Effects of oxaliplatin-based chemotherapy on liver function--an analysis of impact and functional recovery using the LiMAx test.
OBJECTIVE
Chemotherapy-associated liver injury of patients undergoing therapy for colorectal liver metastases stimulates concerns on surgical safety. No common guidelines for the optimal timing of liver surgery after the application of systemic chemotherapy (chemotherapy-free interval) have been established and effects on individual liver function remain unexplored.


METHODS
Maximum liver function capacity (LiMAx) and indocyanine green plasma disappearance rate (ICG-PDR) were measured in 20 patients with colorectal cancer receiving adjuvant oxaliplatin-based chemotherapy (OBC) prior to the first and after the last treatment course as well as 4 and 8 weeks thereafter.


RESULTS
Comparison of pre- and post-chemotherapy test results demonstrated a significant decrease of LiMAx to 73.2 % ± 19.0 % (p = 0.001) and ICG-PDR to 78.2 % ± 21.3 % (p = 0.001) after cessation of OBC. The dynamics of LiMAx indicate an interindividual effect on vulnerability to systemic chemotherapy with subsequent functional regeneration after 8 weeks (pre-OBC 530 ± 144 μg/kg/h vs. 4 weeks post-OBC 463 ± 111 μg/kg/; p = 0.012 and vs. 8 weeks post-OBC 494 ± 138 μg/kg/h; p = 0.134). An analysis of individual regeneration after chemotherapy yielded a highly different course of functional recovery with patients regaining pre-chemotherapy function within 4 weeks, whereas others still showed deterioration after 8 weeks after cessation of chemotherapy.


CONCLUSIONS
Enzymatic liver function (LiMAx) is significantly reduced after oxaliplatin-based chemotherapy and subsequently recovers within 8 weeks after cessation of chemotherapy. However, pace of regeneration appears to be highly different among patients suggesting patient individual chemotherapy-free interval monitored by LiMAx.
Department of General, Visceral and Transplantation Surgery, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
Maximilian
M
Jara
Department of General, Visceral and Transplantation Surgery, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.|Department of General, Visceral and Transplantation Surgery, University Clinic Aachen, Rhine Westphalia Institute of Technology, Pauwelsstraße 32, 52074, Aachen, Germany.
Jan
J
Bednarsch
Department of General, Visceral and Transplantation Surgery, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
Maciej
M
Malinowski
Department of General, Visceral and Transplantation Surgery, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
Johann
J
Pratschke
Department of General, Visceral and Transplantation Surgery, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. martin.stockmann@charite.de.
Martin
M
Stockmann
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008099:Liver / Q000503:physiopathology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000627:therapeutic use*; D000077150:Oxaliplatin; D011446:Prospective Studies; D020127:Recovery of Function
D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin
Breath test; Carbon isotopes; Chemotherapy; Chemotherapy-induced liver injury; ICG-PDR; LiMAx; Liver function; Methacetin