Abstract
The FOXFIRE (5-Fluorouracil, OXaliplatin and Folinic acid ± Interventional Radio-Embolisation) clinical trial combined systemic chemotherapy (OxMdG: Oxaliplatin, 5-fluorouracil and folic acid) with Selective Internal Radiation Therapy (SIRT or radio-embolisation) using yttrium-90 resin microspheres in the first-line management for liver-dominant metastatic colorectal cancer (CRC). We report clinical outcomes for patients having hepatic resection after this novel combination therapy and an exploratory analysis of histopathology. Multi-Disciplinary Teams deemed all patients inoperable before trial registration and reassessed them during protocol therapy. Proportions were compared using Chi-squared tests and survival using Cox models. FOXFIRE randomised 182 participants to chemotherapy alone and 182 to chemotherapy with SIRT. There was no statistically significant difference in the resection rate between groups: Chemotherapy alone was 18%, (n = 33); SIRT combination was 21% (n = 38) (p = 0.508). There was no statistically significant difference between groups in the rate of liver surgery, nor in survival from time of resection (hazard ratio (HR) = 1.55; 95% confidence interval (CI) = 0.83–2.89). In the subgroup studied for histopathology, microsphere density was highest at the tumour periphery. Patients treated with SIRT plus chemotherapy displayed lower values of viable tumour in comparison to those treated with chemotherapy alone (p < 0.05). This study promotes the feasibility of hepatic resection following SIRT. Resin microspheres appear to preferentially distribute at the tumour periphery and may enhance tumour regression.
Highlights
Colorectal cancer (CRC) is the second leading cause of cancer-related death in the United States
We previously showed in 20 patients that the combination of oxaliplatincombination of oxaliplatin-based chemotherapy with results in high radiological response based chemotherapy with Selective internal radiotherapy (SIRT) results in high radiological response rates, and two patients were down-rates, sizedpatients to subsequent hepatic resection
We report the safety of hepatic resection after the novel combination of systemic OxMdG
Summary
Colorectal cancer (CRC) is the second leading cause of cancer-related death in the United States. The liver is the commonest site for metastases from CRC and the leading cause of Colorectal cancer (CRC) is the second leading cause of cancer-related death in the United States patient mortality. Hepatic is offered to patients operable as complete will have a liver-only disease, but resection most of these patients will be with inoperable, duedisease to number or surgical resectionofremains the sole curativeresection treatmentis for disease confinedwith to the liver, offering distribution metastases [1]. Hepatic offered to patients operable disease the as best chance of survival [2]. Resection remains the sole curative treatment for disease confined to the liver, complete surgical offering the best chance of survival [2].used to convert unresectable CRCLM to potentially resectable. The use of triplet drug regimens andtobiological therapies has increased radiological response disease [3]
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