Does chemotherapy prior to liver resection increase the potential for cure in patients with metastatic colorectal cancer? A report from the European Colorectal Metastases Treatment Group.
ABSTRACT Liver resection offers the only chance of cure for patients with advanced colorectal cancer (CRC). Typically, the 5-year survival rates following liver resection range from 25% to 40%. Unfortunately, approximately 85% of patients with stage IV CRC have liver disease which is considered unresectable at presentation. However, the rapid expansion in the use of improved combination therapy regimens has increased the percentage of patients eligible for potentially curative surgery. Despite this, the selection criteria for patients potentially suitable for resection are not well documented and patient management by multidisciplinary teams, although essential, is still evolving. The goal of the European Colorectal Metastases Treatment Group is to establish pan-European guidelines for the treatment of patients with CRC liver metastases that can be adopted more widely by established treatment centres and to develop more accurate staging systems and evaluation criteria.
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ABSTRACT: The liver is the most common site of colorectal cancer metastasis. Although successful resection leads to durable overall survival (OS), local and distant recurrence is common. As a result, multidisciplinary strategies have been developed to decrease recurrence rates as well as increase the number of candidates for resection. A recent update to the European Organisation for Research and Treatment of Cancer (EORTC) Intergroup trial 40983 has been published comparing perioperative chemotherapy to surgery alone. This randomized trial initially demonstrated a benefit in progression free survival (PFS) with the administration of perioperative FOLFOX chemotherapy, albeit with an increased rate of complications. Although this led many investigators and clinicians to adopt the perioperative approach, the recent update failed to report any advantage in OS and therefore results in further controversy as to the role of perioperative systemic chemotherapy in the treatment of resectable colorectal hepatic metastases.
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ABSTRACT: Aim To improve isolated hepatic perfusion (IHP), we performed a phase I dose-escalation study to determine the optimal oxaliplatin dose in combination with a fixed melphalan dose. Methods Between June 2007 and July 2008, 11 patients, comprising of 8 colorectal cancer and 3 uveal melanoma patients and all with isolated liver metastases, were treated with a one hour IHP with escalating doses of oxaliplatin combined with 100mg melphalan. Samples of blood and perfusate were taken during IHP treatment for pharmacokinetic analysis of both drugs and patients were monitored for toxicity, response and survival. Results Dose limiting sinusoidal obstruction syndrome (SOS) occurred at 150mg oxaliplatin. The areas under the concentration-time curves (AUC) of oxaliplatin at the maximal tolerated dose (MTD) of 100mg oxaliplatin ranged from 11.9 mg/L x h to 16.5 mg/L x h. All 4 patients treated at the MTD showed progressive disease 3 months after IHP. Conclusions In view of similar and even higher doses of oxaliplatin applied in both systemic treatment and hepatic artery infusion (HAI), applying this dose in IHP is not expected to improve treatment results in patients with isolated hepatic metastases.European Journal of Surgical Oncology 07/2014; DOI:10.1016/j.ejso.2014.06.010 · 2.89 Impact Factor
Annals of Oncology 09/2014; 25. DOI:10.1093/annonc/mdu260 · 6.58 Impact Factor