WASHINGTONColorectal cancer patients with unresectable
liver metastases responded better to a regimen of regional and systemic
chemotherapy plus cytoreduction than to cytoreduction alone, said David Litvak,
MD, of the John Wayne Cancer Institute, Santa Monica, and Century City
Hospital, Los Angeles.
Speaking at the 54th Annual Cancer Symposium of the Society
of Surgical Oncology, he reported on a review of 185 patients who received
treatment between 1992 and 1999.
Although 40% of colorectal patients develop liver
metastases, Dr. Litvak said, only 20% are candidates for complete resection,
"the only cure," because of the number, size, and location of their
metastases. Cytoreductive techniques can treat all the visible disease, but the
majority of patients still recur, be added. Regional chemotherapy with
intra-arterial floxuridine (FUDR) targets arterially fed hepatic tumors, he
In the current study, 74 patients received regional FUDR and
systemic irinotecan (Camptosar) in addition to cytoreduction using resection
and cryosurgical ablation to remove all visible disease without affecting
hepatic function; 114 patients underwent cytoreduction alone.
The groups were equivalent in the number and size as well as
the synchroni-city or metachronicity of their liver metastases. Laparoscopy
ruled out extrahepatic disease. The majority of complications were
"minor," Dr. Litvak said.
At 20 months median follow-up, 39% of the combined therapy
group had experienced liver recurrences, compared with 66% of the cytoreduction-only
group, a significant difference.
Furthermore, the combined-therapy patients had significantly
longer progression-free survival (19 months) and overall survival (30.6 months)
than the cytoreduction-only group (10 months and 20 months, respectively).
Seventy-five percent of the combined-therapy group survived 2 years.
These results suggest that cytoreduction alone is a
"questionable" approach for hepatic metastases and that additional
clinical studies of the combined-therapy regimen are needed, Dr. Litvak