Clinical Practice Guidelines - National Health and Medical Research ...

More documents

Recommendations

Info

21.1.3 Imaging controlled destruction Local ablative therapies for the treatment of colorectal hepatic metastases have been the focus of much recent research, with most interest being shown in radiofrequency (thermal) ablation (RFA or RFTA). This treatment involves percutaneous (or, less frequently, intraoperative) placement of a metallic probe into a hepatic lesion, using imaging guidance (usually ultrasound, occasionally CT or MRI). Radiofrequency energy passed through the probe causes local ionic excitation resulting in the lesion being ‘heated’ to a level where cell death occurs. The major technical issues are charring at the needle tip and incomplete treatment, based on the proximity of a lesion to vascular structures which act as a ‘heat sink’. 32–34 The procedure may be performed on an outpatient basis using local anaesthetic and intravenous sedation. Most patients can be treated in a single session. Complication rates are as follows: mortality 0.5%, major complications 2%, minor complications 6%. 35,36 Patient eligibility varies between institutions and individuals. There are no accepted standardised criteria. In general, patients should not be surgical candidates (either because of anticipated technical resection difficulties, or comorbidities), have five or less lesions each less than 5 cm in diameter and be free of other distant metastases. 33 Lesion location may also play a part in selection. Those close to or abutting the gallbladder, hepatic flexure of the colon, diaphragm and hepatic hilum require great care in treatment to avoid heat-related damage and may result in patient exclusion. 33 As with all relatively new treatment modalities, little robust data is available in the form of randomised controlled trials and long-term survival statistics. A single prospective randomised controlled trial comparing RFA with surgery for solitary colorectal metastasis has been published, demonstrating similar median and 3-year survival rates between the two treatment modalities. 37 The largest published series to date, of 117 patients with hepatic metastases from colorectal carcinoma, reported that technical success (no radiologically detectable tumour at 7–14 days after treatment) was achieved in 98% of patients. 38 Many other local ablative techniques are under investigation. 33,39–42 These include laser-induced thermotherapy, microwave therapy and high-frequency targeted ultrasound. Cryoablation has been largely abandoned due to a higher rate of major complications than for RFA. Should imaging controlled destruction be considered? Guideline — Imaging controlled destruction Radiofrequency ablation is an alternative to surgery in selected cases. Level of evidence Practice recommendation Refs II Equivocal 37 21.2 Chemotherapy for patients with unresectable liver metastases 21.2.1 Hepatic arterial infusion Hepatic arterial infusion (HAI) involves the administration of chemotherapy agents directly into the liver through a catheter surgically implanted into the hepatic artery. Potential advantages of this approach include: • liver metastases mainly derive their blood supply from the hepatic artery rather than the portal vein 43 • a mean hepatic drug concentration approximately 15-fold higher than can be achieved with intravenous chemotherapy 44 Management of liver and other distant metastases 233
• almost all (94–99%) administered floxuridine, an effective drug for the treatment of Colorectal Cancer, is metabolised by the liver during first pass, which reduces systemic drug concentrations and resulting toxicity. 45–47 However, this also means the systemic concentration of FUDR is insufficient to treat any extrahepatic metastases. Technical complications include an operative mortality below 1% in experienced hands, mechanical problems related to the catheter such as leakage, kinks, migration or breakage (5%), vascular complications from the catheter such as thrombosis or aneurism formation (5%), and problems associated with implantable pumps (8%). 44–47 Toxicities from intrahepatic chemotherapy include sclerosing cholangitis (10%), which is occasionally fatal, chemical gastritis (10%) and peptic ulceration (5%). 45 21.2.2 Efficacy of hepatic arterial infusion Pooled data from a meta-analysis of six of the seven randomised studies published between 1988 and 1993 confirmed the significantly higher response (41% compared to 14%) for HAI compared with intravenous 5-FU-based chemotherapy. 48 However, this analysis failed to demonstrate a significant survival benefit favouring HAI. In a recent study published by Lorenz et al, 49 168 patients with unresectable liver metastases were randomised to receive intravenous 5-FU, HAI 5-FU or HAI FUDR. As expected, HAI chemotherapy (5-FU or FUDR) produced a higher response rate than intravenous 5-FU (p =
Page 1 and 2:
Clinical Practice Guidelines FOR TH
Page 3:
© The Cancer Council Australia/Aus
Page 6 and 7:
2.11 Conclusions...................
Page 8 and 9:
11.2 High ligation ................
Page 10 and 11:
17.4 Cost effectiveness of follow u
Page 12 and 13:
Table 14.3 Pathological TNM staging
Page 14 and 15:
Executive Summary • Colorectal Ca
Page 16 and 17:
STRENGTH OF RECOMMENDATIONS 2,3 The
Page 18 and 19:
Should red meat intake be altered t
Page 20 and 21:
Chapter Recommendations 4 COMMUNICA
Page 22 and 23:
Chapter 8 Recommendations How shoul
Page 24 and 25:
Chapter Recommendations Should bowe
Page 26 and 27:
Chapter Recommendations When should
Page 28 and 29:
Chapter 17 Recommendations What pos
Page 30:
Section I Early Colorectal Cancer
Page 33 and 34:
Adenomatous polyps (adenomas) are b
Page 35 and 36:
17. South Australian Cancer Registr
Page 37 and 38:
CHAPTER 2 PRIMARY PREVENTION Studie
Page 39 and 40:
Colorectal adenomas, especially adv
Page 41 and 42:
vegetable (3.5 serves/1000 kcals) d
Page 43 and 44:
mustard greens, swedes and turnips)
Page 45 and 46:
for protection against Colorectal C
Page 47 and 48:
Does selenium supplementation reduc
Page 49 and 50:
the optimal duration of use, and ad
Page 51 and 52:
References 1. Jass JR. Pathogenesis
Page 53 and 54:
34. Kushi L, Giovannucci E. Dietary
Page 55 and 56:
67. Fearon ER, Vogelstein B. A gene
Page 57 and 58:
100. Il'yasova D, Hodgson ME, Marti
Page 59 and 60:
133. Meyskens FL, Jr., Gerner EW. D
Page 61 and 62:
CHAPTER 3 POPULATION SCREENING FOR
Page 63 and 64:
studies also demonstrate that age i
Page 65 and 66:
• symptoms • family medical his
Page 67 and 68:
Should screening be recommended? Gu
Page 69 and 70:
Box 3.3 Screening Pathway used in t
Page 71 and 72:
References 1. Young GP, Levin B, Ro
Page 73 and 74:
33. Alexander F, Weller D. Evaluati
Page 75 and 76:
CHAPTER 4 COMMUNICATION WITH THE PA
Page 77 and 78:
4.6 Coordination of care Treatment
Page 79 and 80:
• assistance with and care of chi
Page 81 and 82:
17. National Breast Cancer Centre,
Page 83 and 84:
CHAPTER 5 THE PATIENT WITH SYMPTOMS
Page 85 and 86:
considered (see 8.1.5). Double cont
Page 87 and 88:
58 The prevention, early detection
Page 89 and 90:
diagnoses prove difficult to confir
Page 91 and 92:
What recommendations are there for
Page 93 and 94:
References 1. Woolf CM. A genetic s
Page 95 and 96:
34. Australian Health Technology Ad
Page 97 and 98:
CHAPTER 7 HIGH-RISK FAMILIAL COLORE
Page 99 and 100:
offered predictive genetic testing.
Page 101 and 102:
endoscopically uncontrollable numbe
Page 103 and 104:
mutation carriers. 52 There is also
Page 105 and 106:
standard for consideration of MSI a
Page 107 and 108:
added to transvaginal ultrasound. 8
Page 109 and 110:
category 2, see Chapter 6) but may
Page 111 and 112:
What screening is recommended for e
Page 113 and 114:
References 1. Vasen HF, Griffioen G
Page 115 and 116:
33. Giardiello FM, Hamilton SR, Kru
Page 117 and 118:
international criteria for the dete
Page 119 and 120:
96. Burt RW, Jass JR. Hyperplastic
Page 121 and 122:
8.1.2 Sigmoidoscopy: rigid versus f
Page 123 and 124:
For radiological imaging of the lar
Page 125 and 126:
8.2.3 Staging for distant metastase
Page 127 and 128:
The feelings and fears of the patie
Page 129 and 130:
18. Rex DK, Cutler CS, Lemmel GT et
Page 131 and 132:
52. Liu SK, Church JM, Lavery IC, F
Page 133 and 134:
Page 135 and 136:
strong family history of Colorectal
Page 137 and 138:
A screening interval of 4-6 years i
Page 139 and 140:
BRAF mutation, particularly when mu
Page 141 and 142:
18. Jass JR, Young J, Leggett BA. E
Page 143 and 144:
52. Jass JR, Young J, Leggett BA. H
Page 145 and 146:
Page 147 and 148:
What is the role of the stomal ther
Page 149 and 150:
What happens if a blood transfusion
Page 151 and 152:
References 1. Bass EM, Del Pino A,
Page 153 and 154:
32. The National Working Party on t
Page 155 and 156:
CHAPTER 11 ELECTIVE SURGERY FOR COL
Page 157 and 158:
Total or subtotal colectomy may be
Page 159 and 160:
11.12 Self-expanding metal stents f
Page 161 and 162:
18. Gall FP, Tonak J, Altendorf A.
Page 163 and 164:
Page 165 and 166:
etween 1993 and 1999. The local rec
Page 167 and 168:
When should local excision of recta
Page 169 and 170:
What factors influence sphincter pr
Page 171 and 172:
It has been demonstrated that there
Page 173 and 174:
References 1. Smith TJ, Hillner BE,
Page 175 and 176:
36. Vernava AM, III, Moran M, Rothe
Page 177 and 178:
69. Pimentel JM, Duarte A, Gregorio
Page 179 and 180:
Page 181 and 182:
A clinical diagnosis of large bowel
Page 183 and 184:
When should primary anastomosis be
Page 185 and 186:
17. Deans GT, Krukowski ZH, Irwin S
Page 187 and 188:
Page 189 and 190:
Table 14.1 Clinicopathological stag
Page 191 and 192:
The ACPS system embodies the simpli
Page 193 and 194:
14.4 Translation between staging sy
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
16. Shepherd NA, Baxter KJ, Love SB
Page 201 and 202:
CHAPTER 15 ADJUVANT CHEMOTHERAPY FO
Page 203 and 204:
isk of death-favouring treatment (H
Page 205 and 206:
improvement in survival at five yea
Page 207 and 208:
There has been one trial 55 of intr
Page 209 and 210:
References 1. National Institute of
Page 211 and 212:
30. Zaniboni A, Labianca R, Marsoni
Page 213 and 214: 57. Gastrointestinal Tumour Study G
Page 215 and 216: CHAPTER 16 ADJUVANT THERAPY FOR REC
Page 217 and 218: preoperative RT 45Gy over 5 weeks s
Page 219 and 220: This suggests that a policy of preo
Page 221 and 222: Mortality from non-cancer causes wa
Page 223 and 224: References 1. Fu KK. Interactions o
Page 225 and 226: 29. Swedish Rectal Cancer Trial. Im
Page 227 and 228: 198 The prevention, early detection
Page 229 and 230: Rates of intraluminal recurrence an
Page 231 and 232: Ultrasonographic screening Ultrason
Page 233 and 234: References 1. Nava HR, Pagana TJ. P
Page 237 and 238: • those with a history of psychia
Page 239 and 240: References 1. Maisey NR, Norman A,
Page 244 and 245: CHAPTER 19 RECURRENT AND ADVANCED C
Page 246 and 247: What are the recommendations for in
Page 248 and 249: References 1. National Health and M
Page 250 and 251: 31. Phillips RK, Hittinger R, Bleso
Page 252 and 253: Recurrent and advanced colorectal c
Page 254 and 255: (23% compared to 12%, p
Page 256 and 257: more patients having disease down-s
Page 258 and 259: References 1. Best L, Simmonds P, B
Page 260 and 261: 30. Fuchs CS, Moore MR, Harker G, V
Page 262 and 263: CHAPTER 21 MANAGEMENT OF LIVER AND
Page 266 and 267: Does combination systemic chemother
Page 268 and 269: References 1. Woodington FF, Waugh
Page 270 and 271: 34. Wood BJ, Ramkaransingh JR, Fojo
Page 272 and 273: 66. Headrick JR, Miller DL, Nagorne
Page 274 and 275: Management of liver and other dista
Page 276 and 277: years gained can be assessed, which
Page 278 and 279: ‘If neither of the above cases ap
Page 280 and 281: Study Country Study questions Concl
Page 282 and 283: Study Country Comparator/ screening
Page 292 and 293: Three United States studies investi
Page 294 and 295: Table 22.6 Results of studies inves
Page 300 and 301: 22.9 Treatments 22.9.1 Surgery Seve
Page 304 and 305: Table 22.10 Results of studies inve
Page 310 and 311: Table 22.11 Summary of findings fro
Page 312 and 313: References 1. Australian Institute
Page 314 and 315:
32. Nakama, H., B. Zhang, and A.S.
Page 316 and 317:
65. Sieg, A., et al., Screening for
Page 318 and 319:
97. Durand-Zaleski, I., et al., Eco
Page 320 and 321:
Cost effectiveness 289
Page 322 and 323:
References 1. National Health and M
Page 324:
Appendices
Page 327 and 328:
“Zorbas et al 2 Multidisciplinary
Page 329 and 330:
a pathologist-molecular biologist o
Page 331 and 332:
References 1. Australian Cancer Net
Page 333 and 334:
Chapter 2 — Primary prevention an
Page 335 and 336:
Three Cochrane systematic reviews w
Page 337 and 338:
Dates 1 January 1998 to June 2004 S
Page 339 and 340:
Dates Update of 1999 document from
Page 341 and 342:
Search terms MeSH terms were ‘col
Page 343 and 344:
Chapter 20 — The role of systemic
Page 345 and 346:
Search terms Colorectal Cancer, soc
Page 347 and 348:
However, in some cases it was also
Page 349 and 350:
Professor James St John Gastro ente
Page 351 and 352:
Working party on emergency surgery
Page 353 and 354:
Dr Russel Stitz Surgeon, Royal Bris
Page 355 and 356:
14. Dr Michael Izard Radiation Onco
Page 357 and 358:
Mrs Avis Mcphee Consumer (June 9 an
Page 359 and 360:
DVT deep venous thrombosis ECOG Eur
Page 361 and 362:
TNM tumour, node, metastasis stagin
Page 363 and 364:
Chemotherapy The use of drugs (whic
Page 365 and 366:
Malignant Cancerous Malignant cells
Page 367 and 368:
with a specific disease might survi
show all

Clinical Practice Guidelines - National Health and Medical Research ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?