title: Treatment with 5-fluorouracil/folinic acid, oxaliplatin, and irinotecan enables surgical resection of metastases in patients with initially unresectable metastatic colorectal cancer.
abstract: BACKGROUND
  The prognosis of unresectable metastatic colorectal cancer might be improved if a radical surgical resection of metastases could be performed after a response to chemotherapy.
  
  
  METHODS
  We treated 74 patients with unresectable metastatic colorectal cancer (not selected for a neoadjuvant approach) with irinotecan, oxaliplatin, and 5-fluorouracil/leucovorin (FOLFOXIRI and simplified FOLFOXIRI). Because of the high activity of these regimens (response rate, 72%), a secondary curative operation could be performed in 19 patients (26%).
  
  
  RESULTS
  Four patients underwent an extended hepatectomy, nine patients underwent a right hepatectomy, three patients underwent a left hepatectomy, and three patients had a segmental resection. In five patients, surgical removal of extrahepatic disease was also performed. In seven patients, surgical resection was combined with intraoperative radiofrequency ablation. The median overall survival of the 19 patients who underwent operation is 36.8 months, and the 4-year survival rate is 37%. The median overall survival of the 34 patients who were responsive to chemotherapy, but who did not undergo operation, is 22.2 months (P = .0114).
  
  
  CONCLUSIONS
  The FOLFOXIRI regimens we studied have significant antitumor activity and allow a radical surgical resection of metastases in patients with initially unresectable metastatic colorectal cancer not selected for a neoadjuvant approach and also those with extrahepatic disease. The median survival of patients with resected disease is promising.
authors.affiliation: Department of Oncology, Division of Medical Oncology, Presidio Ospedaliero, Viale Alfieri 36, Livorno, 57124, Italy. gl.masi@tin.it
authors.forename: Gianluca
authors.initials: G
authors.lastname: Masi
authors.forename: Samanta
authors.initials: S
authors.lastname: Cupini
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Marcucci
authors.forename: Elisa
authors.initials: E
authors.lastname: Cerri
authors.forename: Fotios
authors.initials: F
authors.lastname: Loupakis
authors.forename: Giacomo
authors.initials: G
authors.lastname: Allegrini
authors.forename: Isa Maura
authors.initials: IM
authors.lastname: Brunetti
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Pfanner
authors.forename: Maurizio
authors.initials: M
authors.lastname: Viti
authors.forename: Orlando
authors.initials: O
authors.lastname: Goletti
authors.forename: Franco
authors.initials: F
authors.lastname: Filipponi
authors.forename: Alfredo
authors.initials: A
authors.lastname: Falcone
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D015179:Colorectal Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D000077146:Irinotecan; D002955:Leucovorin / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000077146:Irinotecan; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin