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. 2011 Jul;4(4 Suppl 1):S2-8.

Recent Advances in the Curative Treatment of Colorectal Liver Metastases

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Free PMC article

Recent Advances in the Curative Treatment of Colorectal Liver Metastases

Andreas Andreou et al. Gastrointest Cancer Res. .
Free PMC article

Abstract

Liver resection provides the basis for curative treatment of colorectal liver metastases (CLM), achieving 5-year survival rates as high as 58%. Use of this approach is limited by the number of patients whose CLM are resectable at the time of initial presentation and the risk of early recurrence after surgery, justifying development of modern perioperative chemotherapy regimens. Chemotherapy-associated hepatotoxicity led to development of standardized treatment strategies that balance the duration and timing of preoperative chemotherapy to minimize postoperative morbidity. The current challenge in the effort to offer curative treatment for CLM is selection of patients who will most benefit from an aggressive surgical approach. New end points of preoperative chemotherapy such as pathologic response and new radiologic response criteria have been evaluated as predictive factors for survival after liver resection and provide useful support in selecting patients for surgery.

Figures

Figure 1.
Figure 1.
Percentage of patients who underwent hepatectomy for CLM increased significantly after 1998 and stabilized at a percentage of approximately 20% in 2002. Adapted from Kopetz et al
Figure 2.
Figure 2.
(A) Percentage of patients with <25% residual viable tumor cells after preoperative chemotherapy with 5-FU/oxaliplatin only or 5-FU/oxaliplatin plus bevacizumab. (B) Percentage of total residual viable tumor cells in groups of patients stratified according to the duration of preoperative chemotherapy. Adapted from Ribero et al
Figure 3.
Figure 3.
Correlation between pathologic response to preoperative chemotherapy and overall survival after liver resection for CLM. Adapted from Blazer et al
Figure 4.
Figure 4.
Morphologic response criteria in patients with CLM who received preoperative therapy that included bevacizumab. Adapted from Chun et al
Figure 5.
Figure 5.
Correlation between morphologic response criteria (A) or RECIST criteria (B) and percentage of residual viable tumor cells after preoperative therapy that included bevacizumab. Adapted from Chun et al
Figure 6.
Figure 6.
Association of overall survival with response to chemotherapy using morphologic (A) or RECIST criteria (B) in 82 patients with unresectable CLM. Adapted from Chun et al
Figure 7.
Figure 7.
Overall survival in patients with advanced bilateral CLM who completed two-stage hepatectomy compared to the survivals of patients who were treated with chemotherapy only or underwent only the first stage of the two-stage strategy. Adapted from Brouquet et al

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