title: Rebound growth of hepatic colorectal metastases after neo-adjuvant chemotherapy: effect on survival after resection.
abstract: A period of recovery is commonly allowed between completion of chemotherapy for colorectal liver metastases (CRLM) and resection, during which tumour progression may occur. The study-aim is to assess the growth of CRLM in this interval and association with outcome.
  
  
  
  Data on 146 patients were analysed. Change in tumour size was assessed by comparing size determined by imaging performed on completion of chemotherapy with that determined by examination of the resected specimen, categorised by RECIST criteria.
  
  
  
  In the interval before surgery sixteen patients (11%) fulfilled criteria for partial response (PR), 48 (33%) had stable disease (SD) and 82 (56%) had progressive disease (PD). Among patients with PD following chemotherapy the median disease-free survival of patients who initially responded (26 months) was longer than in those who initially had stable disease (7 months) (P = 0.002). No association was noted between rate of tumour growth after completion of chemotherapy and disease-free survival.
  
  
  
  Change in tumour size after completion of chemotherapy is variable and can be rapid, especially in patients who initially respond to treatment. However, disease-free survival is determined by tumour behaviour during treatment and not by change in size after completion of chemotherapy.
authors.affiliation: Department of Oncology, Plymouth Hospitals NHS Trust, Plymouth, PL6 8DH, UK. Electronic address: elizabeth.lim@nhs.net.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lim
authors.affiliation: Department of HPB Surgery, Plymouth Hospitals NHS Trust, Plymouth, PL6 8DH, UK; Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, Devon, PL6 8BU, UK. Electronic address: matthew.wiggans1@nhs.net.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Wiggans
authors.affiliation: School of Science and Technology, Nottingham Trent University, Nottingham, NG1 4BU, UK. Electronic address: golnaz.shahtahmassebi@ntu.ac.uk.
authors.forename: Golnaz
authors.initials: G
authors.lastname: Shahtahmassebi
authors.affiliation: Department of HPB Surgery, Plymouth Hospitals NHS Trust, Plymouth, PL6 8DH, UK. Electronic address: s.aroori@nhs.net.
authors.forename: Somaiah
authors.initials: S
authors.lastname: Aroori
authors.affiliation: Department of HPB Surgery, Plymouth Hospitals NHS Trust, Plymouth, PL6 8DH, UK. Electronic address: matthewbowles@nhs.net.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bowles
authors.affiliation: Department of HPB Surgery, Plymouth Hospitals NHS Trust, Plymouth, PL6 8DH, UK. Electronic address: christopherbriggs@nhs.net.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Briggs
authors.affiliation: Department of HPB Surgery, Plymouth Hospitals NHS Trust, Plymouth, PL6 8DH, UK; Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, Devon, PL6 8BU, UK. Electronic address: david.stell@nhs.net.
authors.forename: David A
authors.initials: DA
authors.lastname: Stell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D016208:Databases, Factual; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000401:mortality; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden