201. Conversion chemotherapy followed by hepatic resection in colorectal cancer with initially unresectable liver-limited metastases
- Author
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Anna Zamboli, Andrea Mabilia, Paolo Castellano, Gennaro Galizia, Annamaria Auricchio, Ferdinando De Vita, Andrea Renda, Fortunato Ciardiello, Floriana Morgillo, Michele Orditura, Eva Lieto, Galizia, G., De Vita, F., Lieto, E., Zamboli, A., Morgillo, F., Renda, Andrea, Ciardiello, F., Orditura, M., Galizia, Gennaro, DE VITA, Ferdinando, Lieto, Eva, Zamboli, A, Morgillo, Floriana, Castellano, P, Mabilia, A, Aurichio, A, Renda, A, Ciardiello, Fortunato, and Orditura, Michele
- Subjects
Oncology ,Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,Antineoplastic Agents ,Gastroenterology ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Hepatectomy ,Humans ,Prospective Studies ,Prospective cohort study ,Survival rate ,Aged ,Neoplasm Staging ,Randomized Controlled Trials as Topic ,Aged, 80 and over ,Chemotherapy ,Cetuximab ,business.industry ,Liver Neoplasms ,Cancer ,General Medicine ,Middle Aged ,medicine.disease ,Combined Modality Therapy ,Survival Rate ,Female ,Liver cancer ,business ,Colorectal Neoplasms ,medicine.drug - Abstract
The best management choice in colorectal cancer patients with unresectable liver-only metastases should be represented by conversion chemotherapy aiming to reduce liver cancer deposits, thereby permitting curative surgery. Forty-eight consecutive stage IV colorectal cancer patients were treated with different chemotherapeutic regimens including biological drugs. Objective responses to chemotherapy were seen in 27 patients (56.2%; 95% CI 42.1-70.2%). Four patients (8.3%) showed complete response, 23 patients (47.9%) partial and 13 patients (27.1%) stable response. Eight patients (16.7%) progressed. The conversion rate was 35.4% (95% CI 21.8-48.9%) with 17 patients suitable for liver resection. Four complete responder patients refused surgery. The remaining 13 patients underwent curative hepatic resection (resection rate 27.1%; 95% CI 14.5-39.6%). The likelihood of a successful conversion chemotherapy appeared significantly related to the best response and to the K-Ras status. Wild-type K-Ras patients undergoing cetuximab therapy showed the best conversion rate. The four-year survival rate was significantly enhanced in converted compared to non-converted patients (57.1 and 0%, respectively), and in resected compared to non-resected patients (53.3 and 10.1%, respectively). Synchronous metastases and no conversion were shown to be the only covariates independently associated with a poorer long-term outcome. The possibility of curative liver surgery significantly prolongs outcome for colorectal cancer patients with unresectable liver-limited metastases. Prospective randomized trials are required to define the conversion rates with biological drugs.
- Published
- 2013