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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2010

01-02-2010 | Hepatobiliary Tumors

Systematic Review of Randomized and Nonrandomized Trials of the Clinical Response and Outcomes of Neoadjuvant Systemic Chemotherapy for Resectable Colorectal Liver Metastases

Authors: Terence C. Chua, BScMed (Hons), Akshat Saxena, BMedSc, Winston Liauw, MBBS, MMed Sci, Adel Kokandi, MBBS, David L. Morris, MD, PhD

Published in: Annals of Surgical Oncology | Issue 2/2010

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Abstract

Background

Neoadjuvant chemotherapy prior to hepatectomy in patients with resectable colorectal liver metastases (CLM) may facilitate the resectability of the liver lesions and treat occult metastasis but may also lead to hepatic parenchyma damage. There is argument over the oncologic benefit of this practice in patients who would already be suitable for a curative hepatectomy.

Methods

Extensive literature search of databases (MEDLINE and PubMed) to identify published studies of preoperative systemic chemotherapy for resectable CLM was undertaken with clinical response to treatment and survival outcomes as the endpoints.

Results

Twenty-three studies were reviewed: 1 phase III randomized control trial, 3 phase II studies, and 19 observational studies, comprising 3,278 patients. Objective (complete/partial) radiological response was observed in 64% (range 44–100%) [complete 4% (range 0–38%), partial 52% (range 10–90%)] of patients after neoadjuvant chemotherapy. Pathologically, a median of 9% (range 2–24%) and 36% (range 20–60%) had complete and partial response, respectively. Of patients, 41% (range 0–65%) had stable or progressive disease whilst on neoadjuvant chemotherapy. Median disease-free survival (DFS) was 21 (range 11–40) months. Median overall survival (OS) was 46 (range 20–67) months.

Conclusion

Current evidence suggests that objective response to neoadjuvant chemotherapy may be achieved with improvement in DFS in patients with resectable CLM. A prospective randomized trial of neoadjuvant therapy versus adjuvant therapy after liver resection is required to determine the optimal perisurgical treatment regimen.
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Metadata
Title
Systematic Review of Randomized and Nonrandomized Trials of the Clinical Response and Outcomes of Neoadjuvant Systemic Chemotherapy for Resectable Colorectal Liver Metastases
Authors
Terence C. Chua, BScMed (Hons)
Akshat Saxena, BMedSc
Winston Liauw, MBBS, MMed Sci
Adel Kokandi, MBBS
David L. Morris, MD, PhD
Publication date
01-02-2010
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 2/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0781-1

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