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10.1245/ASO.2006.03.094
Annals of Surgical Oncology 13:58-65 (2006)
© 2006 Society of Surgical Oncology
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Original Article

Treatment with 5-Fluorouracil/Folinic Acid, Oxaliplatin, and Irinotecan Enables Surgical Resection of Metastases in Patients With Initially Unresectable Metastatic Colorectal Cancer

Gianluca Masi, MD1, Samanta Cupini, MD1, Lorenzo Marcucci, MD1, Elisa Cerri, MD1, Fotios Loupakis, MD1, Giacomo Allegrini, MD1, Isa Maura Brunetti, MD2, Elisabetta Pfanner, MD2, Maurizio Viti, MD3, Orlando Goletti, MD4, Franco Filipponi, MD5 and Alfredo Falcone, MD1,6

1 Department of Oncology, Division of Medical Oncology, Presidio Ospedaliero, Viale Alfieri 36, 57124 Livorno, Italy
2 Department of Oncology, Division of Medical Oncology, Ospedale Santa Chiara, Via Roma 67, 56126 Pisa, Italy
3 Department of Oncology, Division of Surgery, Presidio Ospedaliero, Viale Alfieri 36, 57124 Livorno, Italy
4 Department of Oncology, Division of Surgery, Ospedale Lotti, Via Roma 180, 56025 Pontedera, Italy
5 Division of Liver Transplantation, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
6 Cattedra di Oncologia Medica, University of Pisa, Via Roma 55, 56126 Pisa, Italy

Correspondence: Address correspondence and reprint requests to: Gianluca Masi, MD; E-mail: gl.masi{at}tin.it.

Background: The prognosis of unresectable metastatic colorectal cancer might be improved if a radical surgical resection of metastases could be performed after a response to chemotherapy.

Methods: We treated 74 patients with unresectable metastatic colorectal cancer (not selected for a neoadjuvant approach) with irinotecan, oxaliplatin, and 5-fluorouracil/leucovorin (FOLFOXIRI and simplified FOLFOXIRI). Because of the high activity of these regimens (response rate, 72%), a secondary curative operation could be performed in 19 patients (26%).

Results: Four patients underwent an extended hepatectomy, nine patients underwent a right hepatectomy, three patients underwent a left hepatectomy, and three patients had a segmental resection. In five patients, surgical removal of extrahepatic disease was also performed. In seven patients, surgical resection was combined with intraoperative radiofrequency ablation. The median overall survival of the 19 patients who underwent operation is 36.8 months, and the 4-year survival rate is 37%. The median overall survival of the 34 patients who were responsive to chemotherapy, but who did not undergo operation, is 22.2 months (P = .0114).

Conclusions: The FOLFOXIRI regimens we studied have significant antitumor activity and allow a radical surgical resection of metastases in patients with initially unresectable metastatic colorectal cancer not selected for a neoadjuvant approach and also those with extrahepatic disease. The median survival of patients with resected disease is promising.

Key Words: 5-Fluorouracil • Colorectal cancer • Irinotecan • Liver metastases • Oxaliplatin




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