Resection after chemotherapy (CT) with irinotecan (CPT) for initially unresectable liver metastasis (LM) from colorectal cancer (CRC)

Abstract

3692 Background: Surgical resection of LM is the only treatment able to offer long term survival (30–35% at 5 years); however most LM are initially unresectable. Methods: The aim of this retrospective study was to evaluate the outcome of patients (pts) from 14 centers, with LM initially considered unresectable by each investigator and subsequently submitted to liver resection after treatment with CPT. Results: Data were available for 56 pts resected between July 1996 and May 2002. Pts characteristics: male/female: 29/27; median age: 56[34–76]; primary tumor: colon/junction/rectum: 32/17/7; median diameter of LM (mm): 44[21–188]; diameter of the largest LM>3 cm: 76%; median number (nb) of LM: 5[1–10]; nb of pts with>3LM: 66%; extrahepatic sites: 16%; prior CT for metastatic setting: 21 pts (5 pts with 2 or 3 lines CT before CPT). CPT based regimens included: combination with 5FU/AF 42 pts, with oxaliplatin and 5FU/AF 7 pts, with other 2 pts, monotherapy 5 pts. The primary endpoint was the median overall survival (OS), the 1-year (1y) and 2-year (2y) survival rate (SR). Median nb of cycles before surgery: 8[1–43]. LM surgery type: one stage hepatectomy: 50 pts (44 pts with major resection), two stage hepatectomy: 6 pts (all with major resection). All pts were resected and 42 pts (75%) had R0 resection. After a median follow-up (FU) of 15 months, the median OS after surgery was of 34.2 months (38.7 for pts with R0 resection), the 1y SR was 83% and 2y SR of 60%. After a median FU of 23.1 months, the median OS after CT with CPT was 42.1 months (45.4 for pts with R0 resection), the 1y SR was 92% and 2y SR 69%. 41 pts (73%) relapsed and 14 pts underwent a surgical intervention for recurrence (hepatic or extrahepatic). Morbidity rate was 37% (local and general postsurgical complications). Postoperative mortality (≤ 2 months) was 3% and was not related to the treatment. Conclusions: CT with CPT allows some unresectable pts to be further resected of their LM. R0 resection could be achieved in 75% of pts.The survival of these pts compares similarly to that of primarily resected pts. These results must be confirmed by a prospective on-going study. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Laboratoires Aventis