Chemotherapy before and after surgery to remove liver mets reduces the risk of colorectal cancer recurrence.



Chemotherapy given before and after surgery to remove colorectal cancer tumors that have spread to the liver significantly improves three-year progression-free survival.

Results of a randomized phase III clinical trial were discussed at the 2007 ASCO annual meeting in Chicago.  Patients who had cancer that had spread to their liver  considered surgically removable by their doctors either had surgery to remove the liver tumors right away or were assigned to a chemotherapy group.

Patients in the trial had four or fewer liver metastases and had no other cancer outside their livers. 

The chemotherapy group received 6 FOLFOX4 treatments before surgery and 6 treatments afterwards.

After three years there was almost a ten percent absolute improvement in progression-free survival in the group that had chemotherapy — 42.4 percent had not had their cancer return or spread outside the liver versus 33.2 percent for those who had surgery alone.

Bernard Nordlinger M.D. presented the results of the international EPOC trial at the ASCO Plenary session on Monday, June 4th.  In discussing the improved progression-free survival with the use of chemotherapy, he concluded:

This treatment should be proposed as a new standard for these patients and should be delivered by a multidisciplinary team.

Nicholas Petrelli, M.D., a surgical oncologist, disagreed that the approach should be the standard first choice for treating resectable liver metastases.  In a discussion following Nordlinger’s presentation, Petrelli pointed out that chemotherapy can harm normal liver tissue and lead to surgical complications.

He said that doing surgery first is still a good option for people whose liver metastases are resectable.

He called for a clinical trial to compare effectiveness of both pre and post surgical chemotherapy to improve survival.

SOURCE: Nordlinger et. al. Abstract #LBA5 ASCO 2007.

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