Neoadjuvant Chemotherapy in Patients with Stage IV Colorectal Cancer: A Comparison of Histological Response in Liver Metastases, Primary Tumors, and Regional Lymph Nodes
| Autor: | Philippe Morel, Pascal Gervaz, Laura Rubbia-Brandt, Axel Andres, Gilles Mentha, Pietro Majno, Arnaud Roth |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Oncology
Adult Male medicine.medical_specialty Organoplatinum Compounds Colorectal cancer medicine.medical_treatment Leucovorin Adenocarcinoma Irinotecan Surgical oncology Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans Prospective Studies Survival rate Neoadjuvant therapy Aged Neoplasm Staging business.industry Liver Neoplasms Middle Aged medicine.disease Primary tumor Neoadjuvant Therapy Oxaliplatin Survival Rate Treatment Outcome Lymphatic Metastasis Surgery Camptothecin Female Lymph Fluorouracil Lymph Nodes business Colorectal Neoplasms medicine.drug |
| Popis: | Background. We report the histopathological results of a novel ‘‘inversed’’ strategy designed to manage patients with colorectal cancer (CRC) who have synchronous liver metastases by using chemotherapy first, liver surgery second, and resection of the primary tumor as a final step. This study was designed to compare the response to chemotherapy in liver metastases, primary tumors, and locoregional lymph nodes. Methods. Twenty-nine patients with stage IV CRC received a combination of oxaliplatin, irinotecan, 5-fluorouracil, and leucovorin (OCFL) for 3–4 months. Histological response to chemotherapy was assessed by using a tumor regression grading (TRG) score based on presence of residual tumor cells and extent of fibrosis. Results. Median age of patients was 56 (range, 37–69) years. Primary tumor location was right colon ( n= 5), left colon ( n= 7), and rectum ( n= 17 patients). TRG scores correlated across disease sites (Spearman correlation coefficients for TRG in the primary tumor and lymph nodes was 0.59 [ P= 0.005]; for the primary tumor and metastases 0.44 [ P= 0.021]; and for lymph nodes and metastases 0.58 [ P= 0.006]). Complete absence or poor tumor response (TRG4/5) was significantly more frequent in primary tumors (35.7%) and locoregional lymph nodes (38%) than in liver metastases (6.9%; McNemar test, P= 0.02). Two patients had a complete pathologic response (pT0N0M0). Conclusions. In patients with stage IV colorectal cancer, liver metastases exhibit a better histological response than primary tumors to OCFL neoadjuvant chemotherapy. |
| Databáze: | OpenAIRE |
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