Reuters Health Information (2011-04-27): Colorectal liver metastases resection improves survival rates
Colorectal liver metastases resection improves survival rates
Last Updated: 2011-04-27 12:21:27 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Resection of colorectal liver metastases after second-line chemotherapy modestly improves survival rates, according to a report in the March 28th online Cancer.
"Given the lack of highly effective treatment options for patients with liver only metastatic disease with suboptimal response to initial chemotherapy, we consider liver resection for selected patients following second-line therapy an appropriate alternative," the researchers say.
Objective response rates to second-line chemotherapy are only 4% to 28%, but patient outcomes following resection of colorectal liver metastases after such chemotherapy is unknown.
Dr. Antoine Brouquet and colleagues from The University of Texas MD Anderson Cancer Center, Houston, analyzed the feasibility and outcomes of resection of colorectal liver metastases after a second-line chemotherapy regimen in a study of 1099 consecutive patients with advanced colorectal liver metastases.
Sixty of these patients received two or more lines of preoperative chemotherapy and were the subject of the study. Twelve of these patients (20%) had at least five colorectal liver metastases, and 25 (42%) had metastases measuring at least 5 cm in diameter.
Twenty-two patients (37%) had objective responses to the last preoperative chemotherapy regimen, and 16 (27%) had an optimal morphologic response to the last preoperative chemotherapy regimen.
Of the 60 operated patients, two thirds underwent major liver resection. Two patients (3%) died within 90 days after surgery, and 10 patients (17%) developed a major postoperative complication necessitating a surgical, endoscopic or radiologic procedure.
Pathologic examination revealed complete resection in 48 patients (80%) and major or complete pathologic response to systemic therapy in 19 patients (32%).
After a median follow-up time of 32 months, overall survival rates were 83% at 1 year, 41% at 3 years, and 22% at 5 years. Disease-free survival rates were 37% at 1 year, 11% at 3 years, and 11% at 5 years.
Twenty-six patients (43%) received additional chemotherapy post-operatively. Palliative chemotherapy was begun in all 49 patients who experienced recurrence, and eight of these patients underwent further surgery. Median chemotherapy-free survival times were 9.2 months after postoperative chemotherapy or additional surgery and 12 months for the 34 patients who didn't undergo postoperative chemotherapy.
Synchronous colorectal liver metastases and minor pathologic response were the only independent predictors of worse survival, which was 10% in patients with both factors, compared with 32% in patients with neither factor.
"Not all patients receiving second-line chemotherapy for advanced colorectal liver metastases can benefit from resection," they add. "However, in the future, refinements in the assessment of tumor response should help to select surgical candidates in this challenging therapeutic setting."