CHEMOTHERAPY BOOSTS SURVIVAL BEFORE METASTATECTOMY FOR COLORECTAL CANCER

NEW YORK (Reuters Health) Nov 22 - Patients with metastatic colorectal cancer who receive chemotherapy after portal vein embolization (PVE) and before liver resection have significantly better survival than those treated with PVE and surgery alone, new findings show.

"This paper shows that the combination (of PVE and chemotherapy) may provide for a safe and potentially curative strategy for a once uniformly fatal disease," Dr. Yuman Fong of Memorial Sloan Kettering Cancer Center in New York City, one of the new study's authors, told Reuters Health.

PVE is now routinely used to increase residual liver mass before patients undergo major liver surgery, and studies have confirmed that the technique improves outcomes, Dr. Fong and his team explained in their report online October 30 in JAMA Surgery.

However, they add, concerns have been raised that PVE could promote the growth of tumors as well as fostering the expansion of healthy liver tissue.

Chemotherapy can reduce tumor bulk in patients with metastatic colorectal cancer, and Dr. Fong and his colleagues had previously shown that patients can safely undergo PVE while they are on neoadjuvant chemotherapy.

To investigate whether chemotherapy could also affect tumor growth after PVE, the investigators looked at records for 64 consecutive patients with metastatic colorectal cancer who were treated with PVE. All were expected to require resection of at least four liver segments.

The researchers measured 208 tumors before and one month after PVE, including 53 tumors in patients who underwent chemotherapy after PVE.

When patients did not receive chemotherapy, about one-third of tumors progressed. Among the patients who did receive chemotherapy, only 18.9% of the tumors progressed after PVE (p=0.03).

Median survival was 23.7 months for patients who did not receive chemotherapy, and 50.1 months for patients who did. Five-year survival was 24% without chemotherapy, and 49% with chemotherapy (p=0.006).

Based on the findings, Dr. Fong said, chemotherapy after PVE should become the standard of care for patients with metastatic colorectal cancer who require major liver resection.

"Underlying the concept of this paper is a concept that many doctors and the public don't understand: patients with metastatic colon cancer on both sides of the liver can be cured," he said.

SOURCE: http://bit.ly/1iBD6YZ

JAMA Surgery 2013.