title: Neoadjuvant chemotherapy and resection of advanced synchronous liver metastases before treatment of the colorectal primary.
abstract: BACKGROUND
  In many patients with advanced synchronous liver metastases from colorectal tumours, the metastases progress during treatment of the primary, precluding curative treatment. The authors have investigated a management strategy that involves high-impact chemotherapy first, resection of liver metastases second and finally removal of the primary tumour in patients with adverse prognostic factors.
  
  
  METHODS
  Twenty consecutive patients with non-obstructive colonic (nine patients) or rectal (11 patients) cancer and advanced synchronous liver metastases were treated according to this strategy. Median age was 56 years. Patients received between two and six cycles of 5-fluorouracil, oxaliplatin and irinotecan-based chemotherapy. Data were collected prospectively.
  
  
  RESULTS
  Overall survival rates at 1, 2, 3 and 4 years after the start of treatment were 85, 79, 71 and 56 per cent respectively, with a median survival of 46 months. Sixteen of the 20 patients had complete removal of liver metastases and colorectal tumours (resectability rate 80 per cent).
  
  
  CONCLUSIONS
  This new strategy produced resectability and survival rates better than those expected from the published data on patients with disease of similar severity. It allows initial control and downstaging of liver metastases, and delivery of preoperative radiotherapy for rectal cancer without the fear that liver metastases will meanwhile progress beyond the possibility of cure.
authors: Department of Visceral and Transplantation Surgery, University Hospitals of Geneva, 1211 Geneva 14, Switzerland. gilles.mentha@hcuge.ch
authors: G
authors: G
authors: Mentha
authors: P E
authors: PE
authors: Majno
authors: A
authors: A
authors: Andres
authors: L
authors: L
authors: Rubbia-Brandt
authors: P
authors: P
authors: Morel
authors: A D
authors: AD
authors: Roth