Role of adjuvant therapy after resection of colorectal cancer liver metastases Journal Article
| Authors: | Power, D. G.; Kemeny, N. E. |
| Article Title: | Role of adjuvant therapy after resection of colorectal cancer liver metastases |
| Abstract: | Liver resection is the goal of treatment strategies for liver-confined metastatic colorectal cancer. However, after resection the majority of patients will experience recurrence. Chemotherapy seems to improve outcomes compared with surgery alone. We reviewed the data of the role of adjuvant chemotherapy after resection of liver- confined metastatic colorectal cancer. Optimal regimens and sequencing of chemotherapies when liver resection is an option are unclear. Some suggest that resectable liver metastases, in the absence of high-risk features, should begin with surgery and consideration given to adjuvant chemotherapy after surgery. If high-risk features are present, most physicians prefer a short course of systemic preoperative chemotherapy. Perioperative therapy and regional therapy with hepatic arterial infusion (HAI) both increase disease-free survival (DFS) when compared with surgery alone. In unresectable disease, consideration should be given to systemic chemotherapy with or without a biologic agent or HAI with systemic therapy. If the disease becomes resectable, adjuvant treatment should follow surgery. Adjuvant chemotherapy is usually FOLFOX, but HAI combined with systemic chemotherapy is also an option. The role of adjuvant treatment post-liver resection should not be viewed in isolation but rather in the context of prior treatment, surgical preference, and individual patient characteristics. Perioperative therapy and regional therapy have both shown an increase in DFS. Conducting randomized trials examining the role of adjuvant chemotherapy has been difficult because of rapidly changing chemotherapies. © 2010 by American Society of Clinical Oncology. |
| Keywords: | treatment outcome; disease-free survival; overall survival; mortality; review; bevacizumab; fluorouracil; patient selection; systemic therapy; liver neoplasms; capecitabine; adjuvant therapy; cancer adjuvant therapy; disease free survival; chemotherapy, adjuvant; neoadjuvant therapy; antineoplastic agent; evidence based medicine; evidence-based medicine; colorectal cancer; metastasis; antineoplastic combined chemotherapy protocols; morbidity; recurrence; dexamethasone; pathology; cetuximab; cancer mortality; time; time factors; irinotecan; colorectal neoplasms; liver metastasis; colorectal tumor; folinic acid; adjuvant chemotherapy; liver tumor; recurrent disease; liver resection; hepatectomy; preoperative treatment; kaplan meier method; mitomycin; oxaliplatin; floxuridine; fatty liver; clinical trial (topic) |
| Journal Title: | Journal of Clinical Oncology |
| Volume: | 28 |
| Issue: | 13 |
| ISSN: | 0732-183X |
| Publisher: | American Society of Clinical Oncology |
| Date Published: | 2010-05-01 |
| Start Page: | 2300 |
| End Page: | 2309 |
| Language: | English |
| DOI: | 10.1200/jco.2009.26.9340 |
| PUBMED: | 20368552 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 2" - "Export Date: 20 April 2011" - "CODEN: JCOND" - "Source: Scopus" |
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