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Treatment of extensive metastatic colorectal cancer to the liver with systemic and hepatic arterial infusion chemotherapy and two-stage hepatic resection: the role of salvage therapy for recurrent disease.

Publication ,  Journal Article
Cardona, K; Donataccio, D; Kingham, TP; Allen, PJ; DeMatteo, RP; Fong, Y; Jarnagin, WR; Cercek, A; Kemeny, NE; D'Angelica, MI
Published in: Ann Surg Oncol
March 2014

BACKGROUND: Two-stage hepatectomy (TSH) has been adopted as a treatment modality for resection of advanced colorectal liver metastases (CRLM). This study analyzed the recurrence pattern, salvage rate, and survival after TSH combined with systemic and regional chemotherapy. METHODS: A retrospective review of a prospective database identified patients who underwent a TSH for CRLM was performed and outcome data analyzed. RESULTS: From September 2000 to May 2009, a total of 40 patients were eligible for TSH, and 88 % completed both resections. Of the 35 resected patients, the median number of tumors was 8, with 38 % having a tumor >5 cm and 35 % having a carcinoembryonic antigen value >200 ng/ml. All patients received systemic chemotherapy, and 86 % received regional therapy with hepatic artery infusion. Median follow-up for survivors was 40 months; median disease-specific survival was 52 months, and 5-year disease-specific survival was 49 %. The combined rate of major complication for all procedures was 45 % with no operative deaths. Median recurrence-free survival was 11 months with a 3-year probability of recurrence of 81 %. Disease recurrence occurred in 27 patients (77 %), with the liver (42 %) and lung (37 %) being the most common sites. Sixteen of these patients (60 %) underwent salvage therapy via either surgery and/or ablation, 7 (44 %) of whom were free of disease at a median follow-up of 54 months. CONCLUSIONS: TSH combined with systemic and hepatic artery infusion chemotherapy is an effective treatment strategy for selected patients with advanced CRLM. These patients are at considerable risk of local and distant recurrence; however, the majority can be salvaged, and long-term survival can be achieved.

Duke Scholars

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

March 2014

Volume

21

Issue

3

Start / End Page

815 / 821

Location

United States

Related Subject Headings

  • Survival Rate
  • Salvage Therapy
  • Retrospective Studies
  • Prognosis
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Neoplasm Recurrence, Local
  • Neoplasm Grading
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Cardona, K., Donataccio, D., Kingham, T. P., Allen, P. J., DeMatteo, R. P., Fong, Y., … D’Angelica, M. I. (2014). Treatment of extensive metastatic colorectal cancer to the liver with systemic and hepatic arterial infusion chemotherapy and two-stage hepatic resection: the role of salvage therapy for recurrent disease. Ann Surg Oncol, 21(3), 815–821. https://doi.org/10.1245/s10434-013-3351-5
Cardona, Kenneth, Dino Donataccio, T Peter Kingham, Peter J. Allen, Ronald P. DeMatteo, Yuman Fong, William R. Jarnagin, Andrea Cercek, Nancy E. Kemeny, and Michael I. D’Angelica. “Treatment of extensive metastatic colorectal cancer to the liver with systemic and hepatic arterial infusion chemotherapy and two-stage hepatic resection: the role of salvage therapy for recurrent disease.Ann Surg Oncol 21, no. 3 (March 2014): 815–21. https://doi.org/10.1245/s10434-013-3351-5.
Cardona K, Donataccio D, Kingham TP, Allen PJ, DeMatteo RP, Fong Y, Jarnagin WR, Cercek A, Kemeny NE, D’Angelica MI. Treatment of extensive metastatic colorectal cancer to the liver with systemic and hepatic arterial infusion chemotherapy and two-stage hepatic resection: the role of salvage therapy for recurrent disease. Ann Surg Oncol. 2014 Mar;21(3):815–821.
Journal cover image

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

March 2014

Volume

21

Issue

3

Start / End Page

815 / 821

Location

United States

Related Subject Headings

  • Survival Rate
  • Salvage Therapy
  • Retrospective Studies
  • Prognosis
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Neoplasm Recurrence, Local
  • Neoplasm Grading
  • Middle Aged
  • Male