title: Conversion chemotherapy followed by hepatic resection in colorectal cancer with initially unresectable liver-limited metastases.
abstract: The best management choice in colorectal cancer patients with unresectable liver-only metastases should be represented by conversion chemotherapy aiming to reduce liver cancer deposits, thereby permitting curative surgery. Forty-eight consecutive stage IV colorectal cancer patients were treated with different chemotherapeutic regimens including biological drugs. Objective responses to chemotherapy were seen in 27 patients (56.2%; 95% CI 42.1-70.2%). Four patients (8.3%) showed complete response, 23 patients (47.9%) partial and 13 patients (27.1%) stable response. Eight patients (16.7%) progressed. The conversion rate was 35.4% (95% CI 21.8-48.9%) with 17 patients suitable for liver resection. Four complete responder patients refused surgery. The remaining 13 patients underwent curative hepatic resection (resection rate 27.1%; 95% CI 14.5-39.6%). The likelihood of a successful conversion chemotherapy appeared significantly related to the best response and to the K-Ras status. Wild-type K-Ras patients undergoing cetuximab therapy showed the best conversion rate. The four-year survival rate was significantly enhanced in converted compared to non-converted patients (57.1 and 0%, respectively), and in resected compared to non-resected patients (53.3 and 10.1%, respectively). Synchronous metastases and no conversion were shown to be the only covariates independently associated with a poorer long-term outcome. The possibility of curative liver surgery significantly prolongs outcome for colorectal cancer patients with unresectable liver-limited metastases. Prospective randomized trials are required to define the conversion rates with biological drugs.
authors.affiliation: Division of Surgical Oncology, 'F. Magrassi - A. Lanzara' Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Galizia
authors.forename: Ferdinando
authors.initials: F
authors.lastname: De Vita
authors.forename: Eva
authors.initials: E
authors.lastname: Lieto
authors.forename: Anna
authors.initials: A
authors.lastname: Zamboli
authors.forename: Floriana
authors.initials: F
authors.lastname: Morgillo
authors.forename: Paolo
authors.initials: P
authors.lastname: Castellano
authors.forename: Andrea
authors.initials: A
authors.lastname: Mabilia
authors.forename: Annamaria
authors.initials: A
authors.lastname: Auricchio
authors.forename: Andrea
authors.initials: A
authors.lastname: Renda
authors.forename: Fortunato
authors.initials: F
authors.lastname: Ciardiello
authors.forename: Michele
authors.initials: M
authors.lastname: Orditura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents