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Chemo + Cytoreduction Ups Survival in Liver Met Patients

Chemo + Cytoreduction Ups Survival in Liver Met Patients

WASHINGTON—Colorectal 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 said.

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 said. 

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