Oxaliplatin, fluorouracil, and leucovorin for patients with unresectable liver-only metastases from colorectal cancer: A North Central Cancer Treatment Group Phase II study
Oxaliplatin, fluorouracil, and leucovorin for patients with unresectable liver-only metastases from colorectal cancer: A North Central Cancer Treatment Group Phase II study
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DOI：
10.1200/jco.2005.07.740
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发表时间：
2005-12-20
影响因子：
45.3
通讯作者：
Donohue, JH
中科院分区：
文献类型：
--
作者：
Alberts, SR;Horvath, WL;Donohue, JH
目的：结直肠癌肝转移的手术切除已经进行了广泛的评估和审查。新辅助化疗的使用，以提高切除的疾病，是不是最佳切除的可能性还没有得到很好的study.Patients和方法：肝转移的结直肠癌患者认为不是最佳切除的外科医生在肝脏手术的专业知识接受氟尿嘧啶，亚叶酸钙，奥沙利铂（FOLFOX 4）。定期重新评估患者的可切除性。手术反应分为完全可切除（S-CR）、部分可切除（S-PR）或不可切除（S-UR）。研究设计指定的39例患者，与两个或两个以上的S-CR被认为是有前途的活动方面的证据增加S-CR率。25例患者（60%）通过系列成像实现肿瘤缩小。17例患者（40%）在中位化疗6个月后接受了手术（S-CR，n = 14; S-PR，n = 1; S-UR，n = 2）。术后平均随访22个月（范围13 ~ 32个月），15例S-CR和S-PR患者中有11例复发。中位生存时间为26 months.Conclusion：我们的数据表明，FOLFOX 4在结直肠癌肝转移患者中具有较高的缓解率（完全缓解、部分缓解或缓解减少），允许部分患者成功切除疾病，最初未被判定为最佳切除。然而，手术后观察到高复发率，其中73%的患者涉及肝脏。根据本试验中观察到的有希望的结果，指示进一步的试验。
Purpose: Surgical resection of liver-only metastases from colorectal cancer has undergone extensive evaluation and review. The use of neoadjuvant chemotherapy to improve the likelihood of resection in disease that is not optimally resectable has not been as well studied.Patients and Methods: Patients with liver-only metastases from colorectal cancer deemed not optimally resectable by a surgeon with expertise in liver surgery received fluorouracil, leucovorin, and oxaliplatin (FOLFOX4). Patients were periodically reassessed for resectability. Surgical response was classified as completely resectable (S-CR), partially resectable (S-PR), or unresectable (S-UR). Study design specified the accrual of 39 patients, with two or more S-CRs considered evidence of promising activity with respect to increasing the S-CR rate.Results Forty-two of 44 patients were assessable for this analysis. Twenty-five patients (60%) had tumor reduction by serial imaging. Seventeen patients (40%) underwent surgery (S-CR, n = 14; S-PR, n = 1; and S-U R, n = 2) after a median of 6 months of chemotherapy. With a median postsurgical follow-up of 22 months (range, 13 to 32 months), 11 recurrences have occurred in the 15 S-CR and S-PR patients. Median survival time was 26 months.Conclusion: Our data suggest that FOLFOX4 has a high response rate (complete response, partial response, or reduction) in patients with liver-only metastases from colorectal cancer, allowing for successful resection of disease in a portion of patients initially not judged to be optimally resectable. However, a high recurrence rate after surgery was observed, which, in 73% of patients, involved the liver. Further trials are indicated based on the promising results observed in this trial.