Treatment with 5-Fluorouracil/Folinic Acid, Oxaliplatin, and Irinotecan Enables Surgical Resection of Metastases in Patients With Initially Unresectable Metastatic Colorectal Cancer

Masi, Gianluca; Cupini, Samanta; Marcucci, Lorenzo; Cerri, Elisa; Loupakis, Fotios; Allegrini, Giacomo; Brunetti, I.; Pfanner, E.; Viti, Maurizio; Goletti, Orlando; Filipponi, Franco; Falcone, Alfredo

doi:10.1245/aso.2006.03.094

Cited by 148 publications

(63 citation statements)

References 21 publications

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“…Similarly, two-stage hepatectomies in CRLM involve delayed re-hepatectomy after hypertrophy of the residual liver and may be used for large bilateral lesions in which a one stage resection of all the involved segments would lead to liver failure (19). Modern chemotherapeutic regimens combining 5-FU, folinic acid and oxaliplatin and/or irinotecan are associated with much higher response rates and can allow 10-30% of patients with initially unresectable CRLM to be successfully treated with liver surgery (20)(21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

Perioperative use of the LiMON method of indocyanine green elimination measurement for the prediction and early detection of post-hepatectomy liver failure

Carino

O’Reilly

Dajani

et al. 2009

European Journal of Surgical Oncology (EJSO)

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This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Discussionmentioning

confidence: 99%

Perioperative use of the LiMON method of indocyanine green elimination measurement for the prediction and early detection of post-hepatectomy liver failure

Carino

O’Reilly

Dajani

et al. 2009

European Journal of Surgical Oncology (EJSO)

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“…In a study using a neoadjuvant combination of 5-FU/FA/ irinotecan/oxaliplatin (FOLFOXIRI) (Masi et al, 2006), there was a response rate of 72% in unselected patients and a 26% (19 patients) hepatic resection rate. In five patients, extrahepatic disease was also resected.…”

Section: Discussionmentioning

confidence: 99%

Final analysis of colorectal cancer patients treated with irinotecan and 5-fluorouracil plus folinic acid neoadjuvant chemotherapy for unresectable liver metastases

et al. 2007

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We have previously reported that neoadjuvant therapy with modified FOLFIRI enabled nearly a third of patients with metastatic colorectal cancer (mCRC) to undergo surgical resection of liver metastases. Here, we present data from the long-term follow-up of these patients. Forty patients received modified FOLFIRI: irinotecan 180 mg m À2 , day 1; folinic acid, 200 mg m À2 ; and 5-fluorouracil: as a 400 mg m À2 bolus, days 1 and 2, and a 48-h continuous infusion 1200 mg m À2 , from day 1. Treatment was repeated every 2 weeks, with response assessed every six cycles. Resected patients received six further cycles of chemotherapy postoperatively. Nineteen (47.5%) of 40 patients achieved an objective response; 13 (33%) underwent resection. After a median follow-up of 56 months, median survival for all patients was 31.5 months: for non-resected patients, median survival was 24 months and was not reached for resected patients. Median time to progression was 14.3 and 5.2 months for all and non-resected patients, respectively. Median disease-free (DF) survival in resected patients was 52.5 months. At 2 years, all patients were alive (8 DF), and at last follow-up, eight were alive (6 DF). Surgical resection of liver metastases after neoadjuvant treatment with modified FOLFIRI in CRC patients achieved favourable survival times.

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“…[6][7][8][9] With the advent of new chemotherapeutic agents, reports emerged in which some patients with unresectable liver metastases had reductions in their disease burden that were sufficient to enable complete resection of their remaining tumor. [10][11][12][13][14][15][16] That is, tumor shrank sufficiently to enable complete removal of all gross disease, while preserving sufficient functional hepatic parenchyma. In such patients median survivals of 37 to 42 months [10][11][12]16 and 5-year survival rates of 35% to 40% have been reported.…”

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confidence: 99%

Colorectal liver metastases contract centripetally with a response to chemotherapy

Urbanski

Mangat

et al. 2007

Cancer

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BACKGROUND.Recently, there has been considerable interest in neoadjuvant chemotherapy for colorectal liver metastases. However, there is little information that defines how much liver should be removed after a favorable response.METHODS.Liver metastases from 2 groups of patients were analyzed: 25 metastases were evaluated from a group that did not receive chemotherapy and 26 lesions were studied from patients who had received systemic chemotherapy before resection. All patients except for 1 had 5‐fluorouracil (5‐FU), leucovorin (LV), and irinotecan (CPT‐11); 1 had 5‐FU and LV alone. The average duration of chemotherapy was 2.9 ± 0.7 months. Separate assessments of the histopathologic features of the central and peripheral portions of each tumor were made. The pathologist was blinded to all clinical information.RESULTS.All of the untreated metastases had well‐circumscribed borders. Irregular borders were seen in 6 of the postchemotherapy lesions (26%), which was particularly prominent in lesions that had significantly contracted. After chemotherapy, discrete islands of viable tumor cells outside of the main tumor mass were seen in 4 patients, but all were close to the peripheral margin of the tumor mass. Viable tumor cells were more frequent in the periphery of metastases, regardless of chemotherapy exposure. Central necrosis was prominent in untreated metastases, but disappeared after chemotherapy. In lesions treated with chemotherapy, central fibrosis was greater compared with untreated lesions.CONCLUSIONS.After a partial response to chemotherapy, liver metastases shrank in a generally concentric fashion. These findings support the practice of removing less liver after downsizing with chemotherapy. Cancer 2008. © 2007 American Cancer Society.

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Treatment with 5-Fluorouracil/Folinic Acid, Oxaliplatin, and Irinotecan Enables Surgical Resection of Metastases in Patients With Initially Unresectable Metastatic Colorectal Cancer

Cited by 148 publications

References 21 publications

Perioperative use of the LiMON method of indocyanine green elimination measurement for the prediction and early detection of post-hepatectomy liver failure

Perioperative use of the LiMON method of indocyanine green elimination measurement for the prediction and early detection of post-hepatectomy liver failure

Final analysis of colorectal cancer patients treated with irinotecan and 5-fluorouracil plus folinic acid neoadjuvant chemotherapy for unresectable liver metastases

Colorectal liver metastases contract centripetally with a response to chemotherapy

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