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Open Access Highly Accessed Research article

Peri-operative chemotherapy in the management of resectable colorectal cancer pulmonary metastases

Eliza A Hawkes1, George Ladas2, David Cunningham1, Andrew G Nicholson3, Katharina Wassilew3, Yolanda Barbachano4, Gihan Ratnayake1, Sheela Rao1 and Ian Chau1*

Author Affiliations

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

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BMC Cancer 2012, 12:326  doi:10.1186/1471-2407-12-326

Published: 1 August 2012

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

Peri-operative chemotherapy can be safely delivered to CRC patients undergoing pulmonary metastasectomy. Survival in this selected group of patients was favourable.

Keywords:
Colorectal cancer; lung resection; peri-operative chemotherapy