Importance of histological tumor response assessment in predicting the outcome in patients with colorectal liver metastases treated with neo-adjuvant chemotherapy followed by liver surgery

Rubbia‐Brandt, Laura; Giostra, Emiliano; Brézault, Catherine; Roth, Arnaud; Andrès, Axel; Audard, Vincent; Sartoretti, P.; Dousset, B.; Majno, Pietro; Soubrane, Olivier; Chaussade, Stanislas; Mentha, Gilles; Terris, Benoı̂t

doi:10.1093/annonc/mdl386

Cited by 460 publications

(439 citation statements)

References 26 publications

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“…Pathological response to neoadjuvant chemotherapy has shown prognostic potential in patients with liver metastases from CRC, and consequently it has been integrated as an endpoint in several studies [107][108][109]. The degree of pathological response has been shown to vary depending on the chemotherapy regimen used [107,108].…”

Section: Pathological Responsementioning

confidence: 99%

Section: Pathological Responsementioning

confidence: 99%

“…The degree of pathological response has been shown to vary depending on the chemotherapy regimen used [107,108]. In addition to a pathological complete response, in which no residual tumor cells can be observed, other ways of scoring pathological response have been proposed, including tumor re-gression grades [107,110] and a pathological response grade [108,111,112]. The first evaluates the ratio of residual viable tumor cells to fibrous tissue within the tumor and has the advantage of being the same scoring system as the one used for primary colorectal tumors by the American Joint Committee on Cancer (the tumor-node-metastasis staging system), allowing easy comparison of response between the primary tumor and metastases.…”

Section: Pathological Responsementioning

confidence: 99%

“…Most residual tumor cells after chemotherapy are seen in the periphery of the tumor at the interface between the tumor and non-neoplastic liver tissue [107]. A recent study of 22 patients with advanced bilateral liver metastases from CRC found that half of the patients had tumor regrowth at the periphery of the metastasis when neoadjuvant chemotherapy was interrupted, and this occurred regardless of tumor response.…”

Section: Pathological Responsementioning

confidence: 99%

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The Oncosurgery Approach to Managing Liver Metastases from Colorectal Cancer: A Multidisciplinary International Consensus

et al. 2012

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ABSTRACTpatients receive in different centers. Based on current evidence, the group agreed on a number of issues including the following: (a) the primary aim of treatment is achieving a long disease-free survival (DFS) interval following resection; (b) assessment of resectability should be performed with high-quality cross-sectional imaging, staging the liver with magnetic resonance imaging and/or abdominal computed tomography (CT), depending on local expertise, staging extrahepatic disease with thoracic and pelvic CT, and, in selected cases, fluorodeoxyglucose positron emission tomography with ultrasound (preferably contrastenhanced ultrasound) for intraoperative staging; (c) optimal first-line chemotherapy-doublet or triplet chemotherapy regimens combined with targeted therapy-is advisable in potentially resectable patients; (d) in this situation, at least four courses of first-line chemotherapy should be given, with assessment of tumor response every 2 months; (e) response assessed by the Response Evaluation Criteria in Solid Tumors (conventional chemotherapy) or nonsize-based morphological changes (antiangiogenic agents) is clearly correlated with outcome; no imaging technique is currently able to accurately diagnose complete pathological response but high-quality imaging is crucial for patient management; (f) the duration of chemotherapy should be as short as possible and resection achieved as soon as technically possible in the absence of tumor progression; (g) the number of metastases or patient age should not be an absolute contraindication to surgery combined with chemotherapy; (h) for synchronous metastases, it is not advisable to undertake major hepatic surgery during surgery for removal of the primary CRC; the reverse surgical approach (liver first) produces as good an outcome as the conventional approach in selected cases; (i) for patients with resectable liver metastases from CRC, perioperative chemotherapy may be associated with a modestly better DFS outcome; and (j) whether initially resectable or unresectable, cure or at least a long survival duration is possible after complete resection of the metastases, and MDT treatment is essential for improving clinical and survival outcomes. The group proposed a new system to classify initial unresectability based on technical and oncological contraindications.

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Section: Pathological Responsementioning

confidence: 99%

Section: Pathological Responsementioning

confidence: 99%

Section: Pathological Responsementioning

confidence: 99%

Section: Pathological Responsementioning

confidence: 99%

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The Oncosurgery Approach to Managing Liver Metastases from Colorectal Cancer: A Multidisciplinary International Consensus

et al. 2012

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“…Patients experiencing major histological tumor regression showed an improved 3-year disease free survival (DFS) compared with those who had partial or no regression, resulting in a better 5-year OS rate. As for the chemotherapy regimen used as a neoadjuvant systemic treatment, histological tumor regression was most common among oxaliplatintreated patients and it was associated with a better clinical outcome [94].…”

Section: What Happens During Systemic Treatment?mentioning

confidence: 99%

Potentially resectable metastatic colorectal cancer: An individualized approach to conversion therapy

Marino

Leone

D’Avanzo

et al. 2014

Critical Reviews in Oncology/Hematology

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Association of Computed Tomography Morphologic Criteria With Pathologic Response and Survival in Patients Treated With Bevacizumab for Colorectal Liver Metastases

Chun

Vauthey

Boonsirikamchai

et al. 2009

JAMA

451

371

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HE ADDITION OF BEVACIZUMAB, a monoclonal antibody against vascular endothelial growth factor, to cytotoxic chemotherapy is associated with improved survival in patients with stage IV colorectal cancer and higher pathologic response rates in patients undergoing resection of colorectal liver metastases. 1,2 Response to bevacizumab, which exerts an antiangiogenic mechanism of action, may be inadequately assessed by traditional size-based radiologic criteria, the Response Evaluation Criteria in Solid Tumors (RECIST), which were designed for assessing tumor volume reduction following cytotoxic chemotherapy. [3][4][5] In support of this, a recent phase 3 trial showed that the addition of bevacizumab to oxaliplatin-based chemotherapy for metastatic colorectal cancer improved progression-free survival without affecting RECIST-defined response rates. 6 Recently, pathologic response to preoperative chemotherapy has been shown to correlate with improved sur-Author Affiliations are listed at the end of this article.

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Importance of histological tumor response assessment in predicting the outcome in patients with colorectal liver metastases treated with neo-adjuvant chemotherapy followed by liver surgery

Cited by 460 publications

References 26 publications

The Oncosurgery Approach to Managing Liver Metastases from Colorectal Cancer: A Multidisciplinary International Consensus

The Oncosurgery Approach to Managing Liver Metastases from Colorectal Cancer: A Multidisciplinary International Consensus

Potentially resectable metastatic colorectal cancer: An individualized approach to conversion therapy

Association of Computed Tomography Morphologic Criteria With Pathologic Response and Survival in Patients Treated With Bevacizumab for Colorectal Liver Metastases

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