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Timing of multimodality therapy for resectable synchronous colorectal liver metastases: a retrospective multi-institutional analysis.

Publication ,  Journal Article
Reddy, SK; Zorzi, D; Lum, YW; Barbas, AS; Pawlik, TM; Ribero, D; Abdalla, EK; Choti, MA; Kemp, C; Vauthey, J-N; Morse, MA; White, RR; Clary, BM
Published in: Ann Surg Oncol
July 2009

The optimal timing of chemotherapy relative to resection of synchronous colorectal liver metastases (SCRLM) is not known. The objective of this retrospective multi-institutional study was to assess the influence of chemotherapy administered before and after hepatic resection on long-term outcomes among patients with initially resectable SCRLM treated from 1995 to 2005. Clinicopathologic data, treatments, and long-term outcomes from patients with initially resectable SCRLM who underwent partial hepatectomy at three hepatobiliary centers were reviewed. Four hundred ninety-nine consecutive patients underwent resection; 297 (59.5%) and 264 (52.9%) were treated with chemotherapy before and after resection. Chemotherapy strategies included pre-hepatectomy alone (n = 148, 24.7%), post-hepatectomy alone (n = 115, 23.0%), perioperative (n = 149, 29.0%), and no chemotherapy (n = 87, 17.4%). Male gender (p = 0.0029, HR = 1.41 [1.12-1.77]), node-positive primary tumor (p = 0.0046, HR = 1.40 [1.11-1.77]), four or more SCRLM (p = 0.0005, HR = 1.65 [1.24-2.18]), and post-hepatectomy chemotherapy treatment for 6 months or longer (p = 0.039, HR = 0.75 [0.57-0.99]) were associated with recurrence-free survival after discovery of SCRLM. Carcinoembryonic antigen >200 ng/ml (p = 0.0003, HR = 2.33 [1.48-3.69]), extrahepatic metastatic disease (p = 0.0025, HR = 2.34 [1.35-4.05]), four or more SCRLM (p = 0.033, HR = 1.43 [1.03-2.00]), and post-hepatectomy chemotherapy treatment for 2 months or longer (p < 0.0001, HR = 0.59 [0.45-0.76]) were associated with overall survival. Pre-hepatectomy chemotherapy was not associated with recurrence-free or overall survival. Patients treated with perioperative chemotherapy had similar outcomes as patients treated with post-hepatectomy chemotherapy only. We conclude that chemotherapy administered after but not before resection of SCRLM was associated with improved recurrence-free and overall survival. However, prospective randomized trials are needed to determine the optimal timing of chemotherapy.

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Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

July 2009

Volume

16

Issue

7

Start / End Page

1809 / 1819

Location

United States

Related Subject Headings

  • Time Factors
  • Survival Analysis
  • Retrospective Studies
  • Oncology & Carcinogenesis
  • Neoadjuvant Therapy
  • Middle Aged
  • Male
  • Liver Neoplasms
  • Humans
  • Hepatectomy
 

Citation

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MLA
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Reddy, S. K., Zorzi, D., Lum, Y. W., Barbas, A. S., Pawlik, T. M., Ribero, D., … Clary, B. M. (2009). Timing of multimodality therapy for resectable synchronous colorectal liver metastases: a retrospective multi-institutional analysis. Ann Surg Oncol, 16(7), 1809–1819. https://doi.org/10.1245/s10434-008-0181-y
Reddy, Srinevas K., Daria Zorzi, Ying Wei Lum, Andrew S. Barbas, Timothy M. Pawlik, Dario Ribero, Eddie K. Abdalla, et al. “Timing of multimodality therapy for resectable synchronous colorectal liver metastases: a retrospective multi-institutional analysis.Ann Surg Oncol 16, no. 7 (July 2009): 1809–19. https://doi.org/10.1245/s10434-008-0181-y.
Reddy SK, Zorzi D, Lum YW, Barbas AS, Pawlik TM, Ribero D, et al. Timing of multimodality therapy for resectable synchronous colorectal liver metastases: a retrospective multi-institutional analysis. Ann Surg Oncol. 2009 Jul;16(7):1809–19.
Reddy, Srinevas K., et al. “Timing of multimodality therapy for resectable synchronous colorectal liver metastases: a retrospective multi-institutional analysis.Ann Surg Oncol, vol. 16, no. 7, July 2009, pp. 1809–19. Pubmed, doi:10.1245/s10434-008-0181-y.
Reddy SK, Zorzi D, Lum YW, Barbas AS, Pawlik TM, Ribero D, Abdalla EK, Choti MA, Kemp C, Vauthey J-N, Morse MA, White RR, Clary BM. Timing of multimodality therapy for resectable synchronous colorectal liver metastases: a retrospective multi-institutional analysis. Ann Surg Oncol. 2009 Jul;16(7):1809–1819.
Journal cover image

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

July 2009

Volume

16

Issue

7

Start / End Page

1809 / 1819

Location

United States

Related Subject Headings

  • Time Factors
  • Survival Analysis
  • Retrospective Studies
  • Oncology & Carcinogenesis
  • Neoadjuvant Therapy
  • Middle Aged
  • Male
  • Liver Neoplasms
  • Humans
  • Hepatectomy