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Cancer Resources > Cancer News > Cancer News from Reuters > Reuters Cancer News > 2002 > December
Combination approach to unresectable liver metastases may improve survival
Will Boggs, MD
Last Updated: 2002-12-11 10:09:28 -0400 (Reuters Health)
NEW YORK (Reuters Health) - A regimen combining neoadjuvant chemotherapy with cryotherapy and surgical resection offers hope for increased survival to patients with extremely advanced metastatic liver involvement from colorectal carcinoma, according to a report in the December 1st issue of Cancer.
Aggressive surgical excision of hepatic colorectal metastases is the only potentially curative approach to this disease, the authors explain, but surgical resection may be contraindicated in patients due either to the anatomical location or a large number of metastases.
Dr. Michel Rivoire from Centre Leon Berard in Lyon, France, and colleagues examined the safety, efficacy, and long-term results of neoadjuvant chemotherapy and cryotherapy in eradicating liver metastases in 24 patients for whom total excision could not be achieved by resection alone. These results were compared with those for 33 patients who could be treated with resection without cryotherapy.
Cryotherapy was used to treat 69 unresectable liver metastases, the authors report, with mean freezing times of 18 minutes for single metastases and 48 minutes per patient. There were no significant differences in the postoperative complications of the patients who received cryotherapy and those who did not, the results indicate.
Overall survival was 93% at 1 year, 54% at 3 years, and 37% at 4 years, the investigators report, and median survival was 39 months. Though patients in the cryotherapy group had more metastases than did patients in the surgical resection group, the researchers note, overall survival and disease-free survival rates were identical for the two treatment groups.
"One should always remember that these patients have at least 50% chance of objective metastatic response to first-line chemotherapy with new regimens such as FOLFOX or FOLFIRI (i.e., 5-FU + leucovorin + irinotecan)," Dr. Rivoire told Reuters Health. "Liver metastases might well respond to further chemotherapy and surgery. Therefore, primary tumor resection should be as complete as possible [so as] not to impair outcome."
"Neoadjuvant chemotherapy with new drugs and focal liver destruction techniques have thoroughly modified the management of patients with unresectable liver metastases," Dr. Rivoire concluded. "New trials are ongoing that will soon confirm these preliminary results."
Cancer 2002;95:2283-2292.
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