Chemotherapy after portal vein embolization to protect against tumor growth during liver hypertrophy before hepatectomy

IMPORTANCE Portal vein embolization improves the safety of liver resection by increasing the size of residual liver, but the embolization may increase tumor growth during the waiting period before definitive hepatectomy. OBJECTIVE To determine whether the administration of chemotherapy mitigates tumor growth after portal vein embolization (PVE) performed before major hepatectomy for metastatic colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS Review of prospectively collected data at Memorial-Sloan Kettering Cancer Center was conducted. The database included patients subjected to PVE before major hepatectomy for metastatic colorectal cancer. MAIN OUTCOMES AND MEASURES Lesions in both the embolized and nonembolized lobes of the liver before and 1 month after PVE were measured and Response Evaluation Criteria in Solid Tumors were applied to assess disease status. Assessment of survival was based on receipt of post-PVE chemotherapy and then stratified by subsequent resectability. RESULTS Two hundred eight tumors were measured in 64 patients; 53 tumors were in patients undergoing post-PVE chemotherapy. Approximately one-third of the lesions progressed after PVE when no chemotherapy was administered. This did not differ significantly according to whether tumors were ipsilateral or contralateral to the PVE. When chemotherapy was administered, there was a significantly lower rate of progression (18.9%, P =.03). In long-term follow-up, treatment with post-PVE chemotherapy was also independently associated with improved survival (P <.006). CONCLUSIONS AND RELEVANCE Chemotherapy does not retard growth of the liver after PVE and may prevent cancer progression. Thus, the combination of PVE and chemotherapymay enhance both oncologic and operative safety. Copyright © 2013 American Medical Association. All rights reserved.

Duke Scholars

Author Peter Allen Surgical Oncology