Clinical

Neoadjuvant chemo plus resection improves survival in advanced liver cancer

Last Updated: 2006-08-30 10:35:46 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Neoadjuvant chemotherapy followed by resection improves survival in patients with initially unresectable colorectal liver metastases, according to a report in the August issue of the British Journal of Surgery.

"Neoadjuvant chemotherapy plus liver surgery for initially unresectable liver metastases increases the overall survival rate but not the disease-free survival rate," first author Dr. L. Capussotti from Istituto per la Ricerca e la Cura del Cancro, Candiolo, Italy told Reuters Health.

Dr. Capussotti and colleagues reviewed the outcomes for 150 patients who underwent hepatic resection for colorectal metastases, 34 of whom had chemotherapy before liver surgery.

The rate of major hepatic resections and positive resection margins at final pathology was higher among patients who had neoadjuvant chemotherapy before resection, the authors report.

No patient died in-hospital after their liver resection, the results indicate, and the overall rate of postoperative complications did not differ significantly between patients who had preoperative chemotherapy and those who did not.

Overall survival at 1 and 3 years was 95.3% and 62.8%, respectively, and did not differ significantly between the groups, the researchers note.

These survival rates were better than those experienced by patients who did not have liver surgery after neoadjuvant chemotherapy (83.2% and 21.3% at 1 and 3 years, respectively).

Recurrence rates were high, the report indicates, and occurred in nearly three quarters of the patients who had surgery without chemotherapy and 94% of those who had neoadjuvant chemotherapy before liver resection.

At the end of follow-up, 15 of the 34 patients in the neoadjuvant chemotherapy group were still living (11 with recurrent metastases) and 19 had died. In the group without chemotherapy, 67 of 116 were alive (16 with recurrent disease) and 49 had died (4 without recurrence).

In a multivariate analysis, resection of the recurrence was independently associated with the lowest risk of cancer death.

"Based on these data, it is clear that the combination of neoadjuvant chemotherapy and liver resection greatly increases survival compared with chemotherapy alone, but rarely provides cure," the authors conclude.

"Surgeons and oncologists should work together to increase the disease-free survival rate," Dr. Capussotti said, perhaps through "better selection of the patients for surgery (or) more aggressive chemotherapy, such as oxaliplatin plus irinotecan-based chemotherapy."

"Liver re-resections should be attempted whenever possible," Dr. Capussotti added.

Br J Surg 2006;93:1001-1006.