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Title

Neoadjuvant chemotherapy in patients with stage IV colorectal cancer: a comparison of histological response in liver metastases, primary tumors, and regional lymph nodes

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Published in Annals of Surgical Oncology. 2010, vol. 17, no. 10, p. 2714-2719
Abstract BACKGROUND: We report the histopathological results of a novel "inversed" strategy designed to manage patients with colorectal cancer (CRC) who have synchronous liver metastases by using chemotherapy first, liver surgery second, and resection of the primary tumor as a final step. This study was designed to compare the response to chemotherapy in liver metastases, primary tumors, and locoregional lymph nodes. METHODS: Twenty-nine patients with stage IV CRC received a combination of oxaliplatin, irinotecan, 5-fluorouracil, and leucovorin (OCFL) for 3-4 months. Histological response to chemotherapy was assessed by using a tumor regression grading (TRG) score based on presence of residual tumor cells and extent of fibrosis. RESULTS: Median age of patients was 56 (range, 37-69) years. Primary tumor location was right colon (n = 5), left colon (n = 7), and rectum (n = 17 patients). TRG scores correlated across disease sites (Spearman correlation coefficients for TRG in the primary tumor and lymph nodes was 0.59 [P = 0.005]; for the primary tumor and metastases 0.44 [P = 0.021]; and for lymph nodes and metastases 0.58 [P = 0.006]). Complete absence or poor tumor response (TRG4/5) was significantly more frequent in primary tumors (35.7%) and locoregional lymph nodes (38%) than in liver metastases (6.9%; McNemar test, P = 0.02). Two patients had a complete pathologic response (pT0N0M0). CONCLUSIONS: In patients with stage IV colorectal cancer, liver metastases exhibit a better histological response than primary tumors to OCFL neoadjuvant chemotherapy.
Keywords Adenocarcinoma/*drug therapy/secondaryAdultAgedAntineoplastic Combined Chemotherapy Protocols/*therapeutic useCamptothecin/administration & dosage/analogs & derivativesColorectal Neoplasms/*drug therapy/pathologyFemaleFluorouracil/administration & dosageHumansLeucovorin/administration & dosageLiver Neoplasms/*drug therapy/secondaryLymph Nodes/*drug effects/pathologyLymphatic MetastasisMaleMiddle Aged*Neoadjuvant TherapyNeoplasm StagingOrganoplatinum Compounds/administration & dosageProspective StudiesSurvival RateTreatment Outcome
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PMID: 20405223
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Other version: http://www.springerlink.com/content/112644/
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Research groups Chirurgie viscérale (104)
Groupe Roth Arnaud (oncologie) (285)
Hépatologie chirurgicale (327)
Métastases du foie (657)
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GERVAZ, Pascal et al. Neoadjuvant chemotherapy in patients with stage IV colorectal cancer: a comparison of histological response in liver metastases, primary tumors, and regional lymph nodes. In: Annals of Surgical Oncology, 2010, vol. 17, n° 10, p. 2714-2719. https://archive-ouverte.unige.ch/unige:20685

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Deposited on : 2012-05-23

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