Abstract
3613 Background: Perioperative chemotherapy confers 3-year progression free survival advantage following resection of CRLM and good pathologic response is associated with improved overall survival. However, systemic neoadjuvant chemotherapy can increase postoperative morbidity and mortality. TACE using preloaded Irinotecan eluting beads gives sustained delivery of drug directly to tumor, thereby maximising response and reducing systemic exposure. This study examined the feasibility and safety of neoadjuvant DEBIRI-TACE before CRLM resection. Methods: Patients with resectable CRLM received single DEBIRI-TACE (up to 200mg) 1 month pre-hepatectomy. Primary end-point: tumor resectability, secondary end-points: safety, radiologic response (RECIST) and pathologic tumor response. Results: TACE attempted in 49 patients, successful in 40. Reasons for failed TACE included consent withdrawal (n=2), bilobar disease (n=2), tumour involving gallbladder wall (n=1), suspected hepatoma (n=1), arterial access difficulty (n=2), contrast medium allergy (n=1). Post-TACE complications: 1 acute pancreatitis (3%); 4 post-embolization syndromes (10%). Imaging at 4 weeks post-TACE (30 patients): complete response 0/40 (0%); partial response 1/40 (3%); stable disease 19/40 (48%); ‘progressive’ disease 10/40 (25%). 40 patients proceeded to surgery, 38 underwent hepatectomy (2 peritoneal disease, resectability rate 95%). 30-day post-operative mortality 5% (n=2), neither death TACE related (1 intraoperative pneumomediastinum, 1 aspiration pneumonia). 63 lesions (median 2 per patient) targeted with TACE. Histology: no residual disease 17%; 1-49% residual disease 59%; >50% residual disease 22%; no response 2%. Conclusions: Resection after neoadjuvant DEBIRI-TACE for CRLM is feasible and safe. Single treatment with DEBIRI-TACE resulted in tumor pathologic response similar to that seen after protracted systemic chemotherapy.
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