J Korean Soc Coloproctol.  2008 Jun;24(3):184-191. 10.3393/jksc.2008.24.3.184.

Curative Resection Following Neoadjuvant Chemotherapy Including a Molecularly Targeted Agent in Patients with Unresectable Colorectal Distant Metastases

• Kim JS
• Min BS
• Hur H
• Kim NK
• Choi JS
• Sohn SK
• Cho CH
• Ahn JB
• Roh JK

• KMID: 2199054
• DOI: http://doi.org/10.3393/jksc.2008.24.3.184

Abstract

PURPOSE
A colorectal carcinoma is the fourth most common malignancy in the world. Unfortunately, only approximately 20% of the liver metastases are resectable at the initial presentation. Neoadjuvant chemotherapy has been used for downsizing in unresectable disease. In addition, the use of newer biologic agents, such as cetuximab and bevacizumab, has much improved responses in patients with unresectable colorectal liver metastases. The aim of this study was to report on patients who had received a curative resection following neoadjuvant chemotherapy including a molecularly targeted agent for unresectable colorectal liver metastases. METHODS: Following the neoadjuvant chemotherapy using cetuximab plus FOLFIRI (irinotecan and infused fluorouracil plus leucovorin) or bevacizumab plus FOLFOX (oxaliplatin and infused fluorouracil plus leucovorin), 10 patients with initially unresectable colorectal liver metastases underwent a curative surgical resection between September 2005 and June 2007. RESULTS: One patient underwent a right lobectomy, three patients a segmentectomy and five a wedge resection with or without radiofrequency ablation. With a median postoperative follow-up of 14 months (range, 1 to 22 months), five recurrences (50%) occurred. The common toxic effects were grade 2/3 skin toxicity (60%), grade 4 hematologic toxicity (20%), grade 3 gastrointestinal toxicity (10%), and grade 3 neurologic toxicity (10%). CONCLUSIONS: Our preliminary data suggests that neoadjuvant chemotherapy including a molecularly targeted agent may improve resectability in patients with initially unresectable colorectal liver metastases although a high recurrence rate exists. Randomized prospective studies comparing neoadjuvant chemotherapy including a targeted agent in cases of unresectable colorectal liver metastases are warranted.

Keyword

Colorectal cancer; Liver metastasis; Molecularly targeted agent; Curative resection

MeSH Terms

Antibodies, Monoclonal, Humanized
Bevacizumab
Cetuximab
Colorectal Neoplasms
Fluorouracil
Follow-Up Studies
Humans
Liver
Mastectomy, Segmental
Neoplasm Metastasis
Recurrence
Skin
Antibodies, Monoclonal, Humanized
Fluorouracil