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Recommandations pour la pratique clinique Cancer du rectum

Question 6 Comment prendre en charge les cancers du rectum avec métastases synchrones ?

Résumé

Le cancer du rectum avec métastases synchrones regroupe un large éventail de présentations cliniques. Dans cette situation, la stratégie thérapeutique va dépendre du site et de l’extension de la tumeur du rectum, et de l’extension de la maladie métastatique hépatique et extra-hépatique. En cas de métastases non résécables, l’objectif de la prise en charge est de prolonger la survie et de préserver la qualité de vie. L’administration d’une chimiothérapie systémique représente le traitement de première intention car elle permet de cibler la maladie métastatique et, dans la grande majorité des cas, de contrôler les symptômes liés à la tumeur primitive. Chez les malades ayant des métastases résécables, une prise en charge à visée curative doit être envisagée et de nombreuses options peuvent être discutées aussi bien en ce qui concerne l’administration des traitements préopératoires (radiothérapie, radiochimiothérapie et chimiothérapie) que de la séquence chirurgicale optimale (stratégie simultanée du cancer du rectum ou chirurgies séparées). Dans cette situation, la stratégie thérapeutique doit permettre de traiter tous les sites tumoraux de façon optimale. Compte tenu des nombreuses options thérapeutiques qui peuvent être proposées, il n’est pas possible de définir une attitude standardisée convenant à tous les malades. Une discussion pluridisciplinaire doit être envisagée dès le début de la prise en charge de ces malades.

Abstract

Rectal cancer with synchronous metastases includes a wide variety of clinical presentations. Treatment strategy is defined based on the extent of primary rectal cancer and the extent of metastatic disease. In patients with unresectable metastases, the objective of treatment strategy is to prolong survival and to preserve quality of life. Palliative systemic chemotherapy represents the first treatment option as it is effective on metastatic disease and primary cancer symptoms control in most cases. In patients with resectable metastases, treatment approach with curative intent should be considered. In this setting, a large number of options can be discussed with regard to the use of preoperative treatment (radiotherapy, chemoradiotherapy and chemotherapy) and the type of surgical approach (classical approach with primary cancer resection first, simultaneous approach with combined resection of primary cancer and metastases and reverse approach with resection of metastases first). None of these strategies has been shown to be better than another and no standardized approach can be recommended for all patients with rectal cancer and synchronous metastases. Early discussion during multidisciplinary meeting is necessary to define a strategy that can provide optimal treatment to all tumor sites.

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References

  1. 1.

    Benoist S (2007) Recommandations pour la pratique clinique: comment prendre en charge un cancer du rectum avec des métastases synchrones. Gastroenterol Clin Biol 31 Spec No 1:1S75–80, S100-2

  2. 2.

    Stillwell AP, BuettnerPG, Ho YH (2010) Meta-analysis of survival of patients with stage IV colorectal cancer managed with surgical resection versus chemotherapy alone. World J Surg 34: 797–807

  3. 3.

    Cellini C, Hunt SR, Fleshman JW, et al (2010) Stage IV rectal cancer with liver metastases: is there a benefit to resection of the primary tumor? World J Surg 34: 1102–8

  4. 4.

    Scheer MG, Sloots CE, van der Wilt GJ, et al (2008) Management of patients with asymptomatic colorectal cancer and synchronous irresectable metastases. Ann Oncol 19: 1829–35

  5. 5.

    Cirocchi R, Trastulli S, Abraha I, et al (2012). Non-resection versus resection for an asymptomatic primary tumour in patients with unresectable stage IV colorectal cancer. Cochrane Database Syst Rev 8:CD008997

  6. 6.

    Gresham G, Renouf DJ, Chan M, et al (2014). Association between palliative resection of the primary tumor and overall survival in a population-based cohort of metastatic colorectal cancer patients. Ann Surg Oncol 21: 3917–23

  7. 7.

    Ishihara S, Hayama T, Yamada H, et al (2014) Prognostic impact of primary tumor resection and lymph node dissection in stage IV colorectal cancer with unresectable metastasis: a propensity score analysis in a multicenter retrospective study. Ann Surg Oncol 21: 2949–55

  8. 8.

    Cotte E, Villeneuve L, Passot G, et al (2015). GRECCAR 8: impact on survival of the primary tumor resection in rectal cancer with unresectable synchronous metastasis: a randomized multicentre study. BMC Cancer 15:1060

  9. 9.

    Hünerbein M, Krause M, Moesta KT, et al (2005) Palliation of malignant rectal obstruction with self-expanding metal stents. Surgery 137: 42–7

  10. 10.

    Song HY, Kim JH, Kim KR, et al (2008) Malignant rectal obstruction within 5 cm of the anal verge: is there a role for expandable metallic stent placement? Gastrointest Endosc 68: 713–20

  11. 11.

    Endoscopy and Cancer Committee of the French Society of Digestive Endoscopy (SFED) and the French Federation of Digestive Oncology (FFCD) (2014). Place of colorectal stents in therapeutic management of malignant large bowel obstructions. Endoscopy 46: 546–52

  12. 12.

    Bensignor T, Brouquet A, Dariane C, et al (2014) Pathologic response of locally advanced rectal cancer to preoperative chemotherapy without pelvic irradiation. Colorectal Dis. doi: 10.1111/codi.12879. [Epub ahead of print]

  13. 13.

    Schrag D, Weiser MR, Goodman KA, et al (2014) Neoadjuvant chemotherapy without routine use of radiation therapy for patients with locally advanced rectal cancer: a pilot trial. J Clin Oncol 32: 513–8

  14. 14.

    Hasegawa J, Nishimura J, Mizushima T, et al (2014) Neoadjuvant capecitabine and oxaliplatin (XELOX) combined with bevacizumab for high-risk localized rectal cancer. Cancer Chemother Pharmacol 73: 1079–87

  15. 15.

    Poultsides GA, Servais EL, Saltz LB, et al (2009) Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy withoutsurgery as initial treatment. J ClinOncol 27: 3379–84

  16. 16.

    Chua YJ, Barbachano Y, Cunningham D, et al (2010). Neoadjuvantcapecitabine and oxaliplatin before chemoradiotherapy and total mesorectal excision in MRI-defined poor-risk rectal cancer: a phase 2 trial. Lancet Oncol 11: 241–8

  17. 17.

    Fernandez-Martos C, Brown G, Estevan R, et al (2014) Preoperative chemotherapy in patients with intermediate-risk rectal adenocarcinoma selected by high-resolution magnetic resonance imaging: the GEMCAD 0801 Phase II Multicenter Trial. Oncologist 19: 1042–3

  18. 18.

    Tougeron D, Paillot B, Michel P (2010) Outcome of primary tumor in patients withsynchronous stage IV colon or rectal cancer: so much the same yet so different. Gastroenterol Clin Biol 2010 34:e15–6

  19. 19.

    Tyc-Szczepaniak D, Wyrwicz L, Kepka L, et al (2013) Palliative radiotherapy and chemotherapy instead of surgery in symptomatic rectal cancer with synchronous unresectable metastases: a phase II study. Ann Oncol 24: 2829–34

  20. 20.

    Bosset JF, Collette L, Calais G, et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355: 1114–23

  21. 21.

    Nordlinger B, Sorbye H, Glimelius B, et al (2008) Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet 371: 1007–16

  22. 22.

    Manceau G, Brouquet A, Bachet JB, et al (2013) Response of liver metastases to preoperative radiochemotherapy in patients with locally advanced rectal cancer and resectable synchronous liver metastases. Surgery 154: 528–35

  23. 23.

    van Gijn W, Marijnen CA, Nagtegaal ID, et al (2011) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 12: 575–82

  24. 24.

    Silberhumer GR, Paty PB, Temple LK, et al (2014) Simultaneous resection for rectal cancer with synchronous liver metastasisis a safe procedure. Am J Surg doi: 10.1016 [Epub ahead of print]

  25. 25.

    Bretagnol F, Hatwell C, Farges O, et al (2008) Benefit of laparoscopy for rectal resection in patients operated simultaneously for synchronous liver metastases: preliminary experience. Surgery 144: 436–41

  26. 26.

    Hatwell C, Bretagnol F, Farges O, et al (2013) Laparoscopic resection of colorectal cancer facilitates simultaneous surgery of synchronous liver metastases. Colorectal Dis 15:e21–8

  27. 27.

    Lupinacci RM, Andraus W, De Paiva Haddad LB, et al (2014) Simultaneous laparoscopic resection of primary colorectal cancer and associated liver metastases: a systematic review. Tech Coloproctol 18: 129–35

  28. 28.

    Reddy SK, Pawlik TM, Zorzi D, et al (2007) Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis. Ann Surg Oncol 14: 3481–91

  29. 29.

    de Haas RJ, Adam R, Wicherts DA, et al (2010) Comparison of simultaneous or delayed liver surgery for limited synchronous colorectal metastases. Br J Surg 97: 1279–89

  30. 30.

    Zalinski S, Mariette C, Farges O et al (2011) Management of patients with synchronous liver metastases of colorectal cancer. Clinical practice guidelines. Guidelines of the French society of gastrointestinal surgery (SFCD) and of the association of hepatobiliary surgery and liver transplantation (ACHBT). Short version. J ViscSurg 148:e171–82

  31. 31.

    Karoui M, Vigano L, Goyer P, et al (2010) Combined first-stage hepatectomy and colorectal resection in a two-stage hepatectomy strategy for bilobar synchronous liver metastases. Br J Surg 97: 1354–62

  32. 32.

    Mentha G, Majno PE, Andres A, et al (2006) Neoadjuvant chemotherapy and resection of advanced synchronous liver metastases before treatment of the colorectal primary. Br J Surg. 93: 872–8

  33. 33.

    Kopetz S, Chang GJ, Overman MJ, et al (2009) Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy. J Clin Oncol 27: 3677–83

  34. 34.

    van der Pool AE, de Wilt JH, Lalmahomed ZS, et al (2010) Optimizing the outcome of surgery in patients with rectal cancer and synchronous liver metastases. Br J Surg 97: 383–90

  35. 35.

    Brouquet A, Mortenson MM, Vauthey JN, et al (2010) Surgical strategies for synchronous colorectal liver metastases in 156 consecutive patients: classic, combined or reverse strategy? J Am Coll Surg 210: 934–41

  36. 36.

    Andres A, Toso C, Adam R, et al (2012). A survival analysis of the liver-first reversed management of advanced simultaneous colorectal liver metastases: a LiverMetSurvey-based study. Ann Surg 256: 772–8

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Correspondence to A. Brouquet.

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Bachet, J.-., Cauchy, F., Cotte, E. et al. Recommandations pour la pratique clinique Cancer du rectum. Colon Rectum 10, 48–54 (2016). https://doi.org/10.1007/s11725-015-0620-4

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Mots clés

  • Cancer du rectum
  • Métastases synchrones
  • Chirurgie
  • Chimiothérapie
  • Radiochimiothérapie

Keywords

  • Rectal cancer
  • Synchronous metastases
  • Surgery
  • Chemotherapy
  • Radiochemotherapy Introduction