Preoperative Chemotherapy in Patients with Colorectal Liver Metastasis: Experience of Group of Gastrointestinal Tumours of Rimini

Abstract

Introduction:In the recent years approach to colorectal cancer liver metastasis showed that neoadjuvant chemotherapy to patients with initially unresectable colorectal liver metastases can increase the number of patients who can undergo potentially curative liver resection. Also the approach to patients with initially resectable liver metastasis has changed from surgery to perioperative chemotherapy. Methods: We analyzed prospectively data collected from 44 patients with colorectal stage IV disease with liver metastasis only (resectable or non resectable) from January 2012 to January 2014, treated with first line chemotherapy. We evaluated RR, PFS and DFS at 1year and 2 years. Every 3 months patients where evaluated for surgery. After 3 months of chemotherapy patients with resectable liver metastasis underwent surgery. Results: 44 patients were included into the analysis. Patients' characteristics are described in table 1. 3CR (7%), 23 PR (59%), 6 SD (16%) and 7 PD (18%) were observed. 23 patients (58%) underwent liver surgery: 13 of these patients were initially resectable and 20 had R0 surgery. PFS at 1 year and 2 years is 60% and 40% respectively. DFS is 52% and 35% respectively at 1 and 2 years. In the subgroup treated with first line polychemotherapy plus biologic (25 patients) PFS at 1 year and 2 years is 75% and 55% respectively. In the subgroup of patients who underwent resection PFS and DFS at 1 and 2 years is 72%, 58%, 66% and 58% respectively. Conclusion: Systematic treatment in colorectal neoplasm increases the rate of patients with resectable colorectal liver metastasis. This analysis is focused on selected patients with exclusively liver disease and poor prognosis (82% synchronous disease, 71% unresectable disease, 41% of patients undertreated). Despite this, our data seem to highlight that patients positively selected from chemotherapy to surgery, have comparable outcome to reported literature data. Aggressive approach in this subgroup of patients is justified from the greater benefit in terms of oncologic outcome.