The vast majority of colorectal cancer patients who present with liver metastases are not initially candidates for hepatic
resection. Although the combination of systemic chemotherapy and liver surgery can convert a significant proportion of patients
from a palliative situation to a potentially curative situation, the majority of initially unresectable liver metastases do
not respond sufficiently to initial chemotherapy to become resectable. More recently the addition of biologic agents (bevacizumab
or cetuximab) to cytotoxic chemotherapy has increased the rate of tumor response, suggesting that the addition of these agents
could improve resectability rate. Here we report the clinical case of a complete pathological response (pCR) in a 67-year-old
male affected by metastatic colorectal cancer, with initially unresectable liver metastases, after treatment with chemotherapy
[Show abstract][Hide abstract] ABSTRACT: During chemotherapy, some colorectal liver metastases (LMs) disappear on serial imaging. This disappearance may represent a complete response (CR) or a reduction in the sensitivity of imaging during chemotherapy. The objective of the current study was to determine the fate of disappearing LMs (DLMs) and the factors that predict a true CR.
Between 2000 and 2003, 435 patients who were evaluated by hepatobiliary surgeons received chemotherapy before they were considered for resection. Inclusion criteria were <12 LMs before chemotherapy, at least 1 DLM on a computed tomography (CT) scan, and either surgical resection or 1 year of clinical follow-up after the disappearance of LMs. A true CR was defined as either a pathologic CR (no tumor detected in the resection specimen) or a durable clinical CR (did not reappear on follow-up imaging). Clinical and pathologic factors were analyzed to identify those associated with a true CR.
During chemotherapy, 39 patients (9%) had a total of 118 DLMs on follow-up CT scans. Sixty-eight DLMs were resected, and 50 were followed clinically. Overall, 75 DLMs (64%) were true CRs, including 44 pathologic CRs and 31 durable clinical CRs. On multivariate analysis, the use of hepatic arterial infusion (HAI) chemotherapy (odds ratio [OR], 6.2; P = .02), the inability to observe the DLM on a magnetic resonance image (OR, 4.7; P = .005), and normalization of serum carcinoembryonic antigen levels (OR, 4.6; P = .006) were associated independently with a true CR.
Approximately 66% of DLMs represented a true CR according to assessment by resection or radiologic follow-up. Predictive factors may help to stratify patients who are likely to harbor residual disease.
Cancer 03/2010; 116(6):1502-9. DOI:10.1002/cncr.24912 · 4.89 Impact Factor
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