Abstract
Objective: To analyze the volumetric modifications of the non tumourous part of the liver when liver metastases (LM) decrease under chemotherapy. Methods: Patients were highly selected based on the following criteria: multiple bilateral large colorectal LM, response of LM attaining at least 85% under chemotherapy. The volumes and ratios of the whole liver, of the LM, and mainly of the non tumourous (normal) part of the liver, were measured on CT scan before and after chemotherapy. Results: Only ten (5%) among 198 treated patients were eligible. Nine of them had received intra-arterial chemotherapy. Metastatic involvement was initially 34% before chemotherapy (range: 13% - 75%), and was 5% (range: 1% - 25%) after chemotherapy. The whole liver volume decreased by 41% (range: 23% - 68%) after chemotherapy. The non metastatic liver (volume and ratio) decreased after chemotherapy in 6 patients and increased in 4 patients. The volume and ratio increased in the 4 patients whose disease initially exhibited the highest metastatic involvement (p = 0.01). Conclusion: The volume of the non metastatic part of the liver varied slightly under standard chemotherapy. Intra-arterial chemotherapy induces dramatic responses, but also liver injury which impairs liver regeneration. However increasing volumes were observed when initial tumour involvement was major.
Highlights
The resectability of liver metastases (LM) has increased with progress in surgical techniques [1,2] and in chemotherapy for malignancies such as colorectal cancer [3]
The decrease in the volume of LM under chemotherapy ranged from 85% to 97%
Our aim at the beginning of this study was to determine whether the normal liver parenchyma was invaded or compressed by LM, and whether normal liver was able to grow again and to replace the tumour after response to chemotherapy
Summary
The resectability of liver metastases (LM) has increased with progress in surgical techniques [1,2] and in chemotherapy for malignancies such as colorectal cancer [3]. More and more dramatic responses and sometimes complete responses of LM are observed after chemotherapy [4,5,6]. These responses can render, otherwise initially unresectable LM, amenable to surgery. If this hypothesis is true, the volume and ratio of the non-tumourous, normal parenchyma should progressively increase, and this may have a potential impact on the subsequent treatment strategy. No study has focused on variations in the ratio of tumourous/normal liver volumes during chemotherapy
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