Chemotherapy for downsizing unresectable liver metastases from colorectal cancer

PURPOSE Conversion chemotherapy is often used for borderline or unresectable (B/U) liver metastases from colorectal cancer (CRC) with the aim of achieving resectability. Although intensive and costly regimens are often used, the best regimen in this scenario remains unclear. We aimed to evaluate the outcomes of patients with B/U liver metastases from CRC treated with conversion chemotherapy with the modified fluorouracil, leucovorin, and oxaliplatin (mFLOX) regimen followed by metastasectomy. METHODS We performed a single-center retrospective analysis of patients with B/U liver metastases from CRC treated with chemotherapy with the mFLOX regimen followed by surgery. B/U disease was defined as at least one of the following: more than four lesions, involvement of hepatic artery or portal vein, or involvement of biliary structure. RESULTS Fifty-four consecutive patients who met our criteria for B/U liver metastases were evaluated. Thirty-five patients (64%) had more than four liver lesions, 16 (29%) had key vascular structure involvement, and 16 (29%) had biliary involvement. After chemotherapy, all patients had surgery and 42 (77%) had R0 resection. After a median follow-up of 37.2 months, median progression-free survival (PFS) was 16.9 months and median overall survival (OS) was 68.3 months. R1-R2 resections were associated with worse PFS and OS compared with R0 resection (PFS: hazard ratio, 2.65; P = .007; OS: hazard ratio, 2.90; P = .014). CONCLUSION Treatment of B/U liver metastases from CRC with conversion chemotherapy using mFLOX regimen followed by surgical resection was associated with a high R0 resection rate and favorable survival outcomes. On the basis of our results, we consider mFLOX a low-cost option for conversion chemotherapy among other options that have been proposed.

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Potential predictors of survival after surgery for colorectal cancer patients with synchronous unresectable liver metastases

Oncology Reports ◽

10.3892/or.16.6.1369 ◽

2006 ◽

Author(s):

Tsukasa Hotta ◽

Katsunari Takifuji ◽

Kazuhisa Uchiyama ◽

Shozo Yokoyama ◽

Kenji Matsuda ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Metastases ◽

Cancer Patients ◽

Unresectable Liver Metastases ◽

Colorectal Cancer Patients

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Radical surgery in the management of initially unresectable liver metastases from colorectal cancer in the era of bio-chemotherapy

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2014.10.031 ◽

2015 ◽

Vol 41 (1) ◽

pp. S11

Author(s):

T. Piardi ◽

K.L. Amroun ◽

S. Msika ◽

Z. Djerada ◽

M.D. Diebold ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Metastases ◽

Radical Surgery ◽

Unresectable Liver Metastases

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Phase I/II study of irinotecan, UFT, and leucovorin with hepatic arterial infusion in colorectal cancer patients with unresectable liver metastases: Preliminary results

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.14549 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 14549-14549

Author(s):

T. Yamaguchi ◽

H. Matsumoto ◽

K. Takahashi ◽

M. Yasutome ◽

T. Mori

Keyword(s):

Colorectal Cancer ◽

Phase I ◽

Liver Metastases ◽

Phase Ii ◽

Phase I Study ◽

Phase Ii Study ◽

Hepatic Arterial Infusion ◽

Arterial Infusion ◽

Unresectable Liver Metastases ◽

Colorectal Cancer Patients

14549 Background: To determine the maximum-tolerated dose (MTD) and to evaluate the efficacy and tolerability of combination chemotherapy of irinotecan (CPT-11), UFT and leucovorin (LV) with hepatic arterial infusion (HAI) in colorectal cancer patients with unresectable liver metastases. Methods: Patients who had unresectable liver metastases from colorectal cancer were treated concurrently with intravenous CPT-11 on day1 of each 14-day treatment cycle with dose escalation, with orally UFT and LV on day 1–7 of each cycle, and with HAI of 5-FU on day 8–14 of each cycle. The primary objective of this phase I study was to determine the MTD of biweekly intravenous CPT-11 and UFT/LV with HAI of 5-FU. In the phase II study, the primary endpoint was to determine the response rate. Results: In the phase I study, the recommended dose of CPT-11 for phase II study was 140 mg/m2 combined with UFT 300 mg/m2/day, LV 75 mg/body/day and 5-FU 2,000 mg/body/week. Sixteen patients were enrolled onto the phase II study. The six patients treated at the recommended dose during the phase I study also included in the phase II analysis (n = 22). Median number of liver metastases was 12 (range, 3 to 35). Median size of maximum diameter was 6.3 cm (range, 2.0 to 12.0 cm). The most common adverse event was neutropenia. The complete and partial response rate totaled 81.8%. Median survival time has not been reached yet. Eleven patients (50.0%) were ultimately able to undergo liver resection. Conclusions: The combination chemotherapy of CPT-11 and UFT/LV with HAI was safe, well tolerate and effective in current population of the patients with unresectable liver metastases from colorectal cancer. Updated toxicity and response data will be available in the spring of 2007. No significant financial relationships to disclose.

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