title: Role of systemic chemotherapy in the management of resected or resectable             colorectal liver metastases: a systematic review and meta-analysis of randomized             controlled trials.
abstract: Liver metastases are a common event in patients with colorectal cancer.             Surgical resection, if feasible, produces a survival benefit. We performed a systematic             review of randomized clinical trials (RCT) and meta-analysis to address the question             if current available studies support the use of systemic chemotherapy as an adjunct             to surgery in resected/resectable patients. The search was based on major databases             (Pubmed, CancerLit, Embase, Medscape and Cochrane) of published literature and             selecting abstracts from major cancer meetings. We performed a literature for             the January 1982-May 2010 time frame. The hazard ratios (HRs), with confidence             intervals, as presented in retrieved studies, referred to the disease- and/or             progression-free (DFS and/or PFS) and overall survival (OS) were extracted. The             meta-analysis was carried out by the fixed-effect and the random-effects model.             Three studies randomizing combined treatment vs. surgery alone for a total of             666 patients (642 evaluable for survival analysis) were selected and included             in the final analysis. Evidence for chemotherapy-induced benefit in terms of both             DFS (pooled HR, 0.71; CI, 0.582-0.878; p=0.001) and PFS (pooled HR, 0.75; CI,             0.620-0.910; p=0.003) was demonstrated. However, our meta-analysis failed to demonstrate             a significant advantage of combined treatment in terms of OS (pooled HR, 0.743;             CI, 0.527-1.045; p=0.088). Chemotherapy combined with surgical resection of colorectal             liver metastases improves DFS and PFS whereas the benefit in OS is not demonstrated             on the basis of the available results of RCTs. New prospective trials in the era             of targeted therapy are eagerly awaited on this specific topic.
authors.affiliation: Medical Oncology Unit and Center for Innovative Treatments, Magna Graecia University and Tommaso Campanella Cancer Center, Campus Salvatore Venuta, Catanzaro, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Ciliberto
authors.forename: Ubaldo
authors.initials: U
authors.lastname: Prati
authors.forename: Laura
authors.initials: L
authors.lastname: Roveda
authors.forename: Vito
authors.initials: V
authors.lastname: Barbieri
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Staropoli
authors.forename: Alberto
authors.initials: A
authors.lastname: Abbruzzese
authors.forename: Michele
authors.initials: M
authors.lastname: Caraglia
authors.forename: Massimo
authors.initials: M
authors.lastname: Di Maio
authors.forename: Domenico
authors.initials: D
authors.lastname: Flotta
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Tassone
authors.forename: Pierosandro
authors.initials: P
authors.lastname: Tagliaferri
mesh_terms: D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary* / Q000601:surgery; D008297:Male; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis