Multidisciplinary approach to patients with recurrent colorectal liver metastases.

Abstract

426 Background: Recurrence after liver resection (LR) for colorectal metastases (CLM) is common. Re-resection is the standard treatment. In unresectable patients, radiofrequency ablation (RFA) and stereotactic body radiation therapy (SBRT) have been proposed, but they did not show a clear survival benefit in comparison with chemotherapy alone. The present study aims to elucidate the outcome of patients with recurrent CLM according to the received treatment. Methods: A series of 323 consecutive patients undergoing first LR between 2004 and 2013 was considered. Of these, 206 (63.8%) had recurrence and were analyzed. Redo surgery was scheduled whenever possible. If surgery was excluded, RFA was considered for hepatic lesions, while SBRT for both hepatic and extra-hepatic lesions. Results: Among the 206 analyzed patients with recurrence, 72 underwent re-resection, 19 RFA and 14 SBRT. Liver-only recurrences were treated in 68.3% of cases (69/101, 47 surgery), pulmonary ones in 57.9% (22/38, 15 surgery) and other extra-hepatic ones in 20.9% (14/67, 10 surgery). After a median follow-up of 32 months, three-year survival after the diagnosis of recurrence (OS) was 42.2% (median 37.4 months). OS was associated with the administered treatment: at three years 70.5% if surgery, 53.8% if RFA/SBRT, and 15.0% if chemotherapy alone, p < 0.0001. The same association was observed focusing the analysis on patients with a total of three lesions in the liver and/or the lung (1-3 liver/lung group, n = 86): three-year OS was 82.6% if surgery, 55.8% if RFA/SBRT, and 29.2% if chemotherapy, p < 0.0001. Progression-free survival after the treatment of recurrence (PFS) was associated with the received treatment: at two years 29.0% if surgery, 14.4% if RFA/SBRT, and 2.6% if chemotherapy, p < 0.0001. The same result was observed in the “1-3 liver/lung” group: two-year PFS was 32.1% if surgery, 18.3% if RFA/SBRT, and 0% if chemotherapy, p = 0.001. RFA and SBRT groups had similar OS and PFS. Conclusions: Aggressive management of recurrent CLM prolongs OS and PFS. Surgery is the best treatment option. Despite potential selection biases, RFA and SBRT should be considered in unresectable patients because they are associated with better outcome than chemotherapy alone.