46 h. The adrenal metastasis and lymph node recurrence decreased in size, and a right adrenalectomy and para-aortic lymph node dissection was performed in July 2007. A pathological examination of the adrenal gland confirmed the diagnosis of moderately-differentiated adenocarcinoma consistent with metastatic CRC. Metastasis was detected in 1 out of 13 dissected para-aortic lymph nodes. mFOLFOX6 was administered as post-operative chemotherapy for 4 cycles following the third surgery. Subsequently, the CEA level of the patient was elevated to 8 ng/ml and PET-CT revealed a local recurrence in the right adrenal gland. Therefore, mFOLFOX6 with bevacizumab was administered to the patient for 23 cycles and discontinued following the development of adverse reactions, including peripheral neuropathy (grade 2), general fatigue and nausea. Following mFOLFOX and bevacizumab treatment for the local adrenal recurrence, the patient was well and no evidence of an additional recurrence was observed using PET-CT (Fig. 3E). However, 79 months subsequent to the initial resection of adrenal metastasis, the patient underwent a curative resection for recurrence of liver metastases and recurrence in the right adrenal gland. At the last follow-up in February 2015, the patient was alive and no evidence of metastasis was observed using PET-CT and the patient had a normal CEA level for 12 months following the second surgical resection of adrenal and liver metastases.

View Article: PubMed Central - PubMed

ABSTRACT

Metastasis to the adrenal glands is a relatively frequent observation at autopsy of patients that have succumbed to cancer. Long-term disease-free survival has been reported in patients following the resection of solitary adrenal metastasis resulting from colorectal cancer. In addition, following primary resection for colorectal cancer, solitary metastasis to the adrenal glands is rare, even in outpatients at routine follow-ups. Therefore, adrenal metastasis is usually detected in combination with multiple synchronous metastases at other sites in the terminal stages of cancer. Between 1998 and 2002, 3 patients with adrenal metastasis and other synchronous metastatic sites underwent surgery for adrenal metastasis at the Department of Gastroenterological Surgery at Osaka University. The other synchronous metastatic sites observed in the 3 patients consisted of lung and para-aortic lymph nodes. In total, 2 out of the 3 patients experienced long-term disease-free survival for >5 years following surgery and 1 patient underwent curative resection for recurrence of metastases in the liver and right adrenal gland 79 months subsequent to the initial resection for adrenal metastasis. All 3 patients survived for >90 months. In conclusion, aggressive surgical resection for adrenal metastasis and other metastatic sites resulting from colorectal cancer may result in a survival benefit in selected patients.

No MeSH data available.


Related in: MedlinePlus