title: Long-term survival of patients downstaged by oxaliplatin and 5-fluorouracil combination followed by rescue surgery for unresectable colorectal liver metastases.
abstract: OBJECTIVE
  To evaluate long-term survival of patients resected for primarily unresectable colorectal liver metastases downstaged by systemic chemotherapy.
  
  
  METHODS
  Among a group of 82 patients with advanced colorectal cancer, 39 had unresectable liver metastases. After treatment with systemic 3-weekly 5FU/folinic acid/oxaliplatin chemotherapy, the outcome of 11 patients made resectable thanks to chemotherapy was compared to that of 28 patients who were not. Criteria for non-resectability consisted of diffuse bilobar invasion with inability to achieve complete resection, unilobar or bilobar invasion plus vascular extension (invasion of inferior vena cava or 2 supra-hepatic veins plus continuity with the 3rd) or involvment of hepatic pedicle. Before and after surgery, CT scan evaluation was performed every 2 months. Progression free survival was defined as the time between starting chemotherapy and recurrence of the disease. We used Kaplan-Meier survival curves and log-rank test for comparisons, P values were two-sided and considered significant if<0.05.
  
  
  RESULTS
  Progression free survival times were 14 and 6 months, median overall survival were 60 and 18.5 months, respectively, in favour of secondary resected subjects.
  
  
  CONCLUSIONS
  Considering the magnitude of the survival benefit, one may question the need and feasibility for trials to assess more formally the impact of surgery in that setting.
authors.affiliation: Hôpital de l'Archet II, Fédération des Maladies de l'Appareil Digestif, Nice. caroli-bosc.fx@chu-nice.fr
authors.forename: Nathalie
authors.initials: N
authors.lastname: Baize
authors.forename: Béatrice
authors.initials: B
authors.lastname: Gerard
authors.forename: Harry
authors.initials: H
authors.lastname: Bleiberg
authors.forename: François
authors.initials: F
authors.lastname: Caroli-Bosc
authors.forename: Frédéric
authors.initials: F
authors.lastname: Berthier
authors.forename: Hughes
authors.initials: H
authors.lastname: Legendre
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Pector
authors.forename: Alain
authors.initials: A
authors.lastname: Hendlisz
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D015996:Survival Rate; D013997:Time Factors
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D005472:Fluorouracil