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01.11.2010 | Hepatobiliary Tumors | Ausgabe 11/2010

Annals of Surgical Oncology 11/2010

Extended Preoperative Chemotherapy Does Not Improve Pathologic Response and Increases Postoperative Liver Insufficiency After Hepatic Resection for Colorectal Liver Metastases

Zeitschrift:
Annals of Surgical Oncology > Ausgabe 11/2010
Autoren:
MD Yoji Kishi, MD Daria Zorzi, MD Carlo M. Contreras, MD Dipen M. Maru, MD Scott Kopetz, MD Dario Ribero, MD Manuela Motta, MD Nicoletta Ravarino, MD Mauro Risio, MD Steven A. Curley, MD Eddie K. Abdalla, MD Lorenzo Capussotti, MD Jean-Nicolas Vauthey
Wichtige Hinweise
Y. Kishi and D. Zorzi contributed equally to the manuscript.
Presented at GI ASCO, 2009 Gastrointestinal Cancer Symposium San Francisco, CA January 15–17, 2009 (Oral presentation Merit Award).

Abstract

Background

The optimal duration, safety, and benefit of preoperative chemotherapy in patients with colorectal liver metastases (CLM) are unclear. We evaluated the association between the duration of preoperative chemotherapy with 5-fluorouracil (5-FU), leucovorin, oxaliplatin (FOLFOX) ± bevacizumab, pathologic response, and hepatotoxicity after hepatic resection for CLM.

Methods

A total of 219 patients underwent hepatic resection following FOLFOX with or without bevacizumab and were divided into 2 groups according to the chemotherapy duration: 1–8 cycles (short duration [SD]; N = 157) and ≥9 cycles (long duration [LD]; N = 62). The frequency of complete or major pathologic response, sinusoidal injury, and major postoperative morbidity were compared.

Results

Treatment consisting of ≥9 cycles was not associated with an increase in complete or major pathologic response (SD vs. LD, 57% vs. 55%; P = .74). The incidence of sinusoidal injury was higher in the LD group (26% vs. 42%; P = .017). The incidence of liver insufficiency was higher in the LD group (4% vs. 11%; P = .035). Sinusoidal injury did not predict postoperative liver insufficiency; multivariate analysis revealed ≥9 cycles was the only independent predictor of postoperative liver insufficiency (P = .031; odds ratio = 3.90). Chemotherapy including bevacizumab was associated with a significantly higher frequency of complete or major response in both SD and LD groups.

Conclusions

Extended preoperative chemotherapy increases the risk of hepatotoxicity in CLM without improving the pathologic response. The type of chemotherapy (FOLFOX with bevacizumab) has more impact on pathologic response than the duration of chemotherapy.

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