Multicenter Randomized Trial of Adjuvant Fluorouracil and Folinic Acid Compared With Surgery Alone After Resection of Colorectal Liver Metastases: FFCD ACHBTH AURC 9002 Trial

Portier, G.; Élias, Dominique; Bouché, Olivier; Rougier, Philippe; Bosset, Jean-François; Saric, Jean; Belghiti, Jacques; Piedbois, Pascal; Guimbaud, Rosine; Nordlinger, Bernard; Bugat, R.; Lazorthes, F; Bedenne, Laurent

doi:10.1200/jco.2006.06.8353

Cited by 509 publications

(348 citation statements)

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“…Presently, there is no standard guideline for CLM patients after liver resection. There are a few randomised clinical trials published that evaluate the survival effects of HAI of FUdR and/or intravenous systemic chemotherapy after hepatic resection (Lygidakis et al, 1995;Asahara et al, 1998;Lorenz et al, 1998;Lorenz and Muller, 2000;Tono et al, 2000;Kemeny et al, 2002;Kemeny and Gonen, 2005;Portier et al, 2006). Most of these studies, however, have limited statistical power due to small sample sizes (less than 100 subjects) or slow accrual.…”

Section: Discussionmentioning

confidence: 99%

“…An overall survival benefit was observed in two of these studies (Lygidakis et al, 1995;Asahara et al, 1998). The trial by Portier et al (2006) evaluated the survival benefits of systemic intravenous adjuvant chemotherapy and resection alone. Intravenous systemic chemotherapy following hepatectomy improved disease-free survival significantly (HR 0.66, 95% CI: 0.46 -0.96).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, while systemic chemotherapy is frequently administered after resection, the optimal regimen and its contributions to survival outcomes are inconclusive (Kemeny et al, 2002;Portier et al, 2006;Yoshida et al, 2006). We, therefore, conducted a population-based study to investigate the impact of demographic, clinical, and treatment characteristics on survival after hepatic resection for CLMs.…”

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Predictors of survival after hepatic resection among patients with colorectal liver metastasis

et al. 2007

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Studies suggest improved survival following resection of colorectal cancer liver metastases (CLMs). We investigated predictors of survival among patients with CLM who underwent hepatic resection using the SEER-Medicare database to identify patients X65 years diagnosed with CLM, 1991CLM, -2003, who underwent hepatectomy. Cox proportional hazards models were used to identify factors associated with survival after hepatectomy. Of 923 patients with CLM who underwent hepatectomy, 514 were stages I -III and developed CLM46 months after diagnosis (metachronous), and 409 were stage IV with CLM at diagnosis (synchronous). From the date of hepatectomy, 5 year survival was 22%; younger age, being married, female gender, surgery in an NCI-designated cancer centre, fewer comorbidities, fewer positive lymph nodes, and lower grade were associated with improved survival. Both 5-fluorouracil (5FU)-based chemotherapy and hepatic arterial infusion (HAI) of floxuridine-based chemotherapy following hepatectomy improved survival (HR ¼ 0.62, 95% CI: 0.50 -0.78; HR ¼ 0.51, 95% CI: 0.28 -0.97, respectively) in the synchronous, but not metachronous, group. The HR for overall mortality was higher in hospitals with a high vs low procedure volume (0.75, 95% CI: 0.58 -0.94). A substantial subgroup of patients with CLM who undergo hepatectomy experiences long-term survival. High hospital procedure volume and use of 5FU-based or HAI-based chemotherapy after resection were associated with improved prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Predictors of survival after hepatic resection among patients with colorectal liver metastasis

et al. 2007

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“…Mitry E et al reported that a pooled analysis of two randomized trials demonstrated a benefit to adjuvant 5-FU based chemotherapy in both DFS and OS (Mitry et al, 2008). The report by Portier et al represents the first publication of arandomized phase III trial comparing systemic chemotherapy after surgery to surgery alone and patients receiving postoperative systemic FU plus LV exhibited significantly better survival than those receiving surgery alone (24.4 months vs 17.6 months, respectively) (Portier et al, 2006) but, the difference did not reach a statistical significance. In two studies including 1100 and 763 patients with resected hepatic metastases of CRC, no significant benefit of adjuvant therapy after metastasectomy could be detected (Fong et al, 1999;Kato et al, 2003).…”

Section: Figure 3 Overall Survival Curve For 22 Patients Who Underwementioning

confidence: 99%

Survival Outcomes of Liver Metastasectomy in Colorectal Cancer Cases: A Single-Center Analysis in Turkey

Cokmert¹,

Ellıdokuz²,

Demir³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: The purpose of this study was to analyze our series of liver resections for metastatic colorectal carcinoma (mCRC) to determine prognostic factors affecting survival and to evaluate the potential roles of neoadjuvant or adjuvant chemotherapy. Materials and Methods: Ninety-nine patients who underwent metastasectomy for liver metastases due to colorectal cancer at the Department of Medical Oncology, 9 Eylul University Hospital between 1996 and 2010 were evaluated in this study. The patients were followed through July 2013. Demographic, perioperative, laboratory, radiological and chemotherapy as well as survival data were obtained by retrospective chart review. Results: In 47 (47.5%) patients, liver metastases were unresectable at initial evaluation; the remaining 52 (52.5%) patients exhibited resectable liver metastases. Simultaneous hepatic resection was applied to 52 (35.4%) patients with synchronous metastasis, whereas 5 (64.5%) patients underwent hepatic resection after neoadjuvant chemotherapy. Forty-two patients with metachronous metastasis underwent hepatic resection following neoadjuvant chemotherapy. R0 resection was obtained in 79 (79.8%) patients. A second hepatectomy was performed in 22 (23.2%) patients. Adjuvant chemotherapy was given to 85 (85.9%) patients after metastasectomy. The median disease-free and overall survivals after initial metastasectomy were 12 and 37 months, respectively, the 1-year, 3-year and 5-year disease-free survival (DFS) and overall survival (OS) rates being 46.5%, 24.3% and 17.9%and 92.3%, 59.0% and 39.0%, respectively. On multivariate analysis, the primary tumor site, tumor differentiation, resection margin and DFS were independent factors predicting better overall survival. Conclusions: In selected cases, hepatic metastasectomy for mCRC to the liver can result in long-term survival. Neoadjuvant chemotherapy did not exert a positive effect on DFS or OS. Adjuvant chemotherapy also did not appear to impact DFS and OS.

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“…The overall mortality rate is 40% higher if there is a delay Ն2 months before adjuvant chemotherapy is started [59]. In one study, after resection of CRC liver metastases, adjuvant 5-FU-LV resulted in a greater 4-year DFS rate, 42% versus 32% (p ϭ .28), than with surgery alone, but did not affect the OS outcome [60]. A systematic review and meta-analysis of four studies of perioperative chemotherapy around the time of liver resection found no OS benefit (HR, 0.74; 95% confidence interval [CI], 0.53-1.04) but did find a recurrence-free survival benefit of 25% (HR, 0.75; 95% CI, 0.62-0.91) [61].…”

Section: The Role Of Adjuvant Chemotherapy After Liver Resectionmentioning

confidence: 99%

Curative Strategies for Liver Metastases from Colorectal Cancer: A Review

et al. 2012

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After completing this course, the reader will be able to:1. Among patients with liver metastases from colorectal cancer, determine which would benefit from liver resection, the timing for surgery, and an appropriate perioperative chemotherapy regimen.2. Determine which patients are candidates for perioperative chemotherapy and the appropriate timing of chemotherapy, and describe the relevant toxicities and their impact on morbidity and mortality.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTColorectal cancer is a very common malignancy and frequently manifests with liver metastases, often without other systemic disease. Margin-negative (R0) resection of limited metastatic disease, in conjunction with systemic antineoplastic agents, is the primary treatment strategy, leading to long survival times for appropriately selected patients. There is debate over whether the primary tumor and secondaries should be removed at the same time or in a staged manner. Chemotherapy is effective in converting some unresectable liver metastases into resectable disease, with a correspondingly better survival outcome. However, the ideal chemotherapy with or without biological agents and when it should be administered in the course of treatment are uncertain. The role of neoadjuvant chemotherapy in initially resectable liver metastases is controversial. Local delivery of chemotherapy, with and without surgery, can lead to longer disease-free survival times, but it is not routinely used with curative intent. This review focuses on methods to maximize the disease-free survival interval using chemotherapy, surgery, and local methods. The Oncologist 2012;17:201-211

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Multicenter Randomized Trial of Adjuvant Fluorouracil and Folinic Acid Compared With Surgery Alone After Resection of Colorectal Liver Metastases: FFCD ACHBTH AURC 9002 Trial

Abstract: Despite a suboptimal regimen, which was the standard at the beginning of the study, adjuvant intravenous systemic chemotherapy provided a significant disease-free survival benefit for patients with resected liver metastases from colorectal cancer.

Cited by 509 publications

References 29 publications

Predictors of survival after hepatic resection among patients with colorectal liver metastasis

Predictors of survival after hepatic resection among patients with colorectal liver metastasis

Survival Outcomes of Liver Metastasectomy in Colorectal Cancer Cases: A Single-Center Analysis in Turkey

Curative Strategies for Liver Metastases from Colorectal Cancer: A Review

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