Chemotherapy or Liver Transplantation for Nonresectable Liver Metastases From Colorectal Cancer?

Dueland, Svein; Guren, Tormod Kyrre; Hagness, Morten; Glimelius, Bengt; Line, Pål–Dag; Pfeiffer, Per; Foss, Aksel; Tveit, Kjell Magne

doi:10.1097/sla.0000000000000786

Cited by 157 publications

(141 citation statements)

References 17 publications

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“…More recently, the group of Oslo has shown a 60% five-year survival, in 21 patients with colo-rectal metastases (2). Such a survival was better than the one expected on chemotherapy alone (2)(3)(4). However, 95% (20/21) of patients had cancer recurrence, most within the first 18 months after transplantation.…”

Section: To the Editormentioning

confidence: 99%

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Liver transplantation for colorectal liver metastasis: Survival without recurrence can be achieved

et al. 2017

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The management of patients with colo-rectal liver metastases has improved significantly over the recent years. However, most patients still cannot undergo complete resection, generally because the location of the metastases within the liver prevents any radical management, and explaining the interest for transplantation. The first attempts were performed in the eighties with poor outcomes, in part due to a high proportion of death not related to the neoplastic disease (1). More recently, the group of Oslo has shown a 60% five-year survival, in 21 patients with colo-rectal metastases (2). Such a survival was better than the one expected on chemotherapy alone (2-4). However, 95% (20/21) of patients had cancer recurrence, most within the first 18 months after transplantation. At present, liver transplantation for colo-rectal metastases remains highly controversial. The potential for long-term disease-free survival needs to be explored, which is the aim of this multi-centric collaborative retrospective study.A total of 12 patients (6 females/6 males) underwent liver transplantation for colo-rectal liver metastasis, at centers affiliated to the "Compagnons Hépato-Bilaires", an association of hepato-pancreato-biliary and transplant surgeons, most trained at the Paul Brousse Hospital, Paris, France under the guidance of Professor H. Bismuth. Median age at transplant was 56 years (Table 1). Patients were managed in Lisbon (n=8), Coimbra (n=2), Paris (n=1), and Geneva (n=1) between October 1995 and October 2015 (date of transplant), and no other patient underwent transplantation for this indication at these respective transplant centers. Data collection was conducted according the relevant ethical standards at each institution. The location of the primary adenocarcinoma was the colon in 11 patients, and the rectum in one. Most primary cancers were T3 on pathology, and many presented between 1 and 3 involved -N1-lymph nodes (two patients were N2 with more than 3 nodes involved, Table 1).For most patients, liver metastases (9/12) were diagnosed within 12 months after the diagnosis of the primary cancer, and were considered as synchronous. When not diagnosed at the same time as the primary, liver metastases were discovered 4, 7, 19, 24 and 29 months after the primary. At the time of transplantation, patients presented a median of 9 liver metastases. Two had lesions >5 cm, of 5.5 and 8 cm. Median CEA level was 16.9 µg/l, and one patients had CEA >200 µg/l, of 314 µg/l.Most (11/12) patients received chemotherapy prior to transplantation. Chemotherapy included irinotecan and oxaliplatin in 9 (82%) patients, and a biological agent in 6 (cetuximab in 2, bevacizumab in 3, and both agents in 1). Another patient was treated by intra-hepatic chemotherapy prior to transplantation. All patients responded to chemotherapy, and none was in progression at the time of the transplantation. The decision to conduct a post-transplant adjuvant chemotherapy was based, at least in the recent years, on the aim to obtain a minimum of four month...

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Section: To the Editormentioning

confidence: 99%

“…When not diagnosed at the same time as the primary, liver metastases were discovered 4, 7, 19, 24 and 29 months after the primary. At the time of transplantation, patients presented a median of 9 liver metastases.…”

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confidence: 99%

Liver transplantation for colorectal liver metastasis: Survival without recurrence can be achieved

et al. 2017

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“…Overall survival (OS) after liver resections has been shown to be related to | 531 DUELAND Et AL. [5][6][7][8][9] Liver transplant (LT) is the standard of care for selected patients with malignant liver tumors such as hepatocellular carcinoma (HCC) and liver metastases from low-grade neuroendocrine tumors. About 20% of the patients with CRLMs are candidates for liver resections, 3 but about 60% to 70% have recurrence within 3 years.…”

Section: Introductionmentioning

confidence: 99%

Selection criteria related to long-term survival following liver transplantation for colorectal liver metastasis

Dueland

Grut

Syversveen

et al. 2020

American Journal of Transplantation

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Patients with nonresectable colorectal cancer receiving palliative chemotherapy have a 5-year overall survival rate of about 10%. Liver transplant provided a Kaplan-Meier-estimated 5-year overall survival of up to 83%. The objective of the study was to evaluate the ability of different scoring systems to predict long-term overall survival after liver transplant. Patients with colorectal cancer with nonresectable liveronly metastases determined by computed tomography (CT)/magnetic resonance imaging/positron emission tomography (PET)-CT scans from 2 prospective studies (SECA-I and -II) were included. All included patients had previously received chemotherapy. PET-CT was performed within 90 days of the liver transplant. Overall survival, disease-free survival, and survival after relapse based on the Fong Clinical Risk Score, total PET liver uptake (metabolic tumor volume), and Oslo Score were compared. At median follow-up of 85 months for live patients, Kaplan-Meier overall survival rates at 5 years were 100%, 78%, and 67% in patients with Fong Clinical Risk Score 0 to 2, metabolic tumor volume-low group, and Oslo Score 0 to 2, respectively. Median overall survival was 101, 68, and 65 months in patients with Fong ClinicalRisk Score 0 to 2, metabolic tumor volume-low, and Oslo Score 0 to 2. These selection criteria may be used to obtain 5-year overall survival rates comparable to other indications for liver transplant. K E Y W O R D Scancer/malignancy/neoplasia, cancer/malignancy/neoplasia: metastatic disease, clinical research/practice, clinical trial, liver disease: malignant, liver transplantation/hepatology

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“…Surgical interventions in these lesions have a within-surgery mortality of close to zero and low perioperative mortality [7]. In addition, a comparative study was undertaken, looking at the use of chemotherapy as the sole treatment versus neoadjuvant chemotherapy and liver transplantation in patients who present with unresectable disease, with results showing a 5-year survival rate of 9 vs. 56% [4, 9]. …”

Section: Discussionmentioning

confidence: 99%

“…Nowadays, patients with liver metastases are treated with neoadjuvant chemotherapy and then undergo local resection [4]. This treatment has a 5-year survival rate of 30–58%, with a high rate of recurrence [3, 4, 5, 6]. If the metastases are unresectable, the survival rate does not exceed 2% [4].…”

Section: Introductionmentioning

confidence: 99%

Liver Transplantation for Unresectable Metastases from Colon Adenocarcinoma

Caicedo

Buitrago

Thomas

et al. 2017

Case Rep Gastroenterol

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Liver transplantation is an option that improves quality of life and prolongs life expectancy in patients with different types of liver disease. Liver transplantation is controversial for colorectal metastases and is not recommended in clinical practice guidelines. In this case report, we present, to our knowledge, the first liver transplantation for colorectal metastases conducted in Colombia, with a successful follow-up of more than 2 years. Patients with these characteristics who underwent liver transplantation experience reduced mortality and exponentially improved quality of life.

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Chemotherapy or Liver Transplantation for Nonresectable Liver Metastases From Colorectal Cancer?

Abstract: Compared with chemotherapy, liver transplantation resulted in a marked increased OS in CRC patients with nonresectable liver-only metastases.

Cited by 157 publications

References 17 publications

Liver transplantation for colorectal liver metastasis: Survival without recurrence can be achieved

Liver transplantation for colorectal liver metastasis: Survival without recurrence can be achieved

Selection criteria related to long-term survival following liver transplantation for colorectal liver metastasis

Liver Transplantation for Unresectable Metastases from Colon Adenocarcinoma

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