Bowel tumor resection before chemotherapy leads to better survival than first-line chemotherapy in patients with unresectable colorectal hepatic metastases, according to a report in the April issue of the Archives of Surgery.
Both approaches have been recommended for asymptomatic colorectal cancer patients with unresectable liver-only metastases, the authors explain, but the best treatment strategy remains unclear.
Dr. Gennaro Galizia and colleagues from the Second University of Naples School of Medicine, Italy retrospectively compared clinical outcome in patients undergoing bowel tumor resection plus chemotherapy with that in patients treated with chemotherapy first, in an effort to identify selection criteria for the most beneficial treatment of these patients.
Among the 42 patients in the resection group, the authors report, two-thirds died of disease within 5 to 47 months after surgery, whereas 14 patients (the remaining third) were still alive, including five patients who underwent curative hepatic resection after metastasis downstaging by means of chemotherapy.
Seven of the 23 patients (30%) in the chemotherapy group had severe complications related to unresected bowel tumor, the researchers note. Twenty-one (91%) of the patients in this group died of disease, leaving two patients (9%) alive 37 and 43 months after the start of chemotherapy.
The median overall survival in the resection group was 15 months, compared with 12 months in the chemotherapy group. Four-year actuarial survival was 15% in the resection group and 0% in the chemotherapy group.
Patients in the chemotherapy group had a 2-fold increased risk of cancer-related death compared with patients undergoing resection of bowel tumor. Metastatic seeding involving more than 50% of the whole liver was associated with a 5-fold increased risk of cancer death, compared with more limited hepatic spread.
Bowel tumor resection, the investigators conclude, “is feasible for patients showing good performance status, metastatic liver involvement of less than 50% of the whole hepatic volume, and conditions for potentially curative resection of bowel tumor. In the remaining patients, chemotherapy first is preferable as palliative treatment while waiting to switch to curative surgery of distant metastases.”
Arch Surg 2008;143:352-358.
Reviewed by Dr. Ramaz Mitaishvili
