title: Chemotherapy after portal vein embolization to protect against tumor growth during liver hypertrophy before hepatectomy.
abstract: OBJECTIVE
  Portal vein embolization improves the safety of liver resection by increasing the size of residual liver, but the embolization may increase tumor growth during the waiting period before definitive hepatectomy.
  
  
  OBJECTIVE
  To determine whether the administration of chemotherapy mitigates tumor growth after portal vein embolization (PVE) performed before major hepatectomy for metastatic colorectal cancer.
  
  
  METHODS
  Review of prospectively collected data at Memorial-Sloan Kettering Cancer Center was conducted. The database included patients subjected to PVE before major hepatectomy for metastatic colorectal cancer.
  
  
  METHODS
  Lesions in both the embolized and nonembolized lobes of the liver before and 1 month after PVE were measured and Response Evaluation Criteria in Solid Tumors were applied to assess disease status. Assessment of survival was based on receipt of post-PVE chemotherapy and then stratified by subsequent resectability.
  
  
  RESULTS
  Two hundred eight tumors were measured in 64 patients; 53 tumors were in patients undergoing post-PVE chemotherapy. Approximately one-third of the lesions progressed after PVE when no chemotherapy was administered. This did not differ significantly according to whether tumors were ipsilateral or contralateral to the PVE. When chemotherapy was administered, there was a significantly lower rate of progression (18.9%, P = .03). In long-term follow-up, treatment with post-PVE chemotherapy was also independently associated with improved survival (P < .006).
  
  
  CONCLUSIONS
  Chemotherapy does not retard growth of the liver after PVE and may prevent cancer progression. Thus, the combination of PVE and chemotherapy may enhance both oncologic and operative safety.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Catha
authors.initials: C
authors.lastname: Fischer
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Laleh G
authors.initials: LG
authors.lastname: Melstrom
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Dean
authors.initials: D
authors.lastname: Arnaoutakis
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: William
authors.initials: W
authors.lastname: Jarnagin
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Karen
authors.initials: K
authors.lastname: Brown
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Michael
authors.initials: M
authors.lastname: D'Angelica
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Anne
authors.initials: A
authors.lastname: Covey
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Ronald
authors.initials: R
authors.lastname: DeMatteo
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Peter
authors.initials: P
authors.lastname: Allen
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: T Peter
authors.initials: TP
authors.lastname: Kingham
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Scott
authors.initials: S
authors.lastname: Tuorto
authors.affiliation: Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Nancy
authors.initials: N
authors.lastname: Kemeny
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York2Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods; D006529:Hepatomegaly / Q000517:prevention & control; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011169:Portal Vein; D011300:Preoperative Care / Q000379:methods; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden