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Prognostic value of radiologic and pathological response in colorectal cancer liver metastases upon systemic induction treatment: subgroup analysis of the CAIRO5 trial
RECIST may not be optimal for assessing treatment response with current systemic regimens. We evaluated RECIST, morphologic, and pathologically documented response (pathological response) in patients with initially unresectable colorectal cancer liver-only metastases (CRLM). Four hundred and eighty-...
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| Published in: | ESMO open 2024-12, Vol.9 (12), p.104075, Article 104075 |
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| creator | Bond, M.J.G. Mijnals, C. Bolhuis, K. van Amerongen, M.J. Engelbrecht, M.R.W. Hermans, J.J. van Lienden, K.P. May, A.M. Swijnenburg, R.-J. Punt, C.J.A. |
| description | RECIST may not be optimal for assessing treatment response with current systemic regimens. We evaluated RECIST, morphologic, and pathologically documented response (pathological response) in patients with initially unresectable colorectal cancer liver-only metastases (CRLM).
Four hundred and eighty-nine patients from the phase III CAIRO5 trial were included who were treated with FOLFOX/FOLFIRI/FOLFOXIRI and bevacizumab or panitumumab. The association of the different response tools with overall survival (OS) was evaluated for all patients, and with early recurrence ( |
| doi_str_mv | 10.1016/j.esmoop.2024.104075 |
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Four hundred and eighty-nine patients from the phase III CAIRO5 trial were included who were treated with FOLFOX/FOLFIRI/FOLFOXIRI and bevacizumab or panitumumab. The association of the different response tools with overall survival (OS) was evaluated for all patients, and with early recurrence (<6 months) for patients after complete local treatment.
In the overall population, suboptimal [hazard ratio (HR) 1.10, 95% confidence interval (CI) 0.83-1.47] and optimal (HR 0.95, 95% CI 0.74-1.22) morphologic response were not associated with OS compared with no response. RECIST partial response (HR 0.61, 95% CI 0.49-0.76) and progressive disease (HR 5.77, 95% CI 3.97-8.39) were associated with OS compared with stable disease. In 242 patients who underwent local treatment, suboptimal (HR 1.22, 95% CI 0.76-1.96) and optimal (HR 1.28, 95% CI 0.89-1.86) morphologic response were not associated with OS compared with no response. RECIST partial response was not significantly associated with OS (HR 0.73, 95% CI 0.52-1.01), whereas progressive disease was (HR 19.74, 95% CI 5.75-67.78), compared with stable disease. While major pathological response (HR 0.66, 95% CI 0.44-0.99) was associated with OS, partial pathological response (HR 0.82, 95% CI 0.57-1.19) was not, compared with no pathological response. Pathological response, but not morphologic response and RECIST, was significantly associated with early recurrence (P < 0.001) which occurred in 13/58 (22%) patients with major response, 29/61 (48%) patients with partial response, and 51/88 (58%) patients with no response.
Our results show that RECIST but not morphologic response was prognostic for OS. In patients eligible for local treatment, neither RECIST nor morphologic response were associated with early recurrence. Pathological response was associated with early recurrence but is only available post-operatively. Hence, novel preoperative parameters are warranted to predict early recurrence and prevent potentially futile liver surgery.
•Different response tools to systemic treatment of CRLM were evaluated.•Morphologic response was not associated with OS nor early recurrence.•RECIST response was associated with survival, but not with early recurrence.•Major pathological response after local treatment was associated with longer survival and less early recurrence.</description><identifier>ISSN: 2059-7029</identifier><identifier>EISSN: 2059-7029</identifier><identifier>DOI: 10.1016/j.esmoop.2024.104075</identifier><identifier>PMID: 39667310</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols - pharmacology ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Bevacizumab - pharmacology ; Bevacizumab - therapeutic use ; Camptothecin - analogs & derivatives ; Camptothecin - pharmacology ; Camptothecin - therapeutic use ; colorectal cancer ; Colorectal Neoplasms - drug therapy ; Colorectal Neoplasms - pathology ; Female ; Fluorouracil - pharmacology ; Fluorouracil - therapeutic use ; Humans ; Induction Chemotherapy - methods ; Leucovorin - pharmacology ; Leucovorin - therapeutic use ; liver metastases ; Liver Neoplasms - drug therapy ; Liver Neoplasms - secondary ; Male ; Middle Aged ; morphologic response ; Organoplatinum Compounds - pharmacology ; Organoplatinum Compounds - therapeutic use ; Panitumumab - pharmacology ; Panitumumab - therapeutic use ; pathological response ; Prognosis ; RECIST ; Response Evaluation Criteria in Solid Tumors ; Treatment Outcome</subject><ispartof>ESMO open, 2024-12, Vol.9 (12), p.104075, Article 104075</ispartof><rights>2024 The Author(s)</rights><rights>Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c287t-2ba85b91b7368a3c227e1e67886e5c70ceed2a7b1cf68af4c9155faac09c8f153</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S2059702924018453$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3540,27915,27916,45771</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39667310$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bond, M.J.G.</creatorcontrib><creatorcontrib>Mijnals, C.</creatorcontrib><creatorcontrib>Bolhuis, K.</creatorcontrib><creatorcontrib>van Amerongen, M.J.</creatorcontrib><creatorcontrib>Engelbrecht, M.R.W.</creatorcontrib><creatorcontrib>Hermans, J.J.</creatorcontrib><creatorcontrib>van Lienden, K.P.</creatorcontrib><creatorcontrib>May, A.M.</creatorcontrib><creatorcontrib>Swijnenburg, R.-J.</creatorcontrib><creatorcontrib>Punt, C.J.A.</creatorcontrib><title>Prognostic value of radiologic and pathological response in colorectal cancer liver metastases upon systemic induction treatment: subgroup analysis of the CAIRO5 trial</title><title>ESMO open</title><addtitle>ESMO Open</addtitle><description>RECIST may not be optimal for assessing treatment response with current systemic regimens. We evaluated RECIST, morphologic, and pathologically documented response (pathological response) in patients with initially unresectable colorectal cancer liver-only metastases (CRLM).
Four hundred and eighty-nine patients from the phase III CAIRO5 trial were included who were treated with FOLFOX/FOLFIRI/FOLFOXIRI and bevacizumab or panitumumab. The association of the different response tools with overall survival (OS) was evaluated for all patients, and with early recurrence (<6 months) for patients after complete local treatment.
In the overall population, suboptimal [hazard ratio (HR) 1.10, 95% confidence interval (CI) 0.83-1.47] and optimal (HR 0.95, 95% CI 0.74-1.22) morphologic response were not associated with OS compared with no response. RECIST partial response (HR 0.61, 95% CI 0.49-0.76) and progressive disease (HR 5.77, 95% CI 3.97-8.39) were associated with OS compared with stable disease. In 242 patients who underwent local treatment, suboptimal (HR 1.22, 95% CI 0.76-1.96) and optimal (HR 1.28, 95% CI 0.89-1.86) morphologic response were not associated with OS compared with no response. RECIST partial response was not significantly associated with OS (HR 0.73, 95% CI 0.52-1.01), whereas progressive disease was (HR 19.74, 95% CI 5.75-67.78), compared with stable disease. While major pathological response (HR 0.66, 95% CI 0.44-0.99) was associated with OS, partial pathological response (HR 0.82, 95% CI 0.57-1.19) was not, compared with no pathological response. Pathological response, but not morphologic response and RECIST, was significantly associated with early recurrence (P < 0.001) which occurred in 13/58 (22%) patients with major response, 29/61 (48%) patients with partial response, and 51/88 (58%) patients with no response.
Our results show that RECIST but not morphologic response was prognostic for OS. In patients eligible for local treatment, neither RECIST nor morphologic response were associated with early recurrence. Pathological response was associated with early recurrence but is only available post-operatively. Hence, novel preoperative parameters are warranted to predict early recurrence and prevent potentially futile liver surgery.
•Different response tools to systemic treatment of CRLM were evaluated.•Morphologic response was not associated with OS nor early recurrence.•RECIST response was associated with survival, but not with early recurrence.•Major pathological response after local treatment was associated with longer survival and less early recurrence.</description><subject>Adult</subject><subject>Aged</subject><subject>Antineoplastic Combined Chemotherapy Protocols - pharmacology</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Bevacizumab - pharmacology</subject><subject>Bevacizumab - therapeutic use</subject><subject>Camptothecin - analogs & derivatives</subject><subject>Camptothecin - pharmacology</subject><subject>Camptothecin - therapeutic use</subject><subject>colorectal cancer</subject><subject>Colorectal Neoplasms - drug therapy</subject><subject>Colorectal Neoplasms - pathology</subject><subject>Female</subject><subject>Fluorouracil - pharmacology</subject><subject>Fluorouracil - therapeutic use</subject><subject>Humans</subject><subject>Induction Chemotherapy - methods</subject><subject>Leucovorin - pharmacology</subject><subject>Leucovorin - therapeutic use</subject><subject>liver metastases</subject><subject>Liver Neoplasms - drug therapy</subject><subject>Liver Neoplasms - secondary</subject><subject>Male</subject><subject>Middle Aged</subject><subject>morphologic response</subject><subject>Organoplatinum Compounds - pharmacology</subject><subject>Organoplatinum Compounds - therapeutic use</subject><subject>Panitumumab - pharmacology</subject><subject>Panitumumab - therapeutic use</subject><subject>pathological response</subject><subject>Prognosis</subject><subject>RECIST</subject><subject>Response Evaluation Criteria in Solid Tumors</subject><subject>Treatment Outcome</subject><issn>2059-7029</issn><issn>2059-7029</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9Udtq3DAQFaWlCWn-oBQ99mW3ki-S3YdCWHoJBFJK-yxkebzRIluuRl7YL8pvdhanoU8FMZKOzswZzWHsrRRbKaT6cNgCjjHO20IUFUGV0PULdlmIut1oUbQv_zlfsGvEgxBC6opA9ZpdlK1SupTikj1-T3E_Rcze8aMNC_A48GR7H0PcE2anns82P6xXG3gCnOOEwP3EHaEJXCbY2clB4sEfKY6QLdIC5AuROZ4ww0jV_NQvLnuCcgKbR5jyR45Lt09xmUnLhhN6PLeQH4Dvbm5_3NdE9Ta8Ya8GGxCun_Yr9uvL55-7b5u7-6-3u5u7jSsanTdFZ5u6a2WnS9XY0hWFBglKN42C2mnhAPrC6k66gd6HyrWyrgdrnWhdM8i6vGLv17pzir8XwGxGjw5CsBPEBU0pK6UUaSmiVivVpYiYYDBz8qNNJyOFObtkDmZ1yZxdMqtLlPbuSWHpRuifk_56QoRPKwHon0cPyaDzQOPt_XnYpo_-_wp_AATuqbo</recordid><startdate>202412</startdate><enddate>202412</enddate><creator>Bond, M.J.G.</creator><creator>Mijnals, C.</creator><creator>Bolhuis, K.</creator><creator>van Amerongen, M.J.</creator><creator>Engelbrecht, M.R.W.</creator><creator>Hermans, J.J.</creator><creator>van Lienden, K.P.</creator><creator>May, A.M.</creator><creator>Swijnenburg, R.-J.</creator><creator>Punt, C.J.A.</creator><general>Elsevier Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202412</creationdate><title>Prognostic value of radiologic and pathological response in colorectal cancer liver metastases upon systemic induction treatment: subgroup analysis of the CAIRO5 trial</title><author>Bond, M.J.G. ; Mijnals, C. ; Bolhuis, K. ; van Amerongen, M.J. ; Engelbrecht, M.R.W. ; Hermans, J.J. ; van Lienden, K.P. ; May, A.M. ; Swijnenburg, R.-J. ; Punt, C.J.A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c287t-2ba85b91b7368a3c227e1e67886e5c70ceed2a7b1cf68af4c9155faac09c8f153</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Antineoplastic Combined Chemotherapy Protocols - pharmacology</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Bevacizumab - pharmacology</topic><topic>Bevacizumab - therapeutic use</topic><topic>Camptothecin - analogs & derivatives</topic><topic>Camptothecin - pharmacology</topic><topic>Camptothecin - therapeutic use</topic><topic>colorectal cancer</topic><topic>Colorectal Neoplasms - drug therapy</topic><topic>Colorectal Neoplasms - pathology</topic><topic>Female</topic><topic>Fluorouracil - pharmacology</topic><topic>Fluorouracil - therapeutic use</topic><topic>Humans</topic><topic>Induction Chemotherapy - methods</topic><topic>Leucovorin - pharmacology</topic><topic>Leucovorin - therapeutic use</topic><topic>liver metastases</topic><topic>Liver Neoplasms - drug therapy</topic><topic>Liver Neoplasms - secondary</topic><topic>Male</topic><topic>Middle Aged</topic><topic>morphologic response</topic><topic>Organoplatinum Compounds - pharmacology</topic><topic>Organoplatinum Compounds - therapeutic use</topic><topic>Panitumumab - pharmacology</topic><topic>Panitumumab - therapeutic use</topic><topic>pathological response</topic><topic>Prognosis</topic><topic>RECIST</topic><topic>Response Evaluation Criteria in Solid Tumors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bond, M.J.G.</creatorcontrib><creatorcontrib>Mijnals, C.</creatorcontrib><creatorcontrib>Bolhuis, K.</creatorcontrib><creatorcontrib>van Amerongen, M.J.</creatorcontrib><creatorcontrib>Engelbrecht, M.R.W.</creatorcontrib><creatorcontrib>Hermans, J.J.</creatorcontrib><creatorcontrib>van Lienden, K.P.</creatorcontrib><creatorcontrib>May, A.M.</creatorcontrib><creatorcontrib>Swijnenburg, R.-J.</creatorcontrib><creatorcontrib>Punt, C.J.A.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>ESMO open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bond, M.J.G.</au><au>Mijnals, C.</au><au>Bolhuis, K.</au><au>van Amerongen, M.J.</au><au>Engelbrecht, M.R.W.</au><au>Hermans, J.J.</au><au>van Lienden, K.P.</au><au>May, A.M.</au><au>Swijnenburg, R.-J.</au><au>Punt, C.J.A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic value of radiologic and pathological response in colorectal cancer liver metastases upon systemic induction treatment: subgroup analysis of the CAIRO5 trial</atitle><jtitle>ESMO open</jtitle><addtitle>ESMO Open</addtitle><date>2024-12</date><risdate>2024</risdate><volume>9</volume><issue>12</issue><spage>104075</spage><pages>104075-</pages><artnum>104075</artnum><issn>2059-7029</issn><eissn>2059-7029</eissn><abstract>RECIST may not be optimal for assessing treatment response with current systemic regimens. We evaluated RECIST, morphologic, and pathologically documented response (pathological response) in patients with initially unresectable colorectal cancer liver-only metastases (CRLM).
Four hundred and eighty-nine patients from the phase III CAIRO5 trial were included who were treated with FOLFOX/FOLFIRI/FOLFOXIRI and bevacizumab or panitumumab. The association of the different response tools with overall survival (OS) was evaluated for all patients, and with early recurrence (<6 months) for patients after complete local treatment.
In the overall population, suboptimal [hazard ratio (HR) 1.10, 95% confidence interval (CI) 0.83-1.47] and optimal (HR 0.95, 95% CI 0.74-1.22) morphologic response were not associated with OS compared with no response. RECIST partial response (HR 0.61, 95% CI 0.49-0.76) and progressive disease (HR 5.77, 95% CI 3.97-8.39) were associated with OS compared with stable disease. In 242 patients who underwent local treatment, suboptimal (HR 1.22, 95% CI 0.76-1.96) and optimal (HR 1.28, 95% CI 0.89-1.86) morphologic response were not associated with OS compared with no response. RECIST partial response was not significantly associated with OS (HR 0.73, 95% CI 0.52-1.01), whereas progressive disease was (HR 19.74, 95% CI 5.75-67.78), compared with stable disease. While major pathological response (HR 0.66, 95% CI 0.44-0.99) was associated with OS, partial pathological response (HR 0.82, 95% CI 0.57-1.19) was not, compared with no pathological response. Pathological response, but not morphologic response and RECIST, was significantly associated with early recurrence (P < 0.001) which occurred in 13/58 (22%) patients with major response, 29/61 (48%) patients with partial response, and 51/88 (58%) patients with no response.
Our results show that RECIST but not morphologic response was prognostic for OS. In patients eligible for local treatment, neither RECIST nor morphologic response were associated with early recurrence. Pathological response was associated with early recurrence but is only available post-operatively. Hence, novel preoperative parameters are warranted to predict early recurrence and prevent potentially futile liver surgery.
•Different response tools to systemic treatment of CRLM were evaluated.•Morphologic response was not associated with OS nor early recurrence.•RECIST response was associated with survival, but not with early recurrence.•Major pathological response after local treatment was associated with longer survival and less early recurrence.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>39667310</pmid><doi>10.1016/j.esmoop.2024.104075</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Antineoplastic Combined Chemotherapy Protocols - pharmacology Antineoplastic Combined Chemotherapy Protocols - therapeutic use Bevacizumab - pharmacology Bevacizumab - therapeutic use Camptothecin - analogs & derivatives Camptothecin - pharmacology Camptothecin - therapeutic use colorectal cancer Colorectal Neoplasms - drug therapy Colorectal Neoplasms - pathology Female Fluorouracil - pharmacology Fluorouracil - therapeutic use Humans Induction Chemotherapy - methods Leucovorin - pharmacology Leucovorin - therapeutic use liver metastases Liver Neoplasms - drug therapy Liver Neoplasms - secondary Male Middle Aged morphologic response Organoplatinum Compounds - pharmacology Organoplatinum Compounds - therapeutic use Panitumumab - pharmacology Panitumumab - therapeutic use pathological response Prognosis RECIST Response Evaluation Criteria in Solid Tumors Treatment Outcome |
| title | Prognostic value of radiologic and pathological response in colorectal cancer liver metastases upon systemic induction treatment: subgroup analysis of the CAIRO5 trial |
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