Neoadjuvant chemotherapy and resection of advanced synchronous liver metastases before treatment of the colorectal primary

Abstract

Background: In many patients with advanced synchronous liver metastases from colorectal tumours, the metastases progress during treatment of the primary, precluding curative treatment. The authors have investigated a management strategy that involves high-impact chemotherapy first, resection of liver metastases second and finally removal of the primary tumour in patients with adverse prognostic factors. Conclusion:This new strategy produced resectability and survival rates better than those expected from the published data on patients with disease of similar severity. It allows initial control and downstaging of liver metastases, and delivery of preoperative radiotherapy for rectal cancer without the fear that liver metastases will meanwhile progress beyond the possibility of cure.

Good response to leucovorin and fluorouracil plus oxaliplatin and cetuximab therapy in a patient with metastatic ascending colon cancer harboring a KRAS p.G13D mutation

“…By contrast, in Western countries, a number of reports have shown that treatment often commences with drug therapy using FOLFOX/ FOLFIRI + molecularly targeted drugs, followed by resection of the primary cancer. The foci of metastasis are then treated with anticancer drugs followed by surgical resection where possible (9)(10)(11). Each of these therapeutic strategies has advantages and disadvantages.…”

T0 N1 adenocarcinoma of the colon following oxaliplatin‐based neoadjuvant chemotherapy

“…To illustrate our point, we report herein the case of a patient with adenocarcinoma of the transverse colon and synchronous liver metastasis, who was treated according to a previously described ''reversed'' protocol [3]. A 66-year-old lady was investigated for anemia and underwent colonoscopy, which showed a 4-cm adenocarcinoma of the transverse colon.…”

Surgical management of colorectal cancer: A review of the literature

“…Models of simultaneous colon and liver resection as well as resection of the primary followed by chemotherapy to stabilise the liver tumours with the intent to proceed to staged hepatectomy are being debated [26]. Studies have shown a survival benefi t to neoadjuvant chemotherapy and resection of liver metastases prior to the resection of the colon primary [26][27][28].…”

“…In a prospective study by Mentha et al 20 patients over a 6-year period with stage IV CRC were treated with initial 2-6 cycles of chemotherapy prior to undergoing liver resection [26]. After hepatectomy, the colorectal primary resection was planned with addition of radiation therapy preoperatively for rectal cancers.…”