Pre-operative chemotherapy for colorectal cancer liver metastases: an update of recent clinical trials

Nasti, Guglielmo; Ottaiano, Alessandro; Berretta, Massimiliano; Delrio, Paolo; Izzo, Francesco; Cassata, Antonino; Romano, Carmela; Facchini, Gaetano; Scala, D.; Mastro, Angelo Antonio; Romano, G.; Perri, Francesco; Iaffaioli, R. V.

doi:10.1007/s00280-010-1297-x

Cited by 24 publications

(17 citation statements)

References 49 publications

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“…Neoadjuvant chemotherapy prior to hepatectomy in patients with resectable CRLM may increase the resectability of liver lesions, treat occult metastasis, improve progression-free survival, allow for testing of the chemosensitivity of the cancer in situ, help to determine the appropriateness of further treatments, and identify progressive disease that contraindicates immediate surgery [14]. An Italian study of 25 patients with primarily resectable CRLM treated with neoadjuvant chemotherapy found that 18 (72%) responded to chemotherapy, and the 5-year overall survival was 71%, which indicates that the response to chemotherapy is likely to be a significant prognostic factor affecting overall survival after radical hepatic resection [15].…”

Section: Discussionmentioning

confidence: 99%

Effect of Neoadjuvant Chemotherapy in Patients with Resectable Colorectal Liver Metastases

Zhu

Zhong

et al. 2014

PLoS ONE

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BackgroundWhether patients with resectable colorectal liver metastases (CRLM) receive survival benefit from neoadjuvant chemotherapy remains controversial.MethodsWe retrospectively analyzed 466 patients with resectable CRLM between 2000 and 2010. Patient characteristics and survival data were recorded.ResultsThe patients were divided into one group with neoadjuvant chemotherapy (group NC, n = 121) and another without (group WN, n = 345). There was no difference in 5-year survival (52% vs. 48%) between the two groups. No significant differences were identified between the two groups in terms of 30-day mortality (1.7% vs. 1.2%) or morbidity (33.9% vs. 25.8%). A primary tumor at stage T4, ≥4 liver metastases, the largest liver metastasis ≥5 cm in diameter, and a serum CEA level ≥5 ng/ml were independent prognostic factors. By assigning one point to each, the patients were divided into a low-risk group (0–2) and a high-risk (3–4). The patients in the low-risk group received no survival benefit from neoadjuvant chemotherapy, whereas those in the high-risk group received survival benefit (5-year survival, 39% vs. 33%, P = 0.028).ConclusionsPreoperative neoadjuvant chemotherapy did not increase mortality or complications. Not all resectable patients, only those with >2 independent risk factors, received survival benefit from neoadjuvant chemotherapy.

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Section: Discussionmentioning

confidence: 99%

Effect of Neoadjuvant Chemotherapy in Patients with Resectable Colorectal Liver Metastases

Zhu

Zhong

et al. 2014

PLoS ONE

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confidence: 99%

“…Preoperative chemotherapy reduces the size of hepatic metastases, therefore resulting in the conversion of initially unresectable disease to potentially resectable disease, and hence increasing the likelihood that the metastatic tumor will be curatively resected 5-7. In addition, neoadjuvant treatment may also treat micrometastases which are not detected by imaging studies 7. The most popular regimens are those that combine fluoropyrimidines with irinotecan or oxaliplatin, including the 5-fluorouracil (5-FU) and oxaliplatin (FOLFOX) and 5-FU, oxaliplatin and irinotecan (FOLFIRI) regimens 5-11…”

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confidence: 99%

Chemotherapy-Associated Hepatopathy in Korean Colorectal Cancer Liver Metastasis Patients: Oxaliplatin-Based Chemotherapy and Sinusoidal Injury

et al. 2012

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BackgroundAlthough chemotherapy-related hepatic injury has been reported in colorectal cancer liver metastasis (CRLM) patients, the morphologic changes caused by chemotherapeutic agents and the effect of chemotherapy on postoperative outcome remain ill-defined. A comprehensive review of the morphologic changes in the post-chemotherapy non-neoplastic liver was performed and the clinical effect of preoperative chemotherapy in CRLM patients was analyzed.MethodsHematoxylin-eosin, Masson's trichrome and reticulin-stained slides from non-neoplastic livers obtained from 89 CRLM patients were analyzed, and the clinicopathologic features were correlated with the status of chemotherapy exposure.ResultsHistopathologic features of sinusoidal injury (sinusoidal dilatation, centrilobular perivenular fibrosis, parenchymal extinction lesions, small vessel obliteration, and hepatocyte plate disruption) were significantly more frequent in oxaliplatin-exposed livers (p<0.05). The extent of sinusoidal dilatation was positively correlated with increasing numbers of chemotherapy cycles (p=0.022). Abnormal preoperative liver function tests were more frequently seen (p<0.05) and postoperative total bilirubin was higher in the chemotherapy group (p=0.008). Postoperative morbidity was more common in the chemotherapy group (p=0.044).ConclusionsSinusoidal injury is frequently seen in oxaliplatin-treated livers, and its presence, especially when extensive, should be documented in surgical pathology practice. The recognition of sinusoidal injury may provide helpful guidelines for surgeons in deciding the extent of hepatic resection.

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“…For example, the UK National Institute for Health and Clinical Excellence (NICE) does not recommend the use of bevacizumab in mCRC and cetuximab has only recently been recommended for restricted use in the UK [19–21]. Since there is some evidence that adding an mAb to cytotoxic chemotherapy may increase resection rates compared with the use of cytotoxic chemotherapy alone [22], this may partially explain the relatively lower rates of surgical procedures for metastases and curative purposes in the UK.…”

Section: Discussionmentioning

confidence: 99%

Major Surgery in Patients with Metastatic Colorectal Cancer in Western Europe

Zhao

Pelletier²,

Barber

et al. 2011

J Gastrointest Canc

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PurposeGiven the potential interference between treatment for metastatic colorectal cancer (mCRC) and surgical procedures, we sought to determine the prevalence of major surgery following mCRC diagnosis in clinical practice.MethodsThis cohort study used physician-surveyed data from the LifeLink™ Oncology Analyzer database for mCRC patients in five European countries (France, Germany, Italy, Spain, and the United Kingdom [UK]). All patients aged ≥21 years at mCRC diagnosis and with data collected during 2009 were included. Major surgical procedures were examined descriptively by the purpose and location of surgery.ResultsThe study sample included 3,249 mCRC patients; 515, 862, 656, 649, and 567 were from France, Germany, Italy, Spain, and the UK, respectively. Following mCRC diagnosis, at least one major surgical procedure for any purpose was seen in 30.5% (UK), 35.2% (Germany), 35.6% (Spain), 36.3% (France), and 38.4% (Italy) of patients, with a mean of 1.3 (UK) to 1.6 (France) procedures. The rate of major surgery for curative purposes was the highest in Italy (13.4%), followed by France (12.8%), Spain (10.3%), and Germany (9.2%); the lowest was in the UK (7.2%). Major surgery performed on the primary tumor (12.4–27.1% of patients, depending on the country) and metastasis (6.4–14.6%) made up the majority of all surgical procedures.ConclusionsMajor surgery is highly prevalent following mCRC diagnosis, suggesting an important role in meeting the goals of mCRC treatment. The role of pharmacological treatment options and their potential to interfere with both surgery use and surgical outcomes should be considered when evaluating mCRC treatment strategies.

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Pre-operative chemotherapy for colorectal cancer liver metastases: an update of recent clinical trials

Cited by 24 publications

References 49 publications

Effect of Neoadjuvant Chemotherapy in Patients with Resectable Colorectal Liver Metastases

Effect of Neoadjuvant Chemotherapy in Patients with Resectable Colorectal Liver Metastases

Chemotherapy-Associated Hepatopathy in Korean Colorectal Cancer Liver Metastasis Patients: Oxaliplatin-Based Chemotherapy and Sinusoidal Injury

Major Surgery in Patients with Metastatic Colorectal Cancer in Western Europe

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