Role of systemic chemotherapy in the management of resected or resectable colorectal liver metastases: a systematic review and meta-analysis of randomized controlled trials

Abstract

Abstract. Liver metastases are a common event in patients with colorectal cancer. Surgical resection, if feasible, produces a survival benefit. We performed a systematic review of randomized clinical trials (RCT) and meta-analysis to address the question if current available studies support the use of systemic chemotherapy as an adjunct to surgery in resected/ resectable patients. The search was based on major databases (PubMed, CancerLit, Embase, Medscape and Cochrane) of published literature and selecting abstracts from major cancer meetings. We performed a literature for the January 1982-May 2010 time frame. The hazard ratios (HRs), with confidence intervals, as presented in retrieved studies, referred to the disease-and/or progression-free (DFS and/or PFS) and overall survival (OS) were extracted. The meta-analysis was carried out by the fixed-effect and the random-effects model. Three studies randomizing combined treatment vs. surgery alone for a total of 666 patients (642 evaluable for survival analysis) were selected and included in the final analysis. Evidence for chemotherapy-induced benefit in terms of both DFS (pooled HR, 0.71; CI, 0.582-0.878; P=0.001) and PFS (pooled HR, 0.75; CI, 0.620-0.910; P=0.003) was demonstrated. However, our meta-analysis failed to demonstrate a significant advantage of combined treatment in terms of OS (pooled HR, 0.743; CI, 0.527-1.045; P=0.088). Chemotherapy combined with surgical resection of colorectal liver metastases improves DFS and PFS whereas the benefit in OS is not demonstrated on the basis of the available results of RCTs. New prospective trials in the era of targeted therapy are eagerly awaited on this specific topic.

Synchronous hepatic metastasis and metachronous Krukenberg tumor from advanced colon cancer. A case report with an unexpected disease-free survival

“…The exact timing of chemotherapy treatment still remains uncertain today; recently 2 interesting meta-analyses of randomized clinical trials [10], [11] have been published in which patients with a colorectal tumor with synchronous resectable liver metastases were treated with perioperative chemotherapy (neoadjuvant and/or adjuvant) with an improvement statistically significant in terms of progression-free survival or disease-free survival. Unfortunately, both studies did not demonstrate an improvement in overall survival.…”

Systematic Review With Network Meta-Analysis

“…Our results showed that adjuvant SCT reduced both long- and short-term mortality after resection of resected HMCRC by approximately twice that suggested in the previous study. 33 A subsequent traditional meta-analysis in 2012 35 concluded that there was a trend advantage of SCT combined with surgical resection of colorectal liver metastases compared with surgery alone (pooled HR 0.743; CI 0.527–1.045; P = 0.088), but failed to reach statistical significance. The results of our meta-analysis are consistent with the results from this previous study.…”

Role of multi-modality therapy in peritoneal carcinomatosis and visceral metastasis: a case report and review of the literature

“…Appropriate timing of CRS and systemic therapy is also important for these patients. At this time, neoadjuvant chemotherapy for resectable HM [ 16 , 17 ] or PC [ 18 , 19 ] from CRC has demonstrated mixed results in the literature. Determination of optimal timing of treatment should be made based on a multidisciplinary approach, particularly in cases of resectable synchronous HM, PC, and pulmonary metastasis of CRC origin.…”