PMC8175825_01
Circulating tumor DNA (ctDNA) monitoring in plasma during the clinical disease course: (a) serial ctDNA monitoring in response to conversion therapy in a high-risk stage-IV rectal carcinoma patient with synchronous liver metastases. (b) The magnetic resonance imaging (MRI) scans of the baseline and the post-chemotherapy phase of the patient who was diagnosed with advanced colon carcinoma with numerous synchronous liver metastases. (c) Computed tomography (CT) scans of the baseline and the post-chemotherapy phase of the patient's liver metastases.
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The colonoscopy identified a tumor located in the rectum about 5-7 cm above the anal verge (Figure 1(a) and (b)). The computed tomography (CT) and magnetic resonance imaging (MRI) scans confirmed that the tumor was a synchronous CRLM consisting of over 100 LMs (Figure 1(c)). Tumor biomarkers dramatically decreased, and MRI scans showed a partial response (PR) in the primary tumor and LMs according to RECIST v1.1   (Figure 1(b) and (c)). Radiography showed no apparent activity in tumors, as well as undetectable ctDNA or circulating tumor cells (CTCs) (Figure 1(a) and Methods). Plasma ctDNA and CTC remained undetectable (Figure 1(a)). The patient achieved pCR (CRS 0) and was relapse free at the last follow-up on 9 March 2021 (Figure 1(a)).
A curative surgical procedure of the patient's hepatic metastases.
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On 19 December 2018, the patient underwent surgical liver treatment, including middle hepatic lobectomy, left partial hepatic lobectomy, right posterior hepatic lobectomy, partial hepatic caudate lobectomy, and intraoperative radiofrequency ablation (RFA; Figure 2).