Surgical treatment of liver metastases from colorectal carcinoma in elderly patients. When is it worthwhile?

Figueras, Joan; Ramos, Emilio; López‐Ben, Santiago; Torras, Jaume; Albiol, M.; Lladó, Laura; González, Héctor Daniel; Rafecas, Antoni

doi:10.1007/s12094-007-0072-x

Cited by 58 publications

(64 citation statements)

References 27 publications

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“…Nevertheless, the safety of extended hepatic resections in elderly patients is unclear, and some authors have reported higher postoperative mortality rates related to agedassociated co-morbidities [18,19]. No experimental studies have globally analyzed the effect of age on oxidative/nitrosative stress, cytokine profile, and liver regeneration after extended liver resection.…”

Section: Introductionmentioning

confidence: 99%

Impact of Age on Liver Regeneration Response to Injury After Partial Hepatectomy in a Rat Model

Sánchez-Hidalgo

Naranjo

Ciria

et al. 2012

Journal of Surgical Research

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Section: Introductionmentioning

confidence: 99%

Impact of Age on Liver Regeneration Response to Injury After Partial Hepatectomy in a Rat Model

Sánchez-Hidalgo

Naranjo

Ciria

et al. 2012

Journal of Surgical Research

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“…In the HORG-FOLFOXIRI trial, no different clinical outcome was observed in elderly versus non-elderly patients; significantly lower clinical outcome was reported in patients with PS 2 [31, 32]. Liver metastasectomies were reported in 1.3% and 4.4% patients in FOLFIRI and FOLFOXIRI arms, respectively [32] and can achieve OS 43 months, not significantly different from younger patients in the experience of liver resection in elderly patients [35]. Morbidity and/or mortality after liver surgery were significantly higher in elderly patients (8%) [36].…”

Section: Discussionmentioning

confidence: 99%

Clinical parameters to guide decision-making in elderly metastatic colorectal cancer patients treated with intensive cytotoxic and anti-angiogenic therapy

et al. 2016

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IntroductionBevacizumab addiction to triplet chemotherapy, according to FIr-B/FOx schedule, as first-line treatment in young-elderly metastatic colorectal CANCER (MCRC) patients may be more effective. Tailored treatments show worse clinical outcome in unfit patients.MethodsElderly patients were clinically evaluated according to age and comorbidity (Cumulative Illness Rating Scale) to select FIr-B/FOx regimen in fit or tailored treatments in unfit elderly. Limiting toxicity syndromes (LTS) were evaluated.ResultsAt 17 months follow-up, in 28 young-elderly patients treated with first line FIr-B/FOx: objective response rate (ORR) 79%, progression-free survival (PFS) 11 months, overall survival (OS) 21 months. Clinical outcome was not significantly different according to KRAS genotype. G3-4 toxicities were diarrhea 21%, mucositis 11%, neutropenia 11%. LTS were 46%, significantly more multiple than single site. At 8 months follow-up, in 37 unfit patients: ORR 37%, PFS 7 months, OS 13 months. PFS was significantly different in KRAS wild-type compared to mutant patients, while not OS. PFS and OS were significantly worse in KRAS c.35 G > A compared to wild-type and/or other mutant.ConclusionsCareful decision-making process including evaluation of patient's fitness, and individual safety should be included to select FIr-B/FOx intensive first line regimen in young-elderly MCRC patients. KRAS, and specifically c.35 G > A mutant genotype, may significantly affect clinical outcome in patients unfit for FIr-B/FOx.

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“…A complex decision-making process discriminating patients’ fitness, and tailoring a personalized medical treatment, is challenging: patients unfit for FIr-B/FOx can be treated with a two-drug first line combination regimen (31), but showed worse clinical outcome. No increased morbidity, nor mortality was reported in unfit patients who underwent secondary liver metastasectomies, reported as significantly higher in elderly patients (8%) (48). …”

Section: Discussionmentioning

confidence: 99%

Prognostic relevance of KRAS genotype in metastatic colorectal cancer patients unfit for FIr-B/FOx intensive regimen

Bruera

Cannita

Giordano

et al. 2014

International Journal of Oncology

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First-line triplet chemotherapy plus bevacizumab (FIr-B/FOx) can improve efficacy of metastatic colorectal cancer (MCRC), KRAS wild-type and mutant. Prognostic relevance of KRAS genotype was evaluated in patients unfit for FIr-B/FOx, treated with conventional medical treatments. Consecutive MCRC patients not eligible for FIr-B/FOx regimen due to age (≥75 years) and/or comorbidities were treated with tailored conventional first-line treatments. KRAS codon 12/13 mutations were screened by direct sequencing. Activity and efficacy were evaluated and compared according to medical treatments, age (non-elderly and elderly ≥65 years), comorbidity stage (Cumulative Illness Rating Scale), metastatic extension (liver-limited and other/multiple metastatic), and KRAS genotype, using log-rank. Selected first line treatments were medical in 37 patients (92.5%), and surgical in 3 patients (7.5%). Medical treatment regimens: triplet, 18 (45%); doublet, 15 (37.5%); mono-therapy, 4 (10%). At median follow-up of 8 months, objective response rate (ORR) was 37%, median progression-free survival (PFS) 7 months, liver metastasectomies 8% (liver-limited disease 37.5%), median overall survival (OS) 13 months. Triplet regimens failed to significantly affect clinical outcome, compared to doublet. According to KRAS genotype, ORR, PFS and OS were, respectively: wild-type 50%, 8 months, 13 months; mutant 25%, 6 months, 9 months. KRAS genotype wild-type compared to mutant significantly affected PFS, while not OS. KRAS c.35 G>A mutation (G12D) significantly affected worse PFS and OS compared to wild-type and/or other mutations. KRAS genotype, specifically the c.35 G>A KRAS mutation, may indicate poor prognosis in MCRC patients unfit for intensive medical treatments.

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Surgical treatment of liver metastases from colorectal carcinoma in elderly patients. When is it worthwhile?

Abstract: The elderly have a higher mortality. In recent years that difference has been markedly reduced. Excluding the postoperative mortality, the overall survival and disease-free survival are similar between both groups. The criteria to indicate surgery must be the same in both groups.

Cited by 58 publications

References 27 publications

Impact of Age on Liver Regeneration Response to Injury After Partial Hepatectomy in a Rat Model

Impact of Age on Liver Regeneration Response to Injury After Partial Hepatectomy in a Rat Model

Clinical parameters to guide decision-making in elderly metastatic colorectal cancer patients treated with intensive cytotoxic and anti-angiogenic therapy

Prognostic relevance of KRAS genotype in metastatic colorectal cancer patients unfit for FIr-B/FOx intensive regimen

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