Reuters Health Information (2011-11-30): Resectable colorectal liver metastases don't need preop chemo
Resectable colorectal liver metastases don't need preop chemo
Last Updated: 2011-11-30 16:11:15 -0400 (Reuters Health)
NEW YORK (Reuters Health) - When colorectal cancer spreads to the liver, chemotherapy can help shrink inoperable tumors -- but if the liver lesions can be resected, then neoadjuvant chemo adds no benefit, a new review article shows.
This month in Annals of Surgery, Dr. Pierre-Alain Clavien and colleagues at University Hospital Zurich, Switzerland say the value of chemotherapy before hepatic resection of colorectal metastases should be analyzed for two distinct indications: reducing unresectable lesions to resectable status, and as neoadjuvant therapy in patients presenting with resectable tumors.
To assess the risks and benefits of chemo in these scenarios, the authors reviewed clinical articles in English on the topic.
For downsizing, based on a selection of 20 relevant articles, the team concludes that chemotherapy can result in a resectability rate of about 30%, although many regimens are associated with numerous side effects.
In the case of clearly resectable lesions, the authors argue that the only justification for neoadjuvant chemotherapy should be a significant improvement in disease-free and overall survival. They failed to find that in their review of 14 studies.
For example, in the only randomized trial addressing the issue, an increase in progression-free survival at three years with neoadjuvant therapy did not lead to increased overall survival, and rates of steatohepatitis or obstruction syndrome were higher in patients receiving neoadjuvant therapy.
Also, in retrospective studies analyzed, adjuvant therapy after surgery was linked with improved survival but neoadjuvant chemotherapy was not.
Summing up, Dr. Clavien and colleagues conclude: "Taken together, the data indicate that for unresectable liver metastases, downsizing chemotherapy may offer a chance for secondary resection in about a third of patients ... In contrast, routine neoadjuvant chemotherapy cannot be recommended due to the increased risk of complications without clear benefit on survival."
Ann Surg 2011.