Abstract
The benefit of preoperative chemotherapy prior to pulmonary metastasectomy for patients with colorectal carcinoma (CRC) is unknown. Here, we identify outcomes of preoperative chemotherapy in patients with resected primary CRC who then underwent pulmonary metastasectomy. We queried a prospective database to identify treatment characteristics. Multivariate analyses identified predictors of overall survival (OS) and progression-free survival (PFS). 229 patients underwent lung metastasectomy, of whom 115 proceeded to surgery without chemotherapy while 114 received preoperative regimen based on oxaliplatin (32%), irinotecan (46%), capecitabine (16%), or other (6%). Median PFS in preoperative chemotherapy vs. surgery alone arms were comparable (p=0.004). Patients on oxaliplatin-based therapy had an improved OS vs. an irinotecan, capecitabine, or alternate regimen (p=.019). On multivariate analysis, the irinotecan subset had a worse OS (HR 1.846; 95% CI 1.070, 3.185) vs. surgery alone arm (p=0.028). The OS of an oxaliplatin-based regimen vs. no chemotherapy was inconclusive (HR 0.57; 95% CI 0.237 to 1.389, p=0.218). Multivariate analysis demonstrated a worse PFS and OS for the male gender and an incomplete resection (R2). Prospective trials on specific preoperative regimens and criteria for patient selection may identify a role for preoperative chemotherapy prior to a curative pulmonary metastasectomy.
Highlights
Pulmonary recurrence of colorectal cancer (CRC) following resection of the primary CRC lesion presents a significant clinical problem because the lung is a common site of extracolonic recurrence [1, 2]
The optimal sequence of management of pulmonary oligometastatic disease remains unclear, emerging data indicate a role for surgical resection in patients with metastases in the lung alone
We identified 8,712 patients with CRC who were evaluated at MD Anderson from January 1, 2000, to December 3, 2010; of these patients, 2,595 had metastases to the lung
Summary
Pulmonary recurrence of colorectal cancer (CRC) following resection of the primary CRC lesion presents a significant clinical problem because the lung is a common site of extracolonic recurrence [1, 2]. The optimal sequence of management of pulmonary oligometastatic disease remains unclear, emerging data indicate a role for surgical resection in patients with metastases in the lung alone. Surgical intervention for this subset of patients has been explored with reports of 11% to 41%. The significant improvement in survival after resection of pulmonary metastases in the absence of extrapulmonary disease lesions has led to the widespread clinical practice of surgical resection in these patient populations [1, 3, 5, 6]. We identify outcomes of preoperative chemotherapy in patients with resected primary CRC who underwent pulmonary metastasectomy
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