A metastatic colorectal carcinoma: A curative approach?

Background: Unresectable colorectal liver metastases can be resected after response to chemotherapy. The use of neoadjuvant chemotherapy with or without targeted monoclonal antibodies increases the proportion of resectable liver metastasis and conferred a long term survival of 40%. Methods: The current ongoing studies regarding neodjuvant treatment strategies aiming to increase a proportion of patients with resectable liver metastases is going to be presented. Results: Perioperative chemotherapy with FOLFOX4 is compatible with major liver surgery and reduces the risk of events of progression free survival in resected patients. The results of the CELIM study confirm a favourable long-term survival for patients with initially suboptimal or unresectable colorectal liver metastasis who respond to conversion therapy and undergo secondary resection. The New EPOC randomised trial does not support the addition of cetuximab to chemotherapy and surgery for operable colorectal liver metastasis in KRAS exon 2 wild-type patients. Conclusion: The ability of anti-epidermal growth factor receptor agents to increase response rate and resection when added to chemotherapy has been clearly shown in a number of trials. The resection rates are higher with chemotherapy plus Cetuximab, in general, a conversion is contributes to the better overall survival.

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Survival investigation in patients with colorectal liver metastasis: A single-institution analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.617 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 617-617

Author(s):

Jianmin Xu ◽

Dexiang Zhu ◽

Li Ren ◽

Ye Wei

Keyword(s):

Liver Resection ◽

Liver Metastasis ◽

Liver Metastases ◽

Median Survival ◽

Colorectal Liver Metastasis ◽

Survival Rates ◽

Term Survival ◽

Long Term Survival ◽

Primary Colorectal Tumor

617 Background: To investigate survival in patients with colorectal liver metastasis (CRLM) and identify risk factors associated with survival. Methods: Clinical, pathologic, treatment and complete follow-up data were retrospectively collected from 1613 consecutive patients with CRLM in Zhongshan Hospital between 2000 and 2010. The prognostic value of different factors was studied through univariate and multivariate analyses. Results: The median survival was 22.0 mo and 5-yr survival rate was 16%. Survival of synchronous liver metastases (SLM) (21.2 mo and 16%) was lower than that of metachronous liver metastases (MLM) (30.1 mo and 23%, p<0.01). Survival after resection of liver metastases was 49.8 mo and 37%, higher than that after chemotherapy (22.2 mo and 0%), that after intervention(19.0 mo and 11%), that after chemotherapy combined with intervention(22.8 mo and 10%)and that after local regional treatment (28.5 mo and 0%). Expansion of the indications for liver resection (38.0 vs 48.0 mo, 32% vs 40%), simultaneous or staged resection of primary colorectal tumor and liver metastases (47.0 vs 44.0 mo, 33% vs 35%) and preoperative neoadjuvant therapy (44.0 vs 48.0 mo, 38% vs 36%) had no significant effect on survival. 64 initially irresectable patients could undergo surgery after convertible therapy, with the median survival 36.9 mo and 5-yr survival 30%, better than that of unresectable patients (18.2 mo and 8%). Five factors were found to be significant and independent predictors of poor survival by multivariate analysis: SLM, poorly differentiated primary, number of liver metastases >= 4, largest liver metastases >= 5 cm, and no surgical treatment of liver metastases. Giving one point to each above factor, the population was divided into six groups with 5-yr survival rates: 0 (64%), 1 (44%), 2 (29%), 3 (4%), 4 (4%) and 5 (1%) (p<0.01). Conclusions: Survival of SLM was lower than that of MLM. Resection of liver metastases provides good long-term survival benifit for patients with resectable and initially irresectable liver metastases. Expansion of the indications for liver resection is acceptable. Long-term survival outcome can be predicted from a risk factor scoring system.

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