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Objective:
Even though patients with colorectal cancer (CRC) and liver metastases have a poor prognosis, they can benefit from perioperative chemotherapy and complete extirpation of the disease. Oxaliplatin based chemotherapy with bevacizumab has been widely reported to improve outcomes with metastatic CRC. However, its impact on surgical complications and survival benefit after liver resection remains to be determined.
Patients and Methods:
Nineteen patients with potentially curable bilobar metastases from CRC were eligible for this single-center, nonrandomized trial during a period between September 2008 and August 2012 (NAC group). The study group consisted of 13 men and 6 women, with median age of 63 (range 52 to 79) years. Eligible criteria included synchronous liver metastases and metastatic liver disease developed within one year after resection of the primary lesions. Patients received biweekly oxaliplatin, 5-fluorouracil, and folic acid (FOLFOX6) plus bevacizumab therapy. The sixth cycle of neoadjuvant chemotherapy (NAC) did not include bevacizumab, resulting in 4 weeks window-time between the last administration of bevacizumab and hepatectomy. Over all survival (OS) and progression free survival (PFS) were compared with 27 patients who underwent hepateictomies for bilober metastasis during 2002 and 2008 (non NAC group).
Results:
Synchronous liver diseases were observed in 14 (73%). Although objective response to NAC was achieved in 6 patients (32%), 16 patients (84%) underwent liver resection. The liver surgery included 4 hemihepatecitomies, 5 sectorectomies, and 7 partial resections of the liver with median operative time of 186 minutes and median blood loss of 340 mL without blood transfusion. Any postoperative morbidity or morbidity was observed. One- and three-year OS of the NAC group were 100% and 56% (MST 43 months), and those of the non-NAC group were 93% and 49% (MST 31 months), respectively (P=0.47). DFS of the two groups were not different (P=0.50). Among the hepatectomized of NAC group, 10 patients (60%) developed recurrence with median relapse free time of 16.6 months. Initial recurrent deposits were observed in remaining liver in 4 patients, lung in 3, lymph nodes in 3, and peritoneum in 1 (redundant included).
Conclusion:
Our data suggest that FOLFOX6 and bevacizumab can be safely administered until 4 weeks before liver resection in patients with liver metastases from CRC without increasing perioperative complications. Although no contributions to OS and DFS were observed, control of liver recurrence may be achieved. Adjuvant therapies and further study is needed to define the survival benefit of NAC with FOLFOX6 plus bevacizumab in patients with potentially curable bilobar metastases from CRC.