title: Combination of neoadjuvant chemotherapy with cryotherapy and surgical resection for the treatment of unresectable liver metastases from colorectal carcinoma.
abstract: BACKGROUND
  This retrospective study was conducted to assess the safety, efficacy, and long-term results of neoadjuvant chemotherapy and cryotherapy as additional means for eradicating liver metastases from colorectal carcinoma when curative treatment was not possible by resection alone.
  
  
  METHODS
  Between January 1996 and December 1997, 131 patients with unresectable liver metastases were referred to our department and received chemotherapy. After 3-6 months of chemotherapy, curative surgery of liver metastases was considered possible in 57 patients, either by resection alone in 33 patients (25%) or cryotherapy associated with resection in 24 patients (18%). Characteristics and survival of patients in the cryotherapy plus resection group were compared with those of the 33 patients in the resection group.
  
  
  RESULTS
  All patients in the resection group had partial response to neoadjuvant chemotherapy. In the cryotherapy plus resection group, neoadjuvant chemotherapy resulted in 13 partial responses, 9 stable diseases, and 2 disease progressions. The rate of postoperative complications in the entire series was 14%. No major difference was seen between the two groups. After a median follow-up of 48 months, the median survival time was 39 months. The survival rates at 1, 3, and 4 years were similar in both groups: 94, 58, and 37% in the resection group and 92, 50, and 36% in the cryotherapy plus resection group, respectively.
  
  
  CONCLUSIONS
  The combination of neoadjuvant chemotherapy, cryotherapy, and liver resection constitutes a promising treatment strategy for patients with extremely advanced metastatic liver involvement. Patients having more than four liver metastases from a colorectal carcinoma or patients with a poor liver reserve due to previous resection should be screened carefully to determine whether they could be candidates for this procedure.
authors.affiliation: Department of Surgery, Centre Léon Bérard, Lyon, France. rivoire@lyon.fnclcc.fr
authors.forename: Michel
authors.initials: M
authors.lastname: Rivoire
authors.forename: Franco
authors.initials: F
authors.lastname: De Cian
authors.forename: Pierre
authors.initials: P
authors.lastname: Meeus
authors.forename: Sylvie
authors.initials: S
authors.lastname: Négrier
authors.forename: Henri
authors.initials: H
authors.lastname: Sebban
authors.forename: Pierre
authors.initials: P
authors.lastname: Kaemmerlen
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000556:secondary* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D017679:Cryotherapy; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016896:Treatment Outcome