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Preoperative chemotherapy prior to pulmonary metastasectomy in surgically resected primary colorectal carcinoma.

Subbiah IM, Blackmon SH, Correa AM, Kee B, Vaporciyan AA, Swisher SG, Eng C - Oncotarget (2014)

Bottom Line: Patients on oxaliplatin-based therapy had an improved OS vs. an irinotecan, capecitabine, or alternate regimen (p=.019).The OS of an oxaliplatin-based regimen vs. no chemotherapy was inconclusive (HR 0.57; 95% CI 0.237 to 1.389, p=0.218).Multivariate analysis demonstrated a worse PFS and OS for the male gender and an incomplete resection (R2).

View Article: PubMed Central - PubMed

Affiliation: Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.

ABSTRACT

Background: The benefit of preoperative chemotherapy prior to pulmonary metastasectomy for patients with colorectal carcinoma (CRC) is unknown. Here, we identify outcomes of preoperative chemotherapy in patients with resected primary CRC who then underwent pulmonary metastasectomy.

Methods: We queried a prospective database to identify treatment characteristics. Multivariate analyses identified predictors of overall survival (OS) and progression-free survival (PFS).

Results: 229 patients underwent lung metastasectomy, of whom 115 proceeded to surgery without chemotherapy while 114 received preoperative regimen based on oxaliplatin (32%), irinotecan (46%), capecitabine (16%), or other (6%). Median PFS in preoperative chemotherapy vs. surgery alone arms were comparable (p=0.004). Patients on oxaliplatin-based therapy had an improved OS vs. an irinotecan, capecitabine, or alternate regimen (p=.019). On multivariate analysis, the irinotecan subset had a worse OS (HR 1.846; 95% CI 1.070, 3.185) vs. surgery alone arm (p=0.028). The OS of an oxaliplatin-based regimen vs. no chemotherapy was inconclusive (HR 0.57; 95% CI 0.237 to 1.389, p=0.218). Multivariate analysis demonstrated a worse PFS and OS for the male gender and an incomplete resection (R2).

Conclusion: Prospective trials on specific preoperative regimens and criteria for patient selection may identify a role for preoperative chemotherapy prior to a curative pulmonary metastasectomy.

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Related in: MedlinePlus

Kaplan-Meier curve of progression-free survival comparing the surgery alone arm versus overall preoperative chemotherapy arm (A) and each of the 4 subsets of preoperative chemotherapies (B).
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Related In: Results  -  Collection

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Figure 2: Kaplan-Meier curve of progression-free survival comparing the surgery alone arm versus overall preoperative chemotherapy arm (A) and each of the 4 subsets of preoperative chemotherapies (B).


Preoperative chemotherapy prior to pulmonary metastasectomy in surgically resected primary colorectal carcinoma.

Subbiah IM, Blackmon SH, Correa AM, Kee B, Vaporciyan AA, Swisher SG, Eng C - Oncotarget (2014)

Kaplan-Meier curve of progression-free survival comparing the surgery alone arm versus overall preoperative chemotherapy arm (A) and each of the 4 subsets of preoperative chemotherapies (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4196147&req=5

Figure 2: Kaplan-Meier curve of progression-free survival comparing the surgery alone arm versus overall preoperative chemotherapy arm (A) and each of the 4 subsets of preoperative chemotherapies (B).
Bottom Line: Patients on oxaliplatin-based therapy had an improved OS vs. an irinotecan, capecitabine, or alternate regimen (p=.019).The OS of an oxaliplatin-based regimen vs. no chemotherapy was inconclusive (HR 0.57; 95% CI 0.237 to 1.389, p=0.218).Multivariate analysis demonstrated a worse PFS and OS for the male gender and an incomplete resection (R2).

View Article: PubMed Central - PubMed

Affiliation: Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.

ABSTRACT

Background: The benefit of preoperative chemotherapy prior to pulmonary metastasectomy for patients with colorectal carcinoma (CRC) is unknown. Here, we identify outcomes of preoperative chemotherapy in patients with resected primary CRC who then underwent pulmonary metastasectomy.

Methods: We queried a prospective database to identify treatment characteristics. Multivariate analyses identified predictors of overall survival (OS) and progression-free survival (PFS).

Results: 229 patients underwent lung metastasectomy, of whom 115 proceeded to surgery without chemotherapy while 114 received preoperative regimen based on oxaliplatin (32%), irinotecan (46%), capecitabine (16%), or other (6%). Median PFS in preoperative chemotherapy vs. surgery alone arms were comparable (p=0.004). Patients on oxaliplatin-based therapy had an improved OS vs. an irinotecan, capecitabine, or alternate regimen (p=.019). On multivariate analysis, the irinotecan subset had a worse OS (HR 1.846; 95% CI 1.070, 3.185) vs. surgery alone arm (p=0.028). The OS of an oxaliplatin-based regimen vs. no chemotherapy was inconclusive (HR 0.57; 95% CI 0.237 to 1.389, p=0.218). Multivariate analysis demonstrated a worse PFS and OS for the male gender and an incomplete resection (R2).

Conclusion: Prospective trials on specific preoperative regimens and criteria for patient selection may identify a role for preoperative chemotherapy prior to a curative pulmonary metastasectomy.

Show MeSH
Related in: MedlinePlus