Portal vein embolization stimulates tumour growth in patients with colorectal cancer liver metastases.
OBJECTIVE
Portal vein embolization (PVE) can facilitate the resection of previously unresectable colorectal cancer (CRC) liver metastases. Bevacizumab is being used increasingly in the treatment of metastatic CRC, although data regarding its effect on post-embolization liver regeneration and tumour growth are conflicting. The objective of this observational study was to assess the impact of pre-embolization bevacizumab on liver hypertrophy and tumour growth.


METHODS
Computed tomography scans before and 4 weeks after PVE were evaluated in patients who received perioperative chemotherapy with or without bevacizumab. Scans were compared with scans obtained in a control group in which no PVE was administered. Future liver remnant (FLR), total liver volume (TLV) and total tumour volume (TTV) were measured. Bevacizumab was discontinued ≥ 4 weeks before PVE.


RESULTS
A total of 109 patients and 11 control patients were included. Portal vein embolization induced a significant increase in TTV: the right lobe increased by 33.4% in PVE subjects but decreased by 34.8% in control subjects (P < 0.001), and the left lobe increased by 49.9% in PVE subjects and decreased by 33.2% in controls (P= 0.022). A total of 52.8% of the study group received bevacizumab and 47.2% did not. There was no statistical difference between the two chemotherapy groups in terms of tumour growth. Median FLR after PVE was similar in both groups (28.8% vs. 28.7%; P= 0.825).


CONCLUSIONS
Adequate liver regeneration was achieved in patients who underwent PVE. However, significant tumour progression was also observed post-embolization.
Section of Solid Organ Transplant and Hepatopancreatobiliary Surgery, McGill University Health Center, Montreal, QC, Canada.
Eve
E
Simoneau
Murad
M
Aljiffry
Ayat
A
Salman
Nasser
N
Abualhassan
Tatiana
T
Cabrera
David
D
Valenti
Arwa
A
El Baage
Mohammad
M
Jamal
Petr
P
Kavan
Saleh
S
Al-Abbad
Prosanto
P
Chaudhury
Mazen
M
Hassanain
Peter
P
Metrakos
D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000068258:Bevacizumab; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000473:pathology*; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy*; D008115:Liver Regeneration / Q000187:drug effects; D008297:Male; D020360:Neoadjuvant Therapy; D011169:Portal Vein; D011792:Quebec; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden / Q000187:drug effects
D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab