Are We Close to Curative Therapy for Colorectal Cancer Spread to the Liver?
Abstract & Commentary
Synopsis: Giacchetti and colleagues have attempted to increase the fraction of patients with resectable metastases by delivering neoadjuvant chemotherapy to 151 patients with unresectable hepatic metastases.
Source: Giacchetti S, et al. Ann Oncol 1999;10:663-669.
A small number of patients with colorectal cancer involving the liver have been curable by surgical resection of limited numbers of lesions localized to one hepatic lobe. Giacchetti et al have attempted to increase the fraction of patients with resectable metastases by delivering neoadjuvant chemotherapy to 151 patients with unresectable hepatic metastases. Patients received 5-fluorouracil, leucovorin, and oxaliplatin as outpatients. Patients were intermittently reassessed for their eligibility for surgical resection.
The size of liver metastases decreased by more than 50% in 89 patients (59%). Median overall survival was two years, and 28% of the 151 patients were alive at five years. Surgery with curative intent was undertaken in 77 patients (51%) and complete resection was achieved in 58 patients (38% of the total, 75% of those undergoing surgery). The median survival of the patients who were operated on was 48 months.
These results appear almost too good to be true. In an accompanying editorial, it is revealed that much depends on the initial assessment that the liver lesions were unresectable. If a substantial fraction of the patients had resectable metastases before the neoadjuvant chemotherapy, the results would appear somewhat less impressive. However, it is unlikely that a substantial fraction of these patients were misclassified. Perhaps the addition of oxaliplatin to 5-fluorouracil and leucovorin will make a difference in the frequency and magnitude of the responses in colorectal cancer. Efforts to replicate and expand these findings should have a high priority.