Fulltext

Neoadjuvant Chemotherapy in Patients with Stage IV Colorectal Cancer: A Comparison of Histological Response in Liver Metastases, Primary Tumors, and Regional Lymph Nodes

Gervaz, Pascal ; Rubbia-Brandt, Laura ; Andres, Axel ; Majno, Pietro ; Roth, Arnaud ; Morel, Philippe ; Mentha, Gilles

In: Annals of Surgical Oncology, 2010, vol. 17, no. 10, p. 2714-2719

Aggiungi alla tua lista
    Titre
    • Neoadjuvant Chemotherapy in Patients with Stage IV Colorectal Cancer: A Comparison of Histological Response in Liver Metastases, Primary Tumors, and Regional Lymph Nodes
    Auteur
    • Gervaz, Pascal. Department of Surgery, University Hospital Geneva, Geneva, Switzerland
    • Rubbia-Brandt, Laura. Department of Pathology, University Hospital Geneva, Geneva, Switzerland
    • Andres, Axel. Department of Surgery, University Hospital Geneva, Geneva, Switzerland
    • Majno, Pietro. Department of Surgery, University Hospital Geneva, Geneva, Switzerland
    • Roth, Arnaud. Department of Oncology, University Hospital Geneva, Geneva, Switzerland
    • Morel, Philippe. Department of Surgery, University Hospital Geneva, Geneva, Switzerland
    • Mentha, Gilles. Department of Surgery, University Hospital Geneva, Geneva, Switzerland
    Type de document
    • Postprint
    Langue
    • Inglese
    Publié dans
    • Annals of Surgical Oncology, 2010, vol. 17, no. 10, p. 2714-2719. Springer-Verlag
    Autre version électronique
    Classification
    • Santé
    Identifiant OAI-PMH
    • oai:doc.rero.ch:312831
    Summary
    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 3-4months. 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