Optimal indication criteria for neoadjuvant chemotherapy in patients with resectable colorectal liver metastases

Hirofumi Ichida,Kensei Yamaguchi,Yosuke Inoue,Akio Saiura,Yu Takahashi,Hiromichi Ito,Eiji Shinozaki,Yoshihiro Mise,Takeaki Ishizawa

doi:10.1186/s12957-019-1641-5

Abstract

BackgroundThere are no optimal indication criteria for neoadjuvant chemotherapy (NAC) in patients with resectable colorectal liver metastases (CLM). The aim of this study was to prospectively assess the survival benefit of selective NAC administration in this patient population based on tumor characteristics.MethodsBorderline resectable CLM (BR-CLM) were defined as four or more liver metastases, CLM larger than 5 cm, or CLM with concomitant resectable extrahepatic metastases. From 2010 to 2015, NAC was administered to BR-CLM patients. Upfront surgery without NAC was performed to patients having clearly resectable CLM (less than 3 lesions, smaller than 5 cm, and no extrahepatic metastases: CR-US group). Survival outcomes of the two groups were assessed.ResultsThe BR-NAC group comprised 73 patients and the CR-US group 172. All patients in the BR-NAC group underwent subsequent resection, as none showed disease progression or chemotherapy-associated liver damage. The 3- and 5-year overall survival rates of the CR-US group were 83.0% and 74.0%, while patients in the BR-NAC group had comparable 3-year and 5-year overall survivals (80.5% and 66.6%, P = 0.397).ConclusionDefining BR-CLM based on tumor characteristics optimizes patient selection for NAC. Favorable overall survival can be achieved by upfront surgery in patients with clearly resectable CLM and by NAC in patients with BR-CLM.

Highlights

There are no optimal indication criteria for neoadjuvant chemotherapy (NAC) in patients with resectable colorectal liver metastases (CLM)
The theoretical benefits of controlling the disease prior to surgery are well accepted, optimizing patient selection for NAC is a critical issue because preoperative chemotherapy can deprive some patients with resectable tumors of access to surgery due to the development of chemotherapy-related liver damage or disease progression during NAC [6,7,8,9]
Among the clearly resectable CLM (CR-CLM) patients, four received NAC prior to surgery because they participated in other clinical trials; the remaining 172 patients comprised the CRUS group

Summary

Introduction

There are no optimal indication criteria for neoadjuvant chemotherapy (NAC) in patients with resectable colorectal liver metastases (CLM). The aim of this study was to prospectively assess the survival benefit of selective NAC administration in this patient population based on tumor characteristics. The prognoses of patients receiving palliative chemotherapy for unresectable CLM have improved, with the median survival time 30 months [1]. Effective chemotherapy in selected patients can produce resectable tumors from what were initially unresectable tumors [2, 3]. The clinical benefit of neoadjuvant chemotherapy (NAC) has yet to be established in patients with resectable CLM. No prospective studies have demonstrated improved overall survival (OS) in patients receiving NAC for resectable CLM. The theoretical benefits of controlling the disease prior to surgery are well accepted, optimizing patient selection for NAC is a critical issue because preoperative chemotherapy can deprive some patients with resectable tumors of access to surgery due to the development of chemotherapy-related liver damage or disease progression during NAC [6,7,8,9]

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