Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
3269599 | HPB | 2013 | 10 Pages |
Abstract
Systemic therapy for colorectal cancer liver metastases (CRLM) has undergone significant development in the past 15âyears. Therapy regimens consisting of combinations of cytotoxic chemotherapeutic agents have demonstrated greater efficacy and contributed to a significant survival improvement. As the majority of patients who undergo resection for liverâonly CRLM are at risk of disease recurrence and cancerârelated death, combining resection with systemic therapy appears sensible. However, trialâbased evidence is sparse to support this concept. Periâoperative FOLFOX has demonstrated a progressionâfree survival benefit in a single Phase III trial; the safety of chemotherapy and subsequent operations was acceptable and only a few patients showed initial progression. Chemotherapyâassociated liver injury (CALI), including sinusoidal obstruction syndrome and steatohepatitis, has been observed after cytotoxic therapy, and should have implications for chemotherapy plans prior to hepatectomy. In general, preâoperative chemotherapy should not extend beyond 3âmonths. For patients with unresectable liverâonly CRLM, a response to chemotherapy could establish resectability and should be considered an initial treatment goal. In patients with unresectable CRLM, oxaliplatinâ or irinotecanâcontaining combinations represent the standard options, although singleâagent choices may be appropriate for individual patients. The addition of bevacizumab carries the potential for a greater response and possibly for reduced CALI risks. In tumours without Kâras mutations, antiâepidermal growth factor receptor (EGFR) agents are also reasonable choices for a greater response and improved survival outcomes. It is crucial that all systemic CRLM treatment decisions include proper definitions of treatment goals and endpoints, and are derived based on appropriate multidisciplinary considerations for other potentially applicable local or regional modalities.
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Authors
Roderich E. Schwarz, Jordan D. Berlin, Heinz J. Lenz, Bernard Nordlinger, Laura RubbiaâBrandt, Michael A. Choti,