Reuters Health Information (2004-11-04): New CD guides management of liver metastases from colorectal cancer
New CD guides management of liver metastases from colorectal cancer
Last Updated: 2004-11-04 14:58:32 -0400 (Reuters Health)
VIENNA (REUTERS HEALTH) - An international multidisciplinary expert
panel has launched a decision model to assist surgeons and medical
oncologists in defining treatment for patients with liver metastases
from colorectal cancer.
The OncoSurge decision model was produced on a fully integrated
multimedia CR Rom, developed by 16 surgeons, oncologists and
radiologists from North American and Europe. It is based on data from
the literature, expert panel consensus detection techniques and the
expertise of the world's leading practitioners and researchers.
Dr. Graeme Poston, of the Royal Liverpool University Hospital, and
president-elect of the British Association of Surgical Oncology, and
colleagues presented a report on the model at the 29th European Society
of Medical Oncology Congress, where the program was launched.
For management of liver metastases from colorectal cancer, they
note, "surgery is the only potentially curative treatment with a 5-year
survival of 20% to 35%. Only about 20% of patients are initially
resectable." Neoadjuvant combination chemotherapy can increase this by
10% to 20%, but "no published consensus on appropriate treatment
Clinical trial results on relevant therapies are ongoing, but years
away, Dr. Poston noted. In response, the 16 experts developed the model
using the RAND/UCLA Appropriateness Method. The model considers
potentially thousands of combinations of risk factors, and identifies
and individualizes the patient's resectability and makes
recommendations for optimal treatment strategies of colorectal liver
The model indicates appropriate procedures for which the health
benefits exceed the expected negative consequences, as well as
"uncertain procedures," for which benefits and risks are about equal or
the panel members disagree.
In a statement issued along with the CD, Dr. Poston said previous
applications of similar methodology have accurately predicted the
outcome of ongoing clinical trials by as much as 90%.
Dr. Norman Wolmark, chairman and principal investigator
of the National Surgical Adjuvant Breast and Bowel Project, told
Reuters Health that the decision model was constructed in a
"painstaking way, getting the Rand Corporation involved. I think they
went about it in a methodic, step-wise way."
"Our member surgeons are enthusiastic about it, the ones we come
into contact with at the NSABP," he continued. "We're having a
symposium before the next NSABP meeting next week to really feature the
The decision model was produced by Evidis with an unrestricted educational grant from Sanofi-Synthelabo.
Launch of the decision model follows the latest marketing approval
for oxaliplatin, one of the key components featured in the decision
model. In September, it received European marketing approval for the
adjuvant treatment of stage III colon cancer in combination with
5-fluorouracil/leucovorin. Approval for adjuvant use in the United
States is expected shortly.