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From the Centre Hépato-Biliaire (RA, EA, AA, DA, DC, FK, HB), and Centre de Chronothérapie (SG, FL), Service de Cancérologie Hopital Paul Brousse, Villejuif, France.
Correspondence: Address correspondence and reprint requests to: Pr. Rene Adam, Centre Hepato-Biliaire, Hopital Paul Brousse, 12, Av. Paul Vaillant Couturier, BP 200 - 94804 VILLEJUIF Cedex, France; Fax: 01-45-59-38-57; E-mail: rene.adam{at}pbr.ap-hop-paris.fr
Background: Surgical resection is the most effective treatment for colorectal liver metastases but only a minority of patients are candidates for a potentially curative resection. Our experience with neoadjuvant chemotherapy followed by resection and five years survival analysis of the patients treated is presented.
Methods: Between February of 1988 and September of 1996, 701 patients with unresectable colorectal liver metastases were treated with neoadjuvant chemotherapy. Four categories of nonresectable disease were defined: large size, ill location, multinodularity, and extrahepatic disease. Liver resection was performed in those patients whose disease became resectable. After resection, the patients were followed up every 3 months. A 5-year survival analysis by the different categories described was performed.
Results: Ninety-five patients (13.5%) were found to be resectable on reevaluation and underwent a potentially curative resection. There was no perioperative mortality, and the complication rate was 23%. As of December of 1999, 87 patients have completed 5 years of follow-up. The overall 5-year survival is 35% from the time of resection and 39% from the onset of chemotherapy. Respective 5-year survival rates are 60% for large tumors, 49% for ill-located lesions, 34% for multinodular disease, and 18% for liver metastases with extrahepatic disease. In this latter category, however, a 35% 5-year survival was found when all the patients with extrahepatic disease were analyzed rather than only those for whom extrahepatic disease was the main cause of nonresectability.
Conclusions: Neoadjuvant chemotherapy enables liver resection in some patients with initially unresectable colorectal metastases. Long-term survival is similar to that reported for a priori surgical candidates.
Key Words: Neoadjuvant therapy Chronotherapy Colorectal liver metastases Nonresectable hepatic metastases
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