Neoadjuvant Chemotherapy in Patients with Stage IV Colorectal Cancer: A Comparison of Histological Response in Liver Metastases, Primary Tumors, and Regional Lymph Nodes
- 601 Downloads
We report the histopathological results of a novel “inversed” strategy designed to manage patients with colorectal cancer (CRC) who have synchronous liver metastases by using chemotherapy first, liver surgery second, and resection of the primary tumor as a final step. This study was designed to compare the response to chemotherapy in liver metastases, primary tumors, and locoregional lymph nodes.
Twenty-nine patients with stage IV CRC received a combination of oxaliplatin, irinotecan, 5-fluorouracil, and leucovorin (OCFL) for 3–4 months. Histological response to chemotherapy was assessed by using a tumor regression grading (TRG) score based on presence of residual tumor cells and extent of fibrosis.
Median age of patients was 56 (range, 37–69) years. Primary tumor location was right colon (n = 5), left colon (n = 7), and rectum (n = 17 patients). TRG scores correlated across disease sites (Spearman correlation coefficients for TRG in the primary tumor and lymph nodes was 0.59 [P = 0.005]; for the primary tumor and metastases 0.44 [P = 0.021]; and for lymph nodes and metastases 0.58 [P = 0.006]). Complete absence or poor tumor response (TRG4/5) was significantly more frequent in primary tumors (35.7%) and locoregional lymph nodes (38%) than in liver metastases (6.9%; McNemar test, P = 0.02). Two patients had a complete pathologic response (pT0N0M0).
In patients with stage IV colorectal cancer, liver metastases exhibit a better histological response than primary tumors to OCFL neoadjuvant chemotherapy.
KeywordsLiver Metastasis Irinotecan Oxaliplatin Liver Resection Complete Pathologic Response
- 8.Rubbia-Brandt L, Giostra E, Brezault C, Roth AD, Andres A, Audard D, Sartoretti P, et al. Importance of histological tumor response assessment in predicting the outcome in patients with colorectal liver metastases treated with neo-adjuvant chemotherapy followed by liver surgery. Ann Oncol. 2007;18:299–304.CrossRefPubMedGoogle Scholar
- 19.Suarez J, Vera R, Balen E, Gomez M, Arias F, Lera JM, Herrera J, Zazpe C. Pathologic response assessed by Mandard grade is a better prognostic factor than down staging for disease-free survival after preoperative radiochemotherapy for advanced rectal cancer. Colorectal Dis. 2008;10:563–8.CrossRefPubMedGoogle Scholar
- 22.Gervaz P, Scholl B, Mainguene C, Poitry S, Gillet M, Wexner S. Angiogenesis of liver metastases: role of sinusoidal endothelial cells. Dis Colon Rectum.Google Scholar
- 25.Gervaz P, Morel P. T0N1 adenocarcinoma of the colon following oxaliplatin-based neoadjuvant chemotherapy. J Surg Oncol. 2008.Google Scholar
- 26.Hughes R, Glynne-Jones R, Grainger J, Richman P, Makris A, Harrison M, Ashford R, et al. Can pathological complete response of the primary tumour following pre-operative pelvic chemoradiotherapy for T3-T4 rectal cancer predict for sterilisation of pelvic lymph nodes, a low risk of local recurrence and the appropriateness of local excision? Int J Colorectal Dis. 2006;21:11–7.CrossRefPubMedGoogle Scholar