Patients who had tumors shrink in response to chemotherapy given before they had surgery for colorectal cancer that had spread to their livers had no better long-term survival than patients whose cancer remained the same or even got worse.
Doctors in New York followed 111 patients who had chemotherapy before surgery to remove liver metastases (neoadjuvant chemotherapy). After five years of follow-up, median overall survival was 62 months. Overall survival was similar in three different groups: those who had a complete or partial response to neoadjuvant chemotherapy, those whose tumors remained stable, and those whose cancer progressed during chemotherapy.
All patients the study had liver tumors that surgeons believed could be cured surgically.
Median overall survival after liver surgery:
- For all patients: 62 months
- Patients with complete or partial response to chemo: 58 months
- Patients with stable disease after chemo: 65 months
- Patients with progressive disease: 61 months
Factors that predicted better survival after surgery were:
- CEA (carcinoembryonic antigen level) less than 5 ng/dL.
- Metastatic lesions 5 centimeters or less.
- Negative lymph nodes in the primary tumor in colon or rectum.
- No cancer cells in margins of surgically removed tissue.
There was a trend for patients whose cancer progressed during pre-surgical chemotherapy to do better if they had chemotherapy infused directly into their livers after surgery (hepatic arterial infusion). Those who had HAI had 70 percent survival three years after surgery compared to 50 percent of those who didn’t.
David J. Gallagher and the team from Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University concluded,
Response to neoadjuvant chemotherapy did not correlate with overall survival even after controlling for margins, stage of primary tumor, and postoperative carcinoembryonic antigen level. Postoperative salvage treatment may have helped the survival of some patients.
SOURCE: Gallagher et al..Annals of Surgical Oncology, Volume 16, Number 7, July 2009.