This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kemeny, M. M. Articles by Benson, A. B. Search for Related Content PubMed PubMed Citation Articles by Kemeny, M. M. Articles by Benson, A. B., III Social Bookmarking                            What's this?

Combined-Modality Treatment for Resectable Metastatic Colorectal Carcinoma to the Liver: Surgical Resection of Hepatic Metastases in Combination With Continuous Infusion of Chemotherapy—An Intergroup Study

From the Cancer Center of Queens, Queens Hospital Center, Queens, NY; Dana-Farber Cancer Institute, Boston, MA; Morristown Memorial Hospital, Morristown, NJ; Fox Chase Cancer Center and University of Pennsylvania, Philadelphia, PA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; and Royal Perth Hospital, Perth, Australia.

Address reprint requests to M. Margaret Kemeny, MD, Cancer Center of Queens, 82-68 164th St, N Building, Rm 634, Jamaica, NY 11432; email: kemenym{at}nychhc.org

PURPOSE: Despite technical improvements that have minimized the morbidity and mortality of hepatic surgery, the long-term outcome of resection of hepatic metastases of colorectal cancer remains poor, with the majority of patients experiencing treatment failure in the liver. Because arterial chemotherapy regimens targeted to the liver have demonstrated high response rates, an intergroup trial of adjuvant therapy for patients undergoing hepatic resection of liver metastases from colorectal cancer was initiated.

PATIENTS AND METHODS: Patients with one to three potentially resectable metastases were randomized preoperatively to receive no further therapy (control arm, 56 patients) or postoperative hepatic arterial floxuridine combined with intravenous continuous-infusion fluorouracil (chemotherapy arm, 53 patients). After exclusion of patients identified as ineligible for the planned treatment at the time of surgery, there were 45 control patients and 30 on the chemotherapy arm. The study was powered to evaluate improvement in time to recurrence and hepatic disease-free survival, not overall survival.

RESULTS: The 4-year recurrence-free rate was 25% for the control arm and 46% for the chemotherapy group (P = .04). The 4-year liver recurrence-free rate was 43% in the control group and 67% in the chemotherapy group (P = .03). The median survival of the 75 assessable patients was 49 months for the control arm and 63.7 months for the chemotherapy arm (P = .60). The median survival of all 109 patients was 47 months for the control arm compared with 34 months for the chemotherapy arm (P = .19)

CONCLUSION: These data demonstrate that adjuvant intra-arterial and intravenous chemotherapy was beneficial in prolonging time to recurrence and pre-venting hepatic recurrence after hepatic resection of colorectal cancer.

The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				D. J. Gallagher and N. E. Kemeny Colorectal Hepatic Metastases: Adjuvant Chemotherapy and Survival J. Clin. Oncol., July 10, 2009; 27(20): e18 - e19. [Full Text] [PDF]

				N. Kemeny, M. Capanu, M. D'Angelica, W. Jarnagin, D. Haviland, R. Dematteo, and Y. Fong Phase I trial of adjuvant hepatic arterial infusion (HAI) with floxuridine (FUDR) and dexamethasone plus systemic oxaliplatin, 5-fluorouracil and leucovorin in patients with resected liver metastases from colorectal cancer Ann. Onc., July 1, 2009; 20(7): 1236 - 1241. [Abstract] [Full Text] [PDF]

				M. Ychou, W. Hohenberger, S. Thezenas, M. Navarro, J. Maurel, C. Bokemeyer, E. Shacham-Shmueli, F. Rivera, C. Kwok-Keung Choi, and A. Santoro A randomized phase III study comparing adjuvant 5-fluorouracil/folinic acid with FOLFIRI in patients following complete resection of liver metastases from colorectal cancer Ann. Onc., June 30, 2009; (2009) mdp236v1. [Abstract] [Full Text] [PDF]

				D. G. Power and N. E. Kemeny The role of floxuridine in metastatic liver disease Mol. Cancer Ther., May 1, 2009; 8(5): 1015 - 1025. [Abstract] [Full Text] [PDF]

				M. T. Lee, J. J. Kim, R. Dinniwell, J. Brierley, G. Lockwood, R. Wong, B. Cummings, J. Ringash, R. V. Tse, J. J. Knox, et al. Phase I Study of Individualized Stereotactic Body Radiotherapy of Liver Metastases J. Clin. Oncol., April 1, 2009; 27(10): 1585 - 1591. [Abstract] [Full Text] [PDF]

				E. Mitry, A. L.A. Fields, H. Bleiberg, R. Labianca, G. Portier, D. Tu, D. Nitti, V. Torri, D. Elias, C. O'Callaghan, et al. Adjuvant Chemotherapy After Potentially Curative Resection of Metastases From Colorectal Cancer: A Pooled Analysis of Two Randomized Trials J. Clin. Oncol., October 20, 2008; 26(30): 4906 - 4911. [Abstract] [Full Text] [PDF]

				S. R. Alberts and L. D. Wagman Chemotherapy for Colorectal Cancer Liver Metastases Oncologist, October 1, 2008; 13(10): 1063 - 1073. [Abstract] [Full Text] [PDF]

				M. Ychou, D. Azria, C. Menkarios, P. Faurous, F. Quenet, B. Saint-Aubert, P. Rouanet, M. Pelegrin, C. Bascoul-Mollevi, D. Guerreau, et al. Adjuvant Radioimmunotherapy Trial with Iodine-131-Labeled Anti-Carcinoembryonic Antigen Monoclonal Antibody F6 F(ab')2 after Resection of Liver Metastases from Colorectal Cancer Clin. Cancer Res., June 1, 2008; 14(11): 3487 - 3493. [Abstract] [Full Text] [PDF]

				B. Sandoval and Y. Fong Adjuvant Therapy after Resection of Hepatic Colorectal Metastases Ann. Surg. Oncol., January 1, 2008; 15(1): 9 - 10. [Full Text] [PDF]

				S. R. Alberts Evolving Role of Chemotherapy in Resected Liver Metastases J. Clin. Oncol., November 1, 2006; 24(31): 4952 - 4953. [Full Text] [PDF]

				G. Portier, D. Elias, O. Bouche, P. Rougier, J.-F. Bosset, J. Saric, J. Belghiti, P. Piedbois, R. Guimbaud, B. Nordlinger, et al. Multicenter Randomized Trial of Adjuvant Fluorouracil and Folinic Acid Compared With Surgery Alone After Resection of Colorectal Liver Metastases: FFCD ACHBTH AURC 9002 Trial J. Clin. Oncol., November 1, 2006; 24(31): 4976 - 4982. [Abstract] [Full Text] [PDF]

				D. L. Bartlett, J. Berlin, G. Y. Lauwers, W. A. Messersmith, N. J. Petrelli, and A. P. Venook Chemotherapy and Regional Therapy of Hepatic Colorectal Metastases: Expert Consensus Statement Ann. Surg. Oncol., October 1, 2006; 13(10): 1284 - 1292. [Full Text] [PDF]

				D. K. Monga and M. J. O'Connell Surgical Adjuvant Therapy for Colorectal Cancer: Current Approaches and Future Directions Ann. Surg. Oncol., August 1, 2006; 13(8): 1021 - 1034. [Abstract] [Full Text] [PDF]

				L. J. Kohman Cancer and leukemia group B surgery committee. Clin. Cancer Res., June 1, 2006; 12(11): 3622s - 3627s. [Abstract] [Full Text] [PDF]

				L. L. Gluud Bias in Clinical Intervention Research Am. J. Epidemiol., March 15, 2006; 163(6): 493 - 501. [Abstract] [Full Text] [PDF]

				M. M. Kemeny Expressing the Surgery First Position on Treatment of Synchronous Colorectal Metastases in the Asymptomatic Patient Ann. Surg. Oncol., February 1, 2006; 13(2): 140 - 141. [Full Text] [PDF]

				E. S. Ong, M. Poirier, and N. J. Espat Hepatic Intra-Arterial Chemotherapy Ann. Surg. Oncol., February 1, 2006; 13(2): 142 - 149. [Full Text] [PDF]

				R. C. G. Martin II, S. A. McGuffin, L. M. Roetzer, T. D. Abell, and J. L. Studts Method of Presenting Oncology Treatment Outcomes Influences Patient Treatment Decision-Making in Metastatic Colorectal Cancer Ann. Surg. Oncol., January 1, 2006; 13(1): 86 - 95. [Abstract] [Full Text] [PDF]

				G. Chong and D. Cunningham Improving Long-Term Outcomes for Patients With Liver Metastases From Colorectal Cancer J. Clin. Oncol., December 20, 2005; 23(36): 9063 - 9066. [Full Text] [PDF]

				W. D. Ensminger A Role for Hepatic-Directed Chemotherapy in Colorectal Liver Metastases J. Clin. Oncol., August 1, 2005; 23(22): 4815 - 4817. [Full Text] [PDF]

				M. Faynsod, L. D. Wagman, J. Longmate, M. Carroll, and L. A. Leong Improved Hepatic Toxicity Profile of Portal Vein Adjuvant Hepatic Infusional Chemotherapy J. Clin. Oncol., August 1, 2005; 23(22): 4876 - 4880. [Abstract] [Full Text] [PDF]

				T. Delaunoit, S. R. Alberts, D. J. Sargent, E. Green, R. M. Goldberg, J. Krook, C. Fuchs, R. K. Ramanathan, S. K. Williamson, R. F. Morton, et al. Chemotherapy permits resection of metastatic colorectal cancer: experience from Intergroup N9741 Ann. Onc., March 1, 2005; 16(3): 425 - 429. [Abstract] [Full Text] [PDF]

				J. A. Meyerhardt and R. J. Mayer Systemic Therapy for Colorectal Cancer N. Engl. J. Med., February 3, 2005; 352(5): 476 - 487. [Full Text] [PDF]

				M. Schindl, S. J. Wigmore, E. J. Currie, F. Laengle, and O. J. Garden Prognostic Scoring in Colorectal Cancer Liver Metastases: Development and Validation Arch Surg, February 1, 2005; 140(2): 183 - 189. [Abstract] [Full Text] [PDF]

				J. Taieb, P. Artru, F. Paye, C. Louvet, N. Perez, T. Andre, B. Gayet, M. Hebbar, F. M. Goebel, C. Tournigand, et al. Intensive Systemic Chemotherapy Combined With Surgery for Metastatic Colorectal Cancer: Results of a Phase II Study J. Clin. Oncol., January 20, 2005; 23(3): 502 - 509. [Abstract] [Full Text] [PDF]

				S. Sadahiro, T. Suzuki, K. Ishikawa, T. Nakamura, Y. Tanaka, K. Ishizu, S. Yasuda, H. Makuuchi, and C. Murayama Estimation of the Time of Pulmonary Metastasis in Colorectal Cancer Patients with Isolated Synchronous Liver Metastasis Jpn. J. Clin. Oncol., January 1, 2005; 35(1): 18 - 22. [Abstract] [Full Text] [PDF]

				A. D. Cohen and N. E. Kemeny An Update on Hepatic Arterial Infusion Chemotherapy for Colorectal Cancer Oncologist, December 1, 2003; 8(6): 553 - 566. [Abstract] [Full Text] [PDF]

				N. Kemeny, W. Jarnagin, M. Gonen, J. Stockman, L. Blumgart, D. Sperber, A. Hummer, and Y. Fong Phase I/II Study of Hepatic Arterial Therapy With Floxuridine and Dexamethasone in Combination With Intravenous Irinotecan As Adjuvant Treatment After Resection of Hepatic Metastases From Colorectal Cancer J. Clin. Oncol., September 1, 2003; 21(17): 3303 - 3309. [Abstract] [Full Text] [PDF]

				V. Mazzaferro, J. Coppa, M. G. Carrabba, L. Rivoltini, M. Schiavo, E. Regalia, L. Mariani, T. Camerini, A. Marchiano, S. Andreola, et al. Vaccination with Autologous Tumor-derived Heat-Shock Protein Gp96 after Liver Resection for Metastatic Colorectal Cancer Clin. Cancer Res., August 1, 2003; 9(9): 3235 - 3245. [Abstract] [Full Text] [PDF]

				C. L. Scaife, S. A. Curley, F. Izzo, P. Marra, P. Delrio, B. Daniele, F. Cremona, J. E. Gershenwald, J. L. Chase, R. D. Lozano, et al. Feasibility of Adjuvant Hepatic Arterial Infusion of Chemotherapy After Radiofrequency Ablation With or Without Resection in Patients With Hepatic Metastases From Colorectal Cancer Ann. Surg. Oncol., May 1, 2003; 10(4): 348 - 354. [Abstract] [Full Text] [PDF]

				C. Penna and B. Nordlinger Surgery of liver metastases from colorectal cancer: new promises Br. Med. Bull., December 1, 2002; 64(1): 127 - 140. [Abstract] [Full Text] [PDF]

				B. Nordlinger and P. Rougier Liver Metastases From Colorectal Cancer: The Turning Point J. Clin. Oncol., March 15, 2002; 20(6): 1442 - 1445. [Full Text] [PDF]