The Role of Neoadjuvant Chemotherapy in Repeat Local Treatment of Recurrent Colorectal Liver Metastases: A Systematic Review and Meta-Analysis

Petrousjka Van Den Tol,Madelon Dijkstra,Sanne Nieuwenhuizen,Robbert S Puijk,Bart Geboers,Florentine E.F Timmer,Evelien A.C Schouten,Hester J Scheffer,Jan J.J De Vries,Johannes C.F Ket,Kathelijn S Versteeg,Martijn R Meijerink

doi:10.1016/j.ejso.2021.12.198

Abstract

Background: Up to 85% of patients with colorectal liver metastases develop distant intrahepatic recurrence after curative intent local treatment. (Inter)national guidelines and scientific societies consider repeat local treatment, comprising repeat thermal ablation and/or repeat resection, the standard of care to treat recurrent new colorectal liver metastases. This systematic review and meta-analysis assessed the potential additive value of neoadjuvant chemotherapy before repeat local treatment.

Highlights

Colorectal cancer (CRC) is the second most common cancer type in women and the third most common in men; it represents about 10% of the annual global cancer incidence [1]
PubMed, Embase.com, and Clarivate Analytics/Web of Science Core Collection were systematically searched from inception up to 29 October 2020 for publications reporting on the outcomes of neoadjuvant chemotherapy (NAC) before local treatment of recurrent colorectal liver metastases (CRLM)
The following PICO question was used for the search strategy and inclusion criteria: p: patients with recurrent CRLM; (I) intervention: neoadjuvant chemotherapy (NAC) before repeat local treatment; (C) comparison: repeat local treatment alone; (O) outcome: the critical endpoint was overall survival (OS), important endpoints were disease-free survival (DFS), complications, quality of life (QoL), and cost-effectiveness

Summary

Introduction

Colorectal cancer (CRC) is the second most common cancer type in women and the third most common in men; it represents about 10% of the annual global cancer incidence [1]. The prognosis of CRC patients largely depends on the presence of distant metastasis, the liver being the most frequently involved organ. Up to 50% of patients develop colorectal liver metastases (CRLM) during the course of disease [2,3,4,5,6,7]. One-fifth of patients who develop CRLM are eligible for curative intent local treatment options, such as partial hepatectomy or thermal ablation (radiofrequency ablation, RFA; microwave ablation; MWA) [3,11,12,13,14,15,16,17]. The five-year OS for upfront resectable and/or ablatable disease nowadays reaches 44–58% [18,19,20,21,22,23,24,25,26,27,28] and even up to 33% for an increasing number of patients with initially unresectable and unablatable disease who are successfully downstaged after induction chemotherapy [12]

Methods

Results

Discussion

Conclusion