The Case for Selective Use of Pre-Operative Chemotherapy for Hepatic Colorectal Metastases: More Is Not Always Better

Excerpt

The last two decades have seen great improvements in the treatment of hepatic colorectal metastases. The 1990s saw the maturation of data firmly establishing surgical resection as an effective and potentially curative therapy for this once uniformly fatal disease.1,2 In the last decade, introduction of systemic treatments such as oxaliplatin, irinotecan, bevacizumab, and cetuximab have added to favorable outcomes by increasing the number of patients eligible for resection, as well as by decreasing recurrence.3 Fifteen to 20% of patients with previously unresectable disease now have disease that is downstaged routinely by effective chemotherapy to a resectable state.3 On the basis of these data, oncologists in the United States have extended the preoperative use of chemotherapy to include not only those patients with unresectable disease (downstaging strategy), but also those patients with initially resectable disease (neoadjuvant strategy). The article in this issue by Reddy et al. is part of a growing body of data indicating that such liberal use of prehepatic resection chemotherapy may not be justified.4 …