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Ecancermedicalscience. 2007;1:58. doi: 10.3332/ecancer.2008.58. Epub 2007 Oct 16.

Resection of colorectal liver metastases following neoadjuvant chemotherapy.

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1
Department of General Surgery-Laparoscopic Surgery, European Institute of Oncology, University of Milano, 20141, Italy.

Abstract

BACKGROUND/AIMS:

Hepatic resection in metastatic disease from colorectal cancer offers the best chance in selected cases for long-term survival. Neoadjuvant chemotherapy (NACT) has been advocated in some cases initially deemed irresectable, with few reports of the efficacy of such a strategy and the influence of the response to chemotherapy on the outcome of radical hepatic resection.

METHODOLOGY:

Between December 1995 and May 2005, 27 patients with colorectal liver metastases (seven males, 20 females, mean age: 58 ± 8 years; range: 40-75) were treated with neoadjuvant chemotherapy. A seven-year survival analysis was performed. Chemotherapy included mainly 5-fluorouracil, leucovorin and either oxaliplatin or irinotecan for a median of eight courses.

RESULTS:

A total of 16 patients (59%) had synchronous and 11 (41%) metachronous metastases. During pre-operative chemotherapy, tumour regression occurred in ten cases (37%), stable disease in a further ten patients (37%) and progressive disease developed in seven cases (26%). The five-year overall survival for NACT responders was 64% and only 15% for non-responders (p=0.044).

CONCLUSIONS:

The response to chemotherapy is likely to be a significant prognostic factor affecting survival after liver resection for cure.

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