Elsevier

Annals of Oncology

Volume 10, Issue 6, June 1999, Pages 663-669
Annals of Oncology

Original article
Long-term survival of patients with unresectable colorectal cancer liver metastases following infusional chemotherapy with 5-fluorouracil, leucovorin, oxaliplatin and surgery

https://doi.org/10.1023/A:1008347829017Get rights and content
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Summary

Context

Long-term survival of patients with metastatic colorectal cancer has been achieved only in patients who underwent complete resection of metastases. Such surgery could be performed in a greater proportion of patients if effective chemotherapy could downstage previously unresectable metastases. This approach has been limited by the low tumor response rate achieved with conventional chemotherapy.

Objective

We studied the outcome of patients with initially unresectable liver metastases from colorectal cancer treated with a three-drug chemotherapy regimen followed by liver metastases surgery whenever possible.

Patients and methods

From March 1988 to June 1994, 151 patients with colorectal liver metastases were considered initially unresectable because of large tumor size (>5 cm), multi-nodular (>4) or ill-located metastases. All patients received fully ambulatory chemotherapy with 5-fluorouracil, leucovorin and oxaliplatin (chronotherapy in 83% of them). They were periodically reassessed for surgery by a joint medico-surgical team.

Results

In 151 patients, the size of liver metastases decreased by > 50% in 89 patients (59%) and median overall survival was 24 months (95% confidence interval (95% CI): 19–28 months), with 28% surviving at five years (20%–35%). Surgery with curative intent was attempted in 77 patients (51%), complete resection of liver metastases was achieved in 58 patients (38%). The median survival of the 77 operated patients was 48 months (25–71), with a five-year survival rate of 50% (38–61).

Conclusion

This new strategy of combining effective chemotherapy with surgery apparently altered the natural history of unresectable colorectal cancer metastases.

Key words

chronotherapy
colorectal cancer
liver metastases
oxaliplatin
surgery
survival

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