Peri-operative chemotherapy in the management of resectable colorectal cancer pulmonary metastases
1 Department of Medicine, Royal Marsden Hospital, Downs Road, Sutton, Surrey, UK SM2 5PT
2 Department of Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
3 Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, and National Heart and Lung Division, Imperial College, London, UK
4 Department of Clinical Research and Development, Royal Marsden Hospital, London and Surrey, UK
BMC Cancer 2012, 12:326 doi:10.1186/1471-2407-12-326Published: 1 August 2012
Surgery is often advocated in patients with resectable pulmonary metastases from colorectal cancer (CRC). Our study aims to evaluate peri-operative chemotherapy in patients with metastastic CRC undergoing pulmonary metastasectomy.
Patients treated for CRC who underwent pulmonary metastasectomy by a single surgeon were identified. Outcome measures included survival, peri-operative complications, radiological and histological evidence of chemotherapy-induced lung toxicities.
Between 1997 and 2009, 51 eligible patients were identified undergoing a total of 72 pulmonary resections. Thirty-eight patients received peri-operative chemotherapy, of whom 9 received an additional biological agent. Five-year overall survival rate was 72% in the whole cohort - 74% and 68% in those who received peri-operative chemotherapy (CS) and those who underwent surgery alone (S) respectively. Five-year relapse free survival rate was 31% in the whole cohort - 38% and ≤18% in CS and S groups respectively. Only 8% had disease progression during neoadjuvant chemotherapy. There were no post-operative deaths. Surgical complications occurred in only 4% of patients who received pre-operative chemotherapy. There was neither radiological nor histological evidence of lung toxicity in resected surgical specimens.
Peri-operative chemotherapy can be safely delivered to CRC patients undergoing pulmonary metastasectomy. Survival in this selected group of patients was favourable.