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Neoadjuvant chemotherapy for resectable colorectal cancer liver metastases: Impact on magnitude of liver resection and survival.

3598 Background: Curative liver resection remains the best treatment option for colorectal liver metastases (CRCLM). Overall survival is still limited due to high recurrence rates. Adjuvant chemotherapy was ineffective in reducing recurrence, therefore neoadjuvant treatment was explored.


METHODS
During the last two years 50 patients were treated with 6 cycles of neoadjuvant chemotherapy prior to liver resection for CRCLM. Chemotherapy consisted of Oxaliplatin/5-FU/LV according to FOLFOX4 regimen or Oxaliplatin (130mg/m2 d1) and Xeloda (2000mg/m2 d1-7) q14 over a 3 month period. Primary endpoint of these early results were side effects, radiologic and tumor marker response (CEA, CA 19-9), extend of liver resection and perioperative morbidity/mortality.


RESULTS
Grad III and IV side effects were seldom recorded in this 3 months regime and consisted of PNP III in 16%, diarrhea III and IV in 12%, nausea III in 8%; hematologic side effects grade III and IV were neutropenia in 2%, thrombocytopenia in in 6% and anemia in 2%. The achieved response rates were 2 complete responses, 33 partial responses, 11 stable diseases and 4 progressions; leading to an ORR of 70 % and a progression under treatment of 8 %. None of the progredient patients became inoperable after CTX. Tumor marker response correlated with radiologic response, 15% of the responding patients obtained a normalization of their tumor marker. The extent of the liver resection could be substantially reduced in responding patients. The perioperative mortality was 0% and the morbidity was 4% (1 bile leak, 1 biloma). At the time of this analysis 48% of the patients are alive without recurrence, 34% have recurrence and 18% died after tumor recurrence.


CONCLUSIONS
Oxaliplatin based chemotherapy demonstrates a high response rate given preoperatively without increasing the perioperative morbidity. No patient demonstrated with nonresectable disease after CTX. The extend of the intended liver resection was considerably reduced in responders. Survival outcome measurements appear promising and further exploration of preoperative CTX is highly recommended. No significant financial relationships to disclose.