Hope for Colorectal Patients with Operable Liver Metastases

Posted on February 5th, 2009 by

Colorectal cancer is the second leading cause of cancer-related deaths in the United States. Stage IV, or metastatic, colorectal cancer refers to cancer that has spread from the colon or rectum to distant sites in the body. One common site to which colorectal cancer spreads is the liver, referred to as liver or hepatic metastasis.

There are several therapeutic options for the treatment of liver metastases. Researchers continue to evaluate and compare these methods with the goal of achieving optimal outcomes. Often the method of treatment is determined by the size of the cancer, the number of metastases, and the location of the cancers within the liver.

For patients with liver metastases that can be surgically removed, surgery offers a potentially curative treatment approach. Recent research has explored patient survival after surgery for liver metastases, and has also evaluated the effects of giving chemotherapy in addition to surgery.

To describe long-term survival after surgery for liver metastases, researchers in Canada evaluated the outcomes of 423 surgeries that were conducted between 1991 and 2002:1

  • Cancer-free survival at one, five, and 10 years was 64%, 27%, and 22%, respectively.
  • Overall survival at one, five, and 10 years was 93%, 47%, and 28%, respectively.
  • Factors contributing to a worse overall survival included the presence of cancer on the margins of tissue removed by surgery, large sites of cancer within the liver, several sites of cancer within the liver, and patient age of greater than 60 years.

The researchers concluded that long-term overall survival of nearly 50% at five years and nearly 30% at 10 years can safely be achieved with the use of surgery to remove liver metastases among patients with colorectal cancer.

To evaluate the addition of chemotherapy following surgery for liver metastases, researchers in France conducted a study among 173 colorectal cancer patients with liver metastases.2 Approximately half the patients were treated with liver surgery only and half were treated with liver surgery plus chemotherapy. The chemotherapy consisted of 5-fluorouracil plus folinic acid, which was the standard chemotherapy combination when the trial began. However, recent improvements have been made in chemotherapy for colorectal cancer.

  • Five-year cancer-free survival was 33.5% among patients treated with surgery and chemotherapy and 26.7% among patients treated with surgery alone.

The researchers concluded that the addition of systemic chemotherapy to surgery improves cancer-free survival among patients with colorectal cancer and liver metastases.

A third study evaluated outcomes among patients who received pre-surgery chemotherapy (neoadjuvant chemotherapy) for liver metastases that were initially inoperable.3 In some patients with inoperable liver metastases, an initial round of chemotherapy will shrink the liver metastases enough so that surgery becomes possible.

The study was conducted in Italy and involved 150 patients. One hundred and sixteen of the patients had surgery without the need for neoadjuvant chemotherapy, and 34 had initially inoperable liver metastases but became candidates for surgery after neoadjuvant chemotherapy.

  • Three-year overall survival was similar in the two groups.
  • Three-year survival without cancer recurrence was lower in patients with initially inoperable liver metastases. Twenty-one percent of these patients survived for three years without cancer recurrence, compared to fifty percent of the patients who were able to undergo surgery without neoadjuvant chemotherapy.

This study suggests that among patients with initially inoperable liver metastases, those who are able to undergo surgery after neoadjuvant chemotherapy have a high rate of cancer recurrence. Nevertheless, the researchers note that the combination of neoadjuvant chemotherapy and surgery appears to result in better survival than chemotherapy alone for these patients.

Taken together, these studies indicate that some colorectal cancer patients are able to achieve prolonged cancer-free survival after surgery for liver metastases. The combination of surgery and chemotherapy (for those patients who are candidates for both treatments) may result in better survival than either treatment alone.

References:


1 Wei A, Greig P, Grant D, et al. Survival After Hepatic Resection for Colorectal Metastases: A 10-Year Experience. Annals of Surgical Oncology. 2006; 13:668-676.

2 Portier G, Elias D, Bouche O, et al. Multicenter Randomized Trial of Adjuvant Fluorouracil and Folinic Acid Compared With Surgery Alone After Resection of Colorectal Liver Metastases: FFCD ACHBTH AURC 9002 Trial. Journal of Clinical Oncology. 2006; 24: 4976-4982.

3 Capussotti L, Muratore A, Mulas MM, Massucco P, Aglietta M. Neoadjuvant Chemotherapy and Resection for Initially Irresectable Colorectal Liver Metastases. British Journal of Surgery. 2006;93:1001-1006.

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Tags: Colon Cancer

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