title: Chemotherapy or liver transplantation for nonresectable liver metastases from colorectal cancer?
abstract: OBJECTIVE
  The primary objective was to compare overall survival (OS) in patients with colorectal cancer (CRC) with nonresectable liver-only metastases treated by liver transplantation or chemotherapy.
  
  
  BACKGROUND
  CRC is the third most common cancer worldwide. About 50% of patients will develop metastatic disease primarily to the liver and the lung. The majority of patients with liver metastases receive palliative chemotherapy, with a median OS of trial patients of about 2 years, and less than 10% are alive at 5 years.
  
  
  METHODS
  Patients with nonresectable liver-only CRC metastases underwent liver transplantation in the SECA study (n = 21). Disease-free survival (DFS) and OS of patients included in the SECA study were compared with progression-free survival (PFS) and OS in a similar cohort of CRC patients with liver-only disease included in a first-line chemotherapy study, the NORDIC VII study (n = 47). PFS/DFS and OS were estimated by the Kaplan-Meier method.
  
  
  RESULTS
  DFS/PFS in both groups were 8 to 10 months. However, a dramatic difference in OS was observed. The 5-year OS rate was 56% in patients undergoing liver transplantation compared with 9% in patients starting first-line chemotherapy. The reason for the large difference in OS despite similar DFS/PFS is likely different metastatic patterns at relapse/progression. Relapse in the liver transplantation group was often detected as small, slowly growing lung metastases, whereas progression of nonresectable liver metastases was observed in the chemotherapy group.
  
  
  CONCLUSIONS
  Compared with chemotherapy, liver transplantation resulted in a marked increased OS in CRC patients with nonresectable liver-only metastases.
authors.affiliation: *Department of Oncology, Oslo University Hospital, Oslo, Norway †Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway ‡Institute of Clinical Medicine, University of Oslo, Oslo, Norway §Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden; and ¶Department of Oncology, Odense University Hospital, Odense, Denmark.
authors.forename: Svein
authors.initials: S
authors.lastname: Dueland
authors.forename: Tormod K
authors.initials: TK
authors.lastname: Guren
authors.forename: Morten
authors.initials: M
authors.lastname: Hagness
authors.forename: Bengt
authors.initials: B
authors.lastname: Glimelius
authors.forename: Pål-Dag
authors.initials: PD
authors.lastname: Line
authors.forename: Per
authors.initials: P
authors.lastname: Pfeiffer
authors.forename: Aksel
authors.initials: A
authors.lastname: Foss
authors.forename: Kjell M
authors.initials: KM
authors.lastname: Tveit
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002272:Carcinoembryonic Antigen / Q000097:blood; D015179:Colorectal Neoplasms / Q000097:blood / Q000473:pathology*; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery*; D016031:Liver Transplantation; D010865:Pilot Projects; D011446:Prospective Studies
chemical_list: D002272:Carcinoembryonic Antigen