Preoperative hepatic and regional arterial chemotherapy in the prevention of liver metastasis after colorectal cancer surgery.
OBJECTIVE
To investigate whether preoperative hepatic and regional arterial chemotherapy is able to prevent liver metastasis and improve overall survival in patients receiving curative colorectal cancer resection.


METHODS
Patients with stage II or stage III colorectal cancer (CRC) were randomly assigned to receive preoperative hepatic and regional arterial chemotherapy (PHRAC group, n = 110) or surgery alone (control group, n = 112). The primary endpoint was disease-free survival, whereas the secondary endpoints included liver metastasis-free survival and overall survival.


RESULTS
There were no significant differences in overall morbidity between PHRAC and Control groups. During the follow-up period (median, 36 months), the median liver metastasis time for patients with stage III CRC was significantly longer in the PHRAC group (16 +/- 3 months vs. 8 +/- 1 months, P = 0.01). In stage III patients, there was also significant difference between the 2 groups with regard to the incidence of liver metastasis (20.6% vs. 28.3%, P = 0.03), 3-year disease-free survival (74.6% vs. 58.1%, P = 0.0096), 3-year overall survival (87.7% vs. 75.7%, P = 0.020), and the median survival time (40.1 +/- 4.6 months vs. 36.3 +/- 3.2 months, P = 0.03). In the PHRAC arm, the risk ratio of recurrence was 0.61 (95% CI, 0.51-0.79, P = 0.0002), of death was 0.51 (95% CI, 0.32-0.67; P = 0.009), and of liver metastasis was 0.73 (95% CI, 0.52-0.86; P = 0.02). In contrast, PHRAC seemed to be no benefit for stage II patients. Toxicities, such as hepatic toxicity and leukocyte decreasing, were mild and could be cured with medicine.


CONCLUSIONS
Preoperative hepatic and regional arterial chemotherapy, in combination with surgical resection, could be able to reduce and delay the occurrence of liver metastasis and therefore improve survival rate in patients with stage III colorectal cancer.
Xu
Jianmin
J
Department of General Surgery, Zhongshan Hospital, Fudan University; Colorectal Cancer Research Center, Fudan University, Shanghai, P. R. China. xujmin@yahoo.com.cn
Zhong
Yunshi
Y
Weixin
Niu
N
Xinyu
Qin
Q
Yanhan
Lai
L
Li
Ren
R
Jianhua
Wang
W
Zhiping
Yan
Y
Jiemin
Cheng
C
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D005467:Floxuridine / Q000008:administration & dosage*; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000401:mortality / Q000517:prevention & control* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009944:Organoplatinum Compounds / Q000008:administration & dosage*; D000077150:Oxaliplatin; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery
D000964:Antimetabolites, Antineoplastic; D009944:Organoplatinum Compounds; D005467:Floxuridine; D000077150:Oxaliplatin