Review
Copyright ©2009 The WJG Press and Baishideng.
World J Gastroenterol. Aug 21, 2009; 15(31): 3855-3864
Published online Aug 21, 2009. doi: 10.3748/wjg.15.3855
Table 1 Outcomes related to secondary hepatic resection in patients treated with oxaliplatin-based chemotherapy
StudynRegimenResponse rate (%)Resection rate (%)R0 rate (%)MS (mo)
Unselected populations
GERCOR[14]111FOLFOX654.022.013.0NYR
Tournigand et al[24]311FOLFOX458.517.711.338.9
Tournigand et al[24]309FOLFOX7159.215.29.443.0
Colucci et al[23]182FOLFOX434.04.4NRNR
Liver metastases only
Alberts et al[25]44FOLFOX460.040.033.3NR
Table 2 Outcomes related to secondary hepatic resection in patients treated with irinotecan-based chemotherapy
StudynRegimenResponse rate (%)Resection rate (%)R0 rate (%)MS (mo)
Unselected populations
Tournigand et al[14]109FOLFIRI61.09.07.047
Colucci et al[23]178FOLFIRI36.05.1NRNR
Liver metastases only
Pozzo et al[26]405-FU/LV, irinotecan47.540.032.5NYR
Zelek et al[27]315-FU/LV, irinotecan, and HAI of pirarubicin48.035.029.0NYR
Ho et al[28]405-FU/LV, irinotecan55.010.0NRNR
Table 3 Randomized trials comparing first-line chemotherapy with or without cetuximab or bevacizumab that report secondary resection rates
StudynRegimenResponse rate (%)Resection rate (%)R0 rate (%)R0 rate in liver-only disease (%)PFS (mo)
Cetuximab
CRYSTAL[37]559FOLFIRI38.72.51.54.58.0
559FOLFIRI + cetuximab46.96.04.39.88.9
Bevacizumab
Hurwitz et al[38]411IFL34.8< 2%NRNR6.2
402IFL + bevacizumab44.8< 2%NRNR10.6
NO16966[3940]701CT149.04.9NR11.58.0
699CT1 + bevacizumab47.06.3NR12.39.4
Table 4 Liver injury by chemotherapy regimen[12]
RegimenSinusoidal dilation1 (n = 22)
Steatosis > 30% (n = 36)
Steatohepatitis2 (n = 34)
Yes (%)No (%)P value3Yes (%)No (%)P value3Yes (%)No (%)P value3
No CT298991496
FU0100NS1783NS595NS
IRI496NS1189NS20800.001
OX19810.00001496NS694NS
Other0100NS892NS0100NS
Table 5 Secondary resection in patients with initially unresectable liver metastases
Improve patient selection through early and continued consultation in a multidisciplinary team approach, including close cooperation among a radiologist, medical oncologist, and surgeon with experience in liver resection
Conduct surgical evaluation at baseline and, if disease is initially unresectable, reevaluation at intervals during therapy to determine if conversion to resectability has been achieved
Set appropriate goals of therapy (best response, conversion to resectable disease, or palliation)
Determine length of therapy, with consideration for the risk of potential toxicities
Consider the safety profile of individual agents and the risks of overtreatment, including hepatotoxicity
If the treatment goal is conversion to resection, treat to resectability and not to best response