title: Patients with initially unresectable colorectal liver metastases: is there a possibility of cure?
abstract: OBJECTIVE
  Although oncosurgical strategies have demonstrated increased survival in patients with unresectable colorectal liver metastases (CLM), their potential for cure is still questioned. The aim of this study was to evaluate long-term outcome after combining downsizing chemotherapy and rescue surgery and to define prognostic factors of cure.
  
  
  METHODS
  All patients with initially unresectable CLM who underwent rescue surgery and had a minimum follow-up of 5 years were included. Cure was defined as a disease-free interval > or = 5 years from last hepatic or extrahepatic resection until last follow-up.
  
  
  RESULTS
  Mean age of 184 patients who underwent resection (April 1988 through July 2002) was 56.9 years. Patients had a mean number of 5.3 metastases (bilobar in 76%), associated to extrahepatic disease in 27%. Surgery was possible after one (74%) or more (26%) lines of chemotherapy. Five- and 10-year overall survival rates were 33% and 27%, respectively. Of 148 patients with a follow-up > or = 5 years, 24 patients (16%) were considered cured (mean follow-up, 118.6 months), six (25%) of whom were considered cured after repeat resection of recurrence. Twelve "cured" patients (50%) had a disease-free interval more than 10 years. Cured patients more often had three or fewer metastases less than 30 mm (P = .03) responding to first-line chemotherapy (P = .05). Multivariate analysis identified maximum size of metastases less than 30 mm at diagnosis, number of metastases at hepatectomy three or fewer, and complete pathologic response as independent predictors of cure.
  
  
  CONCLUSIONS
  Cure can be achieved overall in 16% of patients with initially unresectable CLM resected after downsizing chemotherapy. In addition to increased survival, this oncosurgical approach has real potential for disease eradication.
authors.affiliation: AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire and Department of Medical Oncology, Villejuif, France. rene.adam@pbr.aphp.fr
authors.forename: René
authors.initials: R
authors.lastname: Adam
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Wicherts
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Haas
authors.forename: Oriana
authors.initials: O
authors.lastname: Ciacio
authors.forename: Francis
authors.initials: F
authors.lastname: Lévi
authors.forename: Bernard
authors.initials: B
authors.lastname: Paule
authors.forename: Michel
authors.initials: M
authors.lastname: Ducreux
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
authors.forename: Henri
authors.initials: H
authors.lastname: Bismuth
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016019:Survival Analysis