[Adjuvant chemotherapy following liver metastasis resection in neoplasms of the colorectum].
BACKGROUND
Adjuvant chemotherapy after hepatic resection of colorectal metastases has been advocated because of the significant risk of tumor recurrence. Data presented in literature show unequivocally that the probability of recurrence and tumor-related death exceeds survival. Although the initial site of disease recurrence varies, both intrahepatic and extrahepatic organs are at risk for tumor progression.


METHODS
To reduce the risk of tumor progression after hepatic resection of colorectal metastases, multiple chemotherapy approaches have been designed. Treatment approaches have varied by chemotherapeutic agents, route and schedule of administration, and duration.


RESULTS
A significant difference in survival between patients treated by resection alone and resection with adjuvant chemotherapy is not evident from these data.


CONCLUSIONS
Metastatic inefficiency is a major driving force in the development of metastatic patterns. Then, the probability of synchronous seeding (from primary colorectal carcinomas) of hematogenous metastases in the liver, lungs, and other organs is less than metachronous seeding, in which only liver metastases are predominantly seeded from the hepatic metastases, and arterial metastases are predominantly seeded from the pulmonary lesions. This sequential development of metastatic patterns creates windows of potential therapeutic opportunity during which metastatic disease is confined to the liver alone.


CONCLUSIONS
The risk of recurrence after hepatic resection of colorectal metastases clearly warrants further prospective study of adjuvant therapy to improve survival. Future trials of adjuvant therapy after hepatic resection of colorectal metastases must address the patterns of tumor recurrence and account for adjuvant chemotherapy given previously, after resection on the primary colorectal carcinoma.
Bajetta
E
E
Divisione Oncologica Medica B, Istituto Nazionale per lo Studio e la Cura dei Tumori di Milano.
Del Vecchio
M
M
Buzzoni
R
R
D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology*; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary* / Q000601:surgery; D011184:Postoperative Period