Surgery after neoadjuvant chemotherapy for colorectal liver metastases is safe and feasible in elderly patients.
BACKGROUND
Surgery for colorectal liver metastases is part of the endeavor to cure metastatic colorectal cancer (mCRC). Neoadjuvant chemotherapy increases progression free survival in resectable patients. The safety and feasibility of this concept has not been investigated in elderly patients.


METHODS
We performed a comparative analysis of data from 244 patients who were resected for colorectal liver metastases between 1999 and 2004 at our institution. Seventy patients were aged 70 or older; they form the basis of this analysis.


RESULTS
Twenty-nine patients received neoadjuvant chemotherapy (oxaliplatin-based chemotherapy (XELOX), 19; 5-fluorouracil (5-FU), 10) prior to surgery. XELOX was associated with higher response rates to chemotherapy (CR + PR: XELOX 68% vs. 5-FU 0%, P = 0.001), and responding patients had a better overall (OS, P < 0.001) and recurrence free survival (RFS, P < 0.001) compared to others. Response to neoadjuvant chemotherapy was the only factor on multivariate analysis predicting longer OS and RFS (P = 0.01 and P = 0.001).


CONCLUSIONS
Neoadjuvant chemotherapy can be administered safely in patients older than 70 years and appears to be effective in prolonging long-term outcome. Patients responding to neoadjuvant treatment have a significantly better prognosis after liver resection.
Tamandl
Dietmar
D
Department of Surgery, Hepatobiliary Service, Medical University Vienna, Vienna, Austria.
Gruenberger
Birgit
B
Herberger
Beata
B
Kaczirek
Klaus
K
Gruenberger
Thomas
T
D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018395:CA-19-9 Antigen / Q000032:analysis; D000069287:Capecitabine; D002272:Carcinoembryonic Antigen / Q000032:analysis; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000473:pathology*; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000556:secondary / Q000628:therapy*; D008297:Male; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D010071:Oxaloacetates
D000964:Antimetabolites, Antineoplastic; D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; D010071:Oxaloacetates; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil