Colon Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage IV and Recurrent Colon Cancer Treatment
In the era of multiagent chemotherapy, two subsequent studies evaluated its role in the adjuvant setting following resection of liver metastases from colorectal cancer.
- A phase III study randomly assigned 306 patients to 2 5-FU/LV or FOLFIRI after a resection of liver metastases.
- There was no difference in DFS (21.6 months of 2 5-FU/LV vs. 24.7 months for FOLFIRI; HR, 0.89; log-rank P = .44) or OS (HR, 1.09; 95% CI, 0.72-1.64).
- The EORTC (EORTC-40983 NCT00006479) randomly assigned 364 patients with up to four resectable liver metastases to perioperative FOLFOX (six cycles presurgery and six cycles postsurgery) or surgery alone.
- The PFS was 28.1% (95.66% CI, 21.3-35.5) for the surgery alone group and 35.4% (28.1-42.7; HR 0.79; 0.62-1.02; P = .058) for the perioperative chemotherapy group. There was no difference in OS. Subsequent, post hoc analysis demonstrated that the difference in PFS in truly eligible patients rose 8.1% (from 28.1% [21.2-36.6] to 36.2% [28.7-43.8]; HR, 0.77 [0.60-1.00]; P = .041). In patients who actually underwent resection of liver metastases, the difference in PFS rose 9.2% (from 33.2% [25.3-41.2] to 42.4% [34.0-50.5]; HR, 0.73 [0.55-0.97]; P = .025)
- Reversible postoperative complications occurred more often after chemotherapy than after surgery (40 [25%] of the 159 complications vs. 27 [16%] of the 170 complications; P = .04). After surgery, there were two deaths in the surgery alone group and one in the perioperative chemotherapy group.
There is no level 1 evidence demonstrating that perioperative or postoperative chemotherapy improves OS for patients undergoing resection of liver metastases. Nevertheless, on the basis of post hoc subset analyses of the EORTC study, some physicians feel perioperative or postoperative therapy is reasonable in this setting.
Intra-arterial chemotherapy after liver resection
Hepatic intra-arterial chemotherapy with floxuridine for liver metastases has produced higher overall response rates but no consistent improvement in survival when compared with systemic chemotherapy.[2,37,38,39,40,41] A meta-analysis of the randomized studies, which were all done in the era when only fluoropyrimidines were available for systemic therapy, did not demonstrate a survival advantage.