P-0261 - Adjuvant Chemotherapy in Combined Treatment of the Colorectal Liver Metastases

Abstract

Background: In half of the patients with recurrences after hepatectomy for liver metastasis, the first site of recurrence is the remnant liver. To improve the survival for colorectal liver metastasis, surgery may be combined with adjuvant chemotherapy. The schedule and combination of oxaliplatin, irinotecan, and fluorouracil plus leucovorin, in adjuvant treatment must be assessed. The purpose of the study was individualized adjuvant chemotherapy. We compared clinical outcomes in patients after resection of liver metastases from CRC who treated with different chemotherapeutic regimens according to molecular tests and expression of apoptosis-related markers. Methods: The data of the experience of combined treatment of 81 CRC patients with synchronous liver metastases is presented. According to expression of intratumoral thymidylate synthase (TS), excision cross-complementing gene (ERCC1), polymorphism of uridin-diphosphat-glucuronozil-transferase (UGT1A1) and proliferate tumor status, adjuvant chemotherapy were used: group 1A - FOLFIRI/FOLFOX (20), group 2А 5-FU/LV (17). Control (standard) group: 1 - FOLFIRI/FOLFOX (17), group 2 - 5-FU/LV (27). All patients received 8 courses adjuvant chemotherapy. cDNAwas derived from paraffin-embedded tumor specimens to determine TS and ERCC1 mRNA expression relative to the internal reference gene beta-actin using fluorescence-based, real-time reverse transcriptase polymerase chain reaction. Results: Eighty-one resections for CRC with liver metastases performed from 2005 to 2008 (91% > or =2 segments) were reviewed. In all cases R0 resection of the colon cancer and liver metastases were made. Postoperative complication rate was 14%. Median survival rate not found in 1A study group; group 1 - 36 month, group 2A – 28 month, group 2 – 15 month. Four-year survival rate were 77,9±8,0%; 46,3±8,1%; 41,9 ±8,4%; 10,3±7,9% respectively in group 1A, 1, 2A, and 2. Conclusion: It is possible to personalize the adjuvant treatment and improve survival rate of the CRC patients with liver metastases. FOLFIRI/FOLFOX regimens is effective as adjuvant treatment.