Florian Lordick, Professor of Medicine at University of Leipzig, shared a post on LinkedIn:
“New Publication in JAMA Surgery
Thrilled to share our team’s international prospective study – DREAM – now published online:
“Diagnostic Accuracy of Imaging in Assessing Nonviability of Disappearing Colorectal Liver Metastasis”
Why it matters:
For patients with initially unresectable colorectal liver metastases (CLM), some liver lesions “disappear” on imaging after chemotherapy, creating a dilemma: should these disappearing lesions (DLMs) be surgically removed or left alone?
What we found:
In 112 patients across 21 centers worldwide, multiparametric MRI plus CT improved detection of disappearing lesions – but did not reliably confirm that these lesions were truly nonviable.
The negative predictive value for confirmed disappearing lesions was only 62.5%, below the prespecified 85% threshold.
Survival outcomes showed no significant benefit from removing all disappearing lesions compared to leaving some in place.
Study highlights:
First large, prospective, international trial to rigorously evaluate this question.
Collaborative effort led by the European Organisation for Research and Treatment of Cancer (EORTC), Japan Clinical Oncology Group (JCOG), and European Society of Surgical Oncology (ESSO), with participation from centers in Europe, the US, and Japan.
These findings challenge current surgical decision-making and underscore the need for more precise imaging and biomarkers to guide treatment of disappearing colorectal liver metastases.
Grateful to all co-authors, patients, and participating centers who made this study possible.”
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