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Conversion chemotherapy followed by hepatic resection in colorectal cancer with initially unresectable liver-limited metastases

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The best management choice in colorectal cancer patients with unresectable liver-only metastases should be represented by conversion chemotherapy aiming to reduce liver cancer deposits, thereby permitting curative surgery. Fortyeight consecutive stage IV colorectal cancer patients were treated with different chemotherapeutic regimens including biological drugs. Objective responses to chemotherapy were seen in 27 patients (56.2%; 95% CI 42.1-70.2%). Four patients (8.3%) showed complete response, 23 patients (47.9%) partial and 13 patients (27.1%) stable response. Eight patients (16.7%) progressed. The conversion rate was 35.4% (95% CI 21.8-48.9%) with 17 patients suitable for liver resection. Four complete responder patients refused surgery. The remaining 13 patients underwent curative hepatic resection (resection rate 27.1%; 95% CI 14.5-39.6%). The likelihood of a successful conversion chemotherapy appeared significantly related to the best response and to the K-Ras status. Wild-type K-Ras patients undergoing cetuximab therapy showed the best conversion rate. The four-year survival rate was significantly enhanced in converted compared to non-converted patients (57.1 and 0%, respectively), and in resected compared to nonresected patients (53.3 and 10.1%, respectively). Synchronous metastases and no conversion were shown to be the only covariates independently associated with a poorer long-term outcome. The possibility of curative liver surgery significantly prolongs outcome for colorectal cancer patients with unresectable liverlimited metastases. Prospective randomized trials are required to define the conversion rates with biological drugs.
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Document Type: Research Article

Affiliations: 1: Division of Surgical Oncology, ‘F. Magrassi - A. Lanzara’ Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy 2: Division of Medical Oncology, ‘F. Magrassi - A. Lanzara’ Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy 3: Division of General Surgery, Federico II University of Naples School of Medicine, Naples, Italy

Publication date: January 1, 2013

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