597P - Liver magnetic resonance imaging (MRI) in potentially resectable colorectal liver metastases (CLM)

Date 29 September 2014
Event ESMO 2014
Session Poster Display session
Topics Colon Cancer
Rectal Cancer
Imaging, Diagnosis and Staging
Presenter Mary Ann Johnson
Citation Annals of Oncology (2014) 25 (suppl_4): iv167-iv209. 10.1093/annonc/mdu333
Authors M.A. Johnson1, J.R. Whittle2, P. Page3, A. Fox1, S. Mackay4, R. Wong5
  • 1Eastern Health Surgical Research Group, Eastern Health, Epworth Eastern & Monash University, Faculty of Medicine, Nursing & Health Sciences, Eastern Health Clinical School, 3128 - Box Hill/AU
  • 2Medical Oncology, Eastern Health, Box Hill/AU
  • 3Radiology, Medical Imaging Australia, Box Hill/AU
  • 4Eastern Health Surgical Research Group, Eastern Health, Epworth Eastern & Monash University, Faculty of Medicine, Nursing & Health Sciences, Eastern Health Clinical School, Box Hill/AU
  • 5Medical Oncology, Eastern Health & Epworth Eastern, Box Hill/AU

Abstract

Aim

Liver MRI is increasingly used to evaluate potentially resectable colorectal liver metastases (CLM). Benefits include: identifying additional CLM, clarifying the nature of equivocal lesions and acquiring greater anatomical detail. This information has the potential to spare patients from futile surgery, or conversely ensure that all sites of CLM are resected. We evaluated local use of liver MRI and impact on patient management.

Methods

We retrospectively identified patients who had MRI for potential CLM between Jan 1 2009 and June 30 2012 and/or resection of CLM between Jan 1 2009 and Dec 31 2012 at Eastern Health and Epworth Eastern, Box Hill, Melbourne, Australia. Histories were audited for staging investigations (CT, PET, MRI, US), details of the primary tumour (synchronous vs metachronous, histology) and use of chemotherapy. Reasons for not proceeding to liver surgery were recorded, including influence of MRI results. For patients undergoing surgery, MRI findings were correlated with operative/histology findings.

Results

Ninety-nine patients were identified with potential CLM, 74 had pre-operative liver MRI. Liver MRI excluded CLM in 8/74 (11%) patients and deemed 18/74 (24%) to be inoperable. Ten patients declined or had comorbidities that contra-indicated surgery. Of the 62 patients who proceeded to surgery, 37/62 (60%) had had pre-operative liver MRI. Five patients did not proceed to liver resection (4 had irresectable disease at laparotomy, 1 had no identifiable lesion after neo-adjuvant chemotherapy). Fifty-seven patients proceeded to liver resection. Forty-seven percent had received pre-operative chemotherapy. On histology, 53 had residual CLM and 3 a pathological complete response to neo-adjuvant chemotherapy. One patient had non-Hodgkin lymphoma rather than CLM.

Conclusions

Liver MRI is a useful tool in the evaluation of potential CLM. In this cohort, 35% of the subset of patients who had pre-operative liver MRI did not proceed to surgery based purely on MRI findings.

Disclosure

All authors have declared no conflicts of interest.