Neoadjuvant Chemotherapy Before Liver Resection for Patients With Unresectable Liver Metastases From Colorectal Carcinoma

Abstract

Colorectal carcinoma is one of the most common cancers in the world, and more than 50% of these patients develop liver metastases. Despite recent advances, systemic chemotherapy for metastatic disease without the use of surgery is considered palliative, as there are rarely long-term survivors. However, patients who are candidates for surgical resection of their liver metastases can have a prolonged survival or possibly a cure. Consensus guidelines on criteria for resection and prognostic scores help facilitate patient selection, yet only 25% of patients with liver metastases are considered to have resectable metastases. Neoadjuvant chemotherapy has been explored in an attempt to render more patients candidates for resection. First reports using neoadjuvant systemic chemotherapy in patients with unresectable disease found that 13% to 16% of patients could be rendered resectable. Efforts to increase response rates using hepatic arterial infusion or biologic agents may increase resection rates. This review summarizes the current data on neoadjuvant chemotherapy, the rationale for this approach, potential complications, and future prospects.

Identification of microRNA-487b as a negative regulator of liver metastasis by regulation of KRAS in colorectal cancer

“…Transfected cells were seeded at a density of 2.5-3.0x10 4 per well in 24-well dishes. After cultured for 24, 48 and 72 h, cells were trypsinized and stained with trypan blue solution (Invitrogen).…”

“…Metastatic diseases occur in ~30-50% of CRC patients, either at the time of initial diagnosis or during follow-up (3,4). CRC metastasizes predominantly to the liver, and liver metastases account for at least two thirds of CRC deaths (3,5,6).…”

Rescue chemotherapy using multidrug chronomodulated hepatic arterial infusion for patients with heavily pretreated metastatic colorectal cancer

“…3 Hepatic resection is the only potentially curative therapeutic option for these patients. 4 Nearly all patients who have metastatic disease and do not undergo resection will die from their disease within 5 years. 4,5 Systemic chemotherapy is the standard of care for patients with unresectable metastatic disease.…”

“…4 Nearly all patients who have metastatic disease and do not undergo resection will die from their disease within 5 years. 4,5 Systemic chemotherapy is the standard of care for patients with unresectable metastatic disease. Intravenous (iv) 5-fluorouracil/leucovorin (5-FU/LV)-based dual regimens with either irinotecan or oxaliplatin have produced increased median overall survival over treatment with 5-FU/LV alone in patients with metastatic CRC.…”

Case report: High-volumetric atypical hemihepatectomy in patient with colorectal cancer with extensive metastatic disease

“…Typically metastases of colorectal cancer are primarily found in liver due to drainage through the portal system. Up to 25% of patients already have liver metastases at the moment of primary diagnosis and 50 to 70% eventually develop liver metastatic disease during the course of treatment [2,3].…”