For Liver Tumors Secondary to Colorectal Cancer, Chemo Plus Surgery Better Than Surgery Alone

Chemotherapy using the FOLFOX 4* regimen both before and after surgery to remove liver tumors secondary to colorectal cancer is more effective than surgery alone in giving patients progression-free survival (PFS). This is the conclusion of authors of an article in the March 22 edition of The Lancet.

Liver metastases (secondary cancer) are found in 40-50 percent of the nearly one million patients worldwide diagnosed with colorectal cancer each year. When surgical resection of these metastases is possible, five-year survival approaches 35 percent. However, relapse is common and occurs in 75 percent of patients. Chemotherapy and surgery can reduce the risk of relapse. Preoperative chemotherapy potentially allows surgery on tumors that have become smaller in response to this chemotherapy, and allows the responsiveness of these tumors to chemotherapy to be assessed to determine whether or not chemotherapy post-operation is also worthwhile.

Professor Bernard Nordlinger, Centre Hospitalier Universitaire Ambroise Paré, Boulogne-Billancourt, Assistance Publique Hopitaux de Paris, France, and colleagues did the EORTC Intergroup trial, which included 364 colorectal cancer patients, each with up to four liver metastases. The patients were randomly assigned to either surgery plus chemotherapy (six cycles before, six cycles after) (182 patients), or surgery alone (182 patients).

In the chemotherapy group, 83 percent of patients had surgery after a median of six chemotherapy cycles, and 63 percent also received a median of six cycles post-operation. For randomized patients, there was a trend of increased PFS at three years in the chemotherapy group with 35.4 percent of patients achieving this, compared with 28.1 percent in the surgery only group, a relative increase of 26 percent. When looking specifically at patients eligible for the study, 36.2 percent achieved PFS in the chemotherapy group compared with 28.1 percent in the surgery only group, a relative increase of 29 percent. And when looking specifically at patients who actually had surgery, 42.4 percent achieved PFS in the chemotherapy group compared with 33.2 percent in the surgery only group, a relative increase of 28 percent. Finally, the researchers found that reversible post-operative complications occurred more often after chemotherapy plus surgery (in 25 percent of patients) than after surgery alone (16 percent); but less than 1 percent of patients died after surgery.

The authors conclude: "In all randomized patients, the study showed a trend favoring administration of chemotherapy. In all eligible and all resected patients, the benefit of administering chemotherapy was significant."

In an accompanying comment, Jean-Nicolas Vauthey, MD, and Scott Kopetz, MD, University of Texas MD Anderson Cancer Center, Houston, say: "This study confirms the importance of multidisciplinary care and the improved outcomes that are available when we integrate the best of medical and surgical oncology."

Source: Lancet

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