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Multimodal treatment options for bilobar colorectal liver metastases.

Homayounfar K, Liersch T, Niessner M, Meller J, Lorf T, Becker H, Ghadimi BM - Langenbecks Arch Surg (2010)

Bottom Line: Postoperatively, 26 patients received anti-cancer therapy (5 x CTx, 21 x anti-CEA-radioimmunotherapy).There was no significant difference in DFS (p = 0.650) and OS (p = 0.435) between straightforward and two-stage liver resection.Compared to "wait and see" strategy, the application of postoperative therapy in adjuvant intent was associated with a better OS (p = 0.048).

View Article: PubMed Central - PubMed

Affiliation: Department of General and Visceral Surgery, University Medical Centre, Georg-August University Goettingen, Robert-Koch-Strasse 40, 37073, Goettingen, Germany. khomayounfar@chirurgie-goettingen.de

ABSTRACT

Purpose: We evaluated individualized multimodal oncological strategies in patients with bilobular colorectal liver metastases (biCRC-LM) as well as their effect on R0 resection rates, disease-free survival (DFS), and overall survival (OS).

Methods: Between January 2001 and December 2008, 64 patients were assigned to straightforward or two-stage liver resection +/- preoperative 5-fluorouracil (5FU)-based chemotherapy (CTx). Postoperative strategy after R0-resection was either "wait and see" or "adjuvant" therapy (3 cycles of CTx or anti-carcinoembryonic antigen (CEA)-radioimmunotherapy with (131)I-labetuzumab in a dose of 40-50 mCi/m(2)).

Results: Forty-three initially unresectable patients received preoperative CTx for downsizing of their biCRC-LM. Straightforward or two-stage liver resection was intended in 40 and 24 patients, respectively. Histopathologically confirmed R0-liver resection could be achieved in 47 patients. Surgical morbidity and mortality rates were 33% and 1.5%, respectively. Postoperatively, 26 patients received anti-cancer therapy (5 x CTx, 21 x anti-CEA-radioimmunotherapy). After R0-liver resection, median OS was significantly better compared to R1/R2 resections followed by palliative 5FU-CTx (38 versus 19 months, p = 0.035). There was no significant difference in DFS (p = 0.650) and OS (p = 0.435) between straightforward and two-stage liver resection. Compared to "wait and see" strategy, the application of postoperative therapy in adjuvant intent was associated with a better OS (p = 0.048).

Conclusion: Extensive liver resection within multimodal treatment concepts is justified in patients with biCRC-LM when complete resection of all metastases seems to be achievable.

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Related in: MedlinePlus

Kaplan–Meier plot of cancer-specific overall survival in 47 R0-resected patients with bilobar CRC-LM. A significant survival benefit (p = 0.048) could be observed for those patients treated by postoperative anti-cancer therapy
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Fig3: Kaplan–Meier plot of cancer-specific overall survival in 47 R0-resected patients with bilobar CRC-LM. A significant survival benefit (p = 0.048) could be observed for those patients treated by postoperative anti-cancer therapy

Mentions: The median OS of the 47 R0-resected patients was 38 months. This was significantly higher (p = 0.035) than of patients with incomplete (R1/R2) resection followed by palliative systemic 5FU-based chemotherapy (19 months, Fig. 2). Stratifying the patients following R0-LR in those with versus those without postoperative anti-cancer therapy in adjuvant intent resulted in two otherwise oncologically comparable subgroups. Receiving anti-cancer therapy postoperatively was not associated with a significant advantage in DFS (p = 0.269) but in OS (p = 0.048) compared to the “wait and see” strategy (Fig. 3) in those patients who denied postoperative anti-cancer treatment on behalf of the national guidelines.Fig. 2


Multimodal treatment options for bilobar colorectal liver metastases.

Homayounfar K, Liersch T, Niessner M, Meller J, Lorf T, Becker H, Ghadimi BM - Langenbecks Arch Surg (2010)

Kaplan–Meier plot of cancer-specific overall survival in 47 R0-resected patients with bilobar CRC-LM. A significant survival benefit (p = 0.048) could be observed for those patients treated by postoperative anti-cancer therapy
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2908753&req=5

Fig3: Kaplan–Meier plot of cancer-specific overall survival in 47 R0-resected patients with bilobar CRC-LM. A significant survival benefit (p = 0.048) could be observed for those patients treated by postoperative anti-cancer therapy
Mentions: The median OS of the 47 R0-resected patients was 38 months. This was significantly higher (p = 0.035) than of patients with incomplete (R1/R2) resection followed by palliative systemic 5FU-based chemotherapy (19 months, Fig. 2). Stratifying the patients following R0-LR in those with versus those without postoperative anti-cancer therapy in adjuvant intent resulted in two otherwise oncologically comparable subgroups. Receiving anti-cancer therapy postoperatively was not associated with a significant advantage in DFS (p = 0.269) but in OS (p = 0.048) compared to the “wait and see” strategy (Fig. 3) in those patients who denied postoperative anti-cancer treatment on behalf of the national guidelines.Fig. 2

Bottom Line: Postoperatively, 26 patients received anti-cancer therapy (5 x CTx, 21 x anti-CEA-radioimmunotherapy).There was no significant difference in DFS (p = 0.650) and OS (p = 0.435) between straightforward and two-stage liver resection.Compared to "wait and see" strategy, the application of postoperative therapy in adjuvant intent was associated with a better OS (p = 0.048).

View Article: PubMed Central - PubMed

Affiliation: Department of General and Visceral Surgery, University Medical Centre, Georg-August University Goettingen, Robert-Koch-Strasse 40, 37073, Goettingen, Germany. khomayounfar@chirurgie-goettingen.de

ABSTRACT

Purpose: We evaluated individualized multimodal oncological strategies in patients with bilobular colorectal liver metastases (biCRC-LM) as well as their effect on R0 resection rates, disease-free survival (DFS), and overall survival (OS).

Methods: Between January 2001 and December 2008, 64 patients were assigned to straightforward or two-stage liver resection +/- preoperative 5-fluorouracil (5FU)-based chemotherapy (CTx). Postoperative strategy after R0-resection was either "wait and see" or "adjuvant" therapy (3 cycles of CTx or anti-carcinoembryonic antigen (CEA)-radioimmunotherapy with (131)I-labetuzumab in a dose of 40-50 mCi/m(2)).

Results: Forty-three initially unresectable patients received preoperative CTx for downsizing of their biCRC-LM. Straightforward or two-stage liver resection was intended in 40 and 24 patients, respectively. Histopathologically confirmed R0-liver resection could be achieved in 47 patients. Surgical morbidity and mortality rates were 33% and 1.5%, respectively. Postoperatively, 26 patients received anti-cancer therapy (5 x CTx, 21 x anti-CEA-radioimmunotherapy). After R0-liver resection, median OS was significantly better compared to R1/R2 resections followed by palliative 5FU-CTx (38 versus 19 months, p = 0.035). There was no significant difference in DFS (p = 0.650) and OS (p = 0.435) between straightforward and two-stage liver resection. Compared to "wait and see" strategy, the application of postoperative therapy in adjuvant intent was associated with a better OS (p = 0.048).

Conclusion: Extensive liver resection within multimodal treatment concepts is justified in patients with biCRC-LM when complete resection of all metastases seems to be achievable.

Show MeSH
Related in: MedlinePlus