Liver-only Colorectal Liver Metastases Research Articles

Perioperative Chemotherapy is Associated with Superior Overall Survival in Patients with Synchronous Colorectal Liver Metastases.

The sequence of localized and systemic treatment for colorectal liver metastases (CRLM) remains debated. Our objective is to analyze the effect of treatment sequence on overall survival (OS) in patients with CRLM using a large cancer database. The national cancer database (NCDB) was utilized to identify patients with stage IV colorectal cancer (CRC) diagnosed between 2004 and 2016. OS was analyzed using standard univariate and multivariate methods. We identified 72,376 patients with synchronous CRLM, of whom 43,039 had liver-only metastases. Patients with liver-only CRLM had a median OS of 18.9 months, versus those with CRLM plus extrahepatic sites (11.3 months). In patients with liver-only CRLM, resection of both the primary and metastatic site was associated with median OS 38.9 months versus 30.2 months after resection of the metastatic site alone, and resection of the primary tumor alone (22.3 months, all p < 0.001). Receipt of perioperative chemotherapy correlated with a median OS of 44.7 months versus preoperative chemotherapy only (38.4 months) or postoperative chemotherapy only (27.9 months, all p < 0.001). Patients who received chemotherapy alone had a median OS of 16.4 months versus those who underwent resection without chemotherapy (9.5 months, p < 0.001). This study reveals a correlation between perioperative chemotherapy and superior OS in patients with liver-only CRLM, and shows that resection of the metastatic site was linked to better OS. Despite obvious cohort heterogeneity, the data can support a resection approach with additional, preferably peri- or preoperative systemic therapy for patients with CRLM.

The toronto management of initially unresectable liver metastases from colorectal cancer in a living donor liver transplant program

Background: Living donor liver transplantation (LDLT) is an attractive option for patients with unresectable, bilobar, liver-only colorectal liver metastases (CRLM). However, it is not available in most centres beyond study protocols. This study describes the interim experience with LDLT for CRLM at a large transplant and hepatobiliary centre in North America.

Treatment intensification with hepatic arterial infusion chemotherapy in patients with liver-only colorectal metastases still unresectable after systemic induction chemotherapy \u2013 a randomized phase II study -- SULTAN UCGI 30/PRODIGE 53 (NCT03164655)- study protocol

BackgroundApproximately 40% of colorectal cancer patients will develop colorectal liver metastases (CRLM). The most effective approach to increase long-term survival is CRLM complete resection. Unfortunately, only 10–15% of CRLM are initially considered resectable. The objective response rates (ORR) after current first-line systemic chemotherapy (sys-CT) regimens range from 40 to 80% and complete resection rates (CRR) range from 25 to 50% in patients with initially unresectable CRLM. When CRLM patients are not amenable to complete resection after induction of sys-CT, ORRs obtained with second-line sys-CT are much lower (between 10 and 30%) and consequently CRRs are also low (< 10%). Hepatic arterial infusion (HAI) oxaliplatin may represent a salvage therapy in patients with CRLM unresectable after one or more sys-CT regimens with ORRs and CRRs up to 60 and 30%, respectively. This study is designed to evaluate the efficacy of an intensification strategy based on HAI oxaliplatin combined with sys-CT as a salvage treatment in patients with CRLM unresectable after at least 2 months of first-line induction sys-CT.Objectives and endpoints of the phase II studyOur main objective is to investigate the efficacy, in term of CRR (R0-R1), of treatment intensification in patients with liver-only CRLM not amenable to curative-intent resection (and/or ablation) after at least 2 months of induction sys-CT. Patients will receive either HAI oxaliplatin plus systemic FOLFIRI plus targeted therapy (i.e. anti-EGFR antibody or bevacizumab) or conventional sys-CT plus targeted therapy (i.e. anti-EGFR or antiangiogenic antibody). Secondary objectives are to compare: progression-free survival, overall survival, objective response rate, depth of response, feasibility of delivering HAI oxaliplatin including HAI catheter-related complications, and toxicity (NCI-CTCAE v4.0).MethodsThis study is a multicenter, randomized, comparative phase II trial (power, 80%; two-sided alpha-risk, 5%). Patients will be randomly assigned in a 1:1 ratio to receive HAI oxaliplatin combined with systemic FOLFIRI plus targeted therapy (experimental arm) or the best sys-CT plus targeted therapy on the basis of their first-line prior sys-CT history and current guidelines (control arm). One hundred forty patients are required to account for non-evaluable patients.Trial registrationClinicalTrials.gov, (NCT03164655). Trial registration date: 11th May 2017.

Treatment With Hepatic Arterial Infusion of Oxaliplatin in Combination With Systemic FOLFIRI Chemotherapy and Bevacuzimab in Patients With Liver-only Colorectal Liver Metastases (CRLM): Conversion to Complete Resection in Patients With Initially Inoperable Liver-only CRLM.

Treatment With Hepatic Arterial Infusion of Oxaliplatin in Combination With Systemic FOLFIRI Chemotherapy and Bevacuzimab in Patients With Liver-only Colorectal Liver Metastases (CRLM): Conversion to Complete Resection in Patients With Initially Inoperable Liver-only CRLM. - Full Text View.

Colorectal liver metastases and concomitant extrahepatic disease: is resection justified? Single center survival analysis on 84 patients

Background: Limited extrahepatic disease (EHD) in patients with colorectal liver metastases (CRLM) is no longer considered an absolute contraindication to resection. However the impact of the different sites of EHD on survival remains to be defined. Methods: Between 2000 and 2015, 702 patients underwent liver resection for CRLM at our Unit. Of these, 84 patients (11.8%) underwent resection of concomitant EHD and they are the object of our study. Results: Site of EHD was: lung in 27 patients (32.1%), hepatic pedicle lymph nodes (LN) in 38 (44.1%), peritoneum in 18 (19.0%), distant LN (inguinal and aortocaval sites) in 4 (4.8%). Sixty patients (71.4%) underwent preoperative chemotherapy (CT): 5-year overall survival (OS) after resection of CRLM and concomitant EHD was significantly higher in patients with response to CT than that in patients resected with progression (32.4% vs. 14.6%, respectively, p=0.01). Five-year OS of patients resected for liver-only CRLM was not significantly different from that of patients resected for CRLM and concomitant lung metastases (55.3% vs. 39.5%, respectively, p=ns). Resection of concomitant hepatic pedicle LN metastases was associated with a significantly lower 5-year OS (15.0%, p<0.001). Conclusion: In selected patients resection of concomitant lung metastases can be associated with similar OS to that of patients resected for liver-only disease. Presence of hepatic pedicle LN metastases is a poor prognostic factor and resection should be considered in patients showing response to CT.

Colorectal liver metastases and concomitant extrahepatic disease: is resection justified? Single center survival analysis on 84 patients

Background: Limited extrahepatic disease (EHD) in patients with colorectal liver metastases (CRLM) is no longer considered an absolute contraindication to resection. However the impact of the different sites of EHD on survival remains to be defined. Methods: Between 2000 and 2015, 702 patients underwent liver resection for CRLM at our Unit. Of these, 84 patients (11.8%) underwent resection of concomitant EHD and they are the object of our study. Results: Site of EHD was: lung in 27 patients (32.1%), hepatic pedicle lymph nodes (LN) in 38 (44.1%), peritoneum in 18 (19.0%), distant LN (inguinal and aortocaval sites) in 4 (4.8%). Sixty patients (71.4%) underwent preoperative chemotherapy (CT): 5-year overall survival (OS) after resection of CRLM and concomitant EHD was significantly higher in patients with response to CT than that in patients resected with progression (32.4% vs. 14.6%, respectively, p=0.01). Five-year OS of patients resected for liver-only CRLM was not significantly different from that of patients resected for CRLM and concomitant lung metastases (55.3% vs. 39.5%, respectively, p=ns). Resection of concomitant hepatic pedicle LN metastases was associated with a significantly lower 5-year OS (15.0%, p<0.001). Conclusion: In selected patients resection of concomitant lung metastases can be associated with similar OS to that of patients resected for liver-only disease. Presence of hepatic pedicle LN metastases is a poor prognostic factor and resection should be considered in patients showing response to CT.

First-line treatment with hepatic arterial infusion plus capecitabine vs capecitabine alone for elderly patients with unresectable colorectal liver metastases

ABSTRACTThis study aimed to compare the efficacy and safety of HAI fluoropyrimidine (FUDR)/capecitabine or single capecitabine as first-line treatment for elderly patients with unresectable colorectal liver metastases (CLMs). Fifty-one elderly patients with liver-only CLMs were eligible for enrollment. Patients were divided into HAI FUDR /capecitabine group and single capecitabine group randomly. The primary endpoint was median survival time (MST), defined as the time from the date of catheter implantation to the date of death or the date of the last follow-up. The secondary endpoint was objective antitumor response and adverse events. The HAI pump was implanted before chemotherapy. All patients received a 3-week cycle of oral capecitabin. In Group A, the RR and DCR were both 95.8%. In Group B, the RR and DCR were 48.1% and 81.5%, respectively. There was significant difference between the RRs of the 2 groups (P < 0.001). But there was no significant difference between the DCRs of the 2 groups (P = 0.053). There was a statistical difference between the MSTs of the 2 groups (18.5 vs.13 months, P = 0.0312). HAI FUDR combined with oral capecitabine as the first-line treatment for elderly patients with CLMs has promising efficacy and safety.

Chance of Cure Following Liver Resection for Initially Unresectable Colorectal Metastases: Analysis of Actual 5-Year Survival

BackgroundSurvival with long-term follow-up following liver resection for unresectable colorectal liver metastases (CRLM) downsized by chemotherapy has rarely been reported. The aim of this study was to determine the chance of cure following liver resection for initially unresectable CRLM. MethodsBetween January 2000 and December 2009, 61 patients underwent hepatectomy for unresectable liver-only CRLM downsized after chemotherapy. Cure was defined as a recurrence-free interval of at least 5 years after primary hepatectomy. ResultsResectability of CRLM was achieved after a mean number of 11 courses, and 42.6 % of patients underwent liver resection after ≥10 courses. Postoperative mortality was nil, and morbidity rate was 19.7 %. The 5- and 10-year actuarial overall survival rates were 42.6 and 16.0 %. Of 30 patients with a follow-up ≥5 years, 11 were alive, yielding a 5-year actual overall survival rate of 36.7 %, and 7 (23.3 %) were considered cured because they are alive without recurrence. On multivariate analysis, response to chemotherapy was the only independent predictor of both overall and disease-free survival. ConclusionsCure can be achieved in about 23 % of patients resected for initially unresectable CRLM downsized by chemotherapy. Liver resection can be safely performed in selected patients even after multiple courses of chemotherapy.