Perioperative chemotherapy for resectable colorectal liver metastases: Where now?

被引:36
作者
Jones, R. P. [1 ,2 ]
Malik, H. Z. [2 ]
Fenwick, S. W. [2 ]
Poston, G. J. [2 ]
机构
[1] Univ Liverpool, Sch Canc Studies, Inst Translat Med, Liverpool L69 3GA, Merseyside, England
[2] Aintree Univ Hosp NHS Fdn Trust, Northwestern Hepatobiliary Unit, Liverpool L9 7AL, Merseyside, England
来源
EJSO | 2013年 / 39卷 / 08期
关键词
Colorectal; Liver; Chemotherapy; LONG-TERM SURVIVAL; HEPATIC RESECTION; NEOADJUVANT TREATMENT; FOLINIC ACID; SURGERY; CANCER; OXALIPLATIN; 5-FLUOROURACIL; RECURRENCE; STEATOHEPATITIS;
D O I
10.1016/j.ejso.2013.04.002
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Following the publication of the EORTC trial (40983), perioperative chemotherapy has become the standard of care for all patients with resectable colorectal cancer liver metastases (CRLM). However recently presented data suggest that the earlier advantage seen in progression free survival (PFS) may not translate over into a meaningful overall survival (OS) advantage. At the other end of the spectrum, patients with irresectable but liver limited CRLM continue to be offered treatment based on improving PFS, at the expense of regimens with greater response rates (but maybe poorer PFS rates) that could bring them to potentially curative liver resection. We therefore argue that patients with liver limited CRLM should be managed in three separate groups: Group One: those with easily resectable disease who should be offered immediate surgery, followed by adjuvant therapy if considered appropriate. Group Two: those with borderline resectable or high recurrence risk CRLM who could be offered appropriate systemic neoadjuvant therapy prior to planned liver surgery. Group Three: those with inoperable but liver limited CRLM who should be offered the most effective and appropriate systemic therapy with the primary purpose of achieving maximal disease response (and not PFS) with the intention of conversion to surgical resectability with curative intent. (C) 2013 Elsevier Ltd. All rights reserved.
引用
收藏
页码:807 / 811
页数:5
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