Individualizse the treatment of liver metastases from colorectal cancer using RAND appropriateness method: Oncosurge decision model. Results of a consensus detecting from the international taskforce group

Abstract

3595 Background: Less than 20% of patients with colorectal liver metastases (CLM) are suitable for liver resection with curative intent. Recent studies suggested that the use of oxaliplatin based neoadjuvant chemotherapy may increase this figure to 30–40% of all patients. However, there is no consensus that determine which patients might benefit from such chemotherapy and subsequently have the chance of coming to curative liver surgery. It will be many years before clinical trials addressing this question are able to report. The aim of this project was to create a therapeutic decision model using the RAND Appropriateness Method. Methods: Following a comprehensive literature review, an international panel of liver surgeons, oncologists and radiologists (16 in total) provided both quantitative and qualitative expressions of opinion concerning the resectability of CLM. During 2 panel meetings a consensus was detected regarding specific patient characteristics in decision making for CLM resection. These characteristics are: contraindications; primary tumour characteristics and CLM characteristics. All characteristics were applied to appropriateness relating to resection and chemotherapy. The appropriateness of each therapeutic decision was assessed by the panel for all possible patient scenarios. Results: Consensus was agreed that features which totally pre-clude consideration for resection included not-treatable extra-hepatic disease, unfit for surgery, CLM involvement of >70% liver or 6 segments. Optimal type (5FU/LV, oxaliplatin, irinotecan) and sequences of chemotherapy pre and post resectability were evaluated. Other specific data relating to CLM (number and size of mets, resection margin, portal nodes) will be presented. Conclusions: This validated decision model tool would help healthcare providers to analyse the appropriateness of liver resection alone or in association with optimal chemotherapeutic sequence based upon individual patient and tumour characteristics. This tool will be available on academic website. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Sanofi-Synthelabo Evidis Sarl; Pfizer; Sanofi-Synthelabo Pfizer; Sanofi-Synthelabo Sanofi-Synthelabo Sanofi-Synthelabo