Research article

Importance of response to neoadjuvant chemotherapy in potentially curable colorectal cancer liver metastases

Birgit Gruenberger¹ , Werner Scheithauer¹ , Robert Punzengruber³ , Christoph Zielinski¹ , Dietmar Tamandl² and Thomas Gruenberger²

¹  Department of Medicine, Medical University Vienna, Vienna, Austria

²  Department of Surgery, Medical University Vienna, Vienna, Austria

³  Department of Internal Medicine, LKH Amstetten, Austria

author email corresponding author email

BMC Cancer 2008, 8:120doi:10.1186/1471-2407-8-120

Published:	25 April 2008

Abstract

Background

Surgical resection of liver metastases arising from colorectal cancer is considered the only curative treatment option. However, many patients subsequently experience disease recurrence. We prospectively investigated whether neoadjuvant chemotherapy reduces the risk of recurrence following potentially curative liver resection. Special emphasis was directed to the importance of response.

Methods

50 patients with resectable liver metastases received neoadjuvant XELOX or FOLFOX4 for six cycles (3 months). Complete resection of liver metastases was intended thereafter. Assessments included response rate, postoperative morbidity and recurrence-free survival.

Results

An objective response was observed in 72% of all patients, including two complete responses. Chemotherapy was well tolerated and the majority of adverse events were mild to moderate (grade 1/2). Potentially curative R0 resection was performed in all patients and postoperative complications were observed in only 12%. The median recurrence-free survival was significantly influenced by tumor response with 24.7 months (95% CI: 4.50 to 44.97) in responding patients, 8.2 months (95% CI: 3.09 to 13.31) in patients with stable disease and 3.0 months (95% CI: 0 to 8.91) in patients with progressive disease.

Conclusion

These data suggest that neoadjuvant Oxaliplatin based chemotherapy provides high response rates without increased risk of perioperative morbidity. Response to chemotherapy can lead to long-term recurrence-free survival. Neoadjuvant chemotherapy may identify best candidates for a potentially curative treatment approach.