Background
No standard treatment for advanced rectal cancer with synchronous resectable liver
metastases (LM) has been defined. Radiochemotherapy prior to simultaneous or staged
curative resection of both primary tumor and LM is one of the treatment options available.
The response of LM to radiochemotherapy has never been evaluated and, in particular,
the risk for progression of LM is unknown.
Methods
Between 2000 and 2011, 20 patients underwent preoperative radiochemotherapy for advanced
rectal cancer with synchronous limited but resectable LM. Imaging responses of LM
to radiochemotherapy were analyzed on per-patient and per-lesion bases using Response
Evaluation Criteria in Solid Tumors (RECIST) criteria.
Results
Of the patients, 20 had 41 LM; 15 of the 20 patients (75%) had rectal cancer with
expected circumferential margins <1 mm on magnetic resonance imaging (MRI), and 50%
had a solitary LM before treatment. Of the patients, 13 received oxaliplatin-based
chemotherapy, and 7 received fluorouracil (FU)-based chemotherapy in combination with
radiation. Of the 41 LM, 7 showed complete response (17%); 7 showed partial response
(17%); 20 remained stable (49%); and 7 progressed (17%). Of the 25 LM treated with
oxaliplatin-based chemotherapy, only 1 LM (4%) progressed. All 20 patients were suitable
for resection of LM with curative intent after the radiochemotherapy.
Conclusion
In patients with advanced rectal cancer and synchronous limited, but resectable LM,
the risk for progression of LM during radiochemotherapy is low, especially if the
chemotherapy regimen contains oxaliplatin. This low risk does not compromise a curative
surgical approach to LM.
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Article info
Publication history
Published online: April 18, 2013
Accepted:
February 7,
2013
Footnotes
Supported by grants from l'Association pour la Recherche en Oncologie Digestive.
Identification
Copyright
© 2013 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
