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      Centralization of Liver Cancer Surgery and Impact on Multidisciplinary Teams Working on Stage IV Colorectal Cancer

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          Abstract

          Surgical resection is the most effective treatment approach for colorectal liver metastases but only a minority of patients is suitable for upfront surgery. The treatment strategies of stage IV colorectal cancer have shifted towards a continuum of care in which medical and surgical treatment combinations are tailored to the clinical setting of the individual patient. The optimization of treatment through appropriate decision-making and multimodal therapy for stage IV colorectal cancer require a joint multidisciplinary meeting in a centralized liver cancer unit.

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          Metastatic colorectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

          E Van Cutsem, A Cervantes, B Nordlinger … (2014)
          Article 0 comments Cited 400 times – based on 0 reviews     Review now
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            Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial

            Bernard Nordlinger, Halfdan Sorbye, Bengt Glimelius … (2008)
            Summary Background Surgical resection alone is regarded as the standard of care for patients with liver metastases from colorectal cancer, but relapse is common. We assessed the combination of perioperative chemotherapy and surgery compared with surgery alone for patients with initially resectable liver metastases from colorectal cancer. Methods This parallel-group study reports the trial's final data for progression-free survival for a protocol unspecified interim time-point, while overall survival is still being monitored. 364 patients with histologically proven colorectal cancer and up to four liver metastases were randomly assigned to either six cycles of FOLFOX4 before and six cycles after surgery or to surgery alone (182 in perioperative chemotherapy group vs 182 in surgery group). Patients were centrally randomised by minimisation, adjusting for centre and risk score. The primary objective was to detect a hazard ratio (HR) of 0·71 or less for progression-free survival. Primary analysis was by intention to treat. Analyses were repeated for all eligible (171 vs 171) and resected patients (151 vs 152). This trial is registered with ClinicalTrials.gov, number NCT00006479. Findings In the perioperative chemotherapy group, 151 (83%) patients were resected after a median of six (range 1–6) preoperative cycles and 115 (63%) patients received a median six (1–8) postoperative cycles. 152 (84%) patients were resected in the surgery group. The absolute increase in rate of progression-free survival at 3 years was 7·3% (from 28·1% [95·66% CI 21·3–35·5] to 35·4% [28·1–42·7]; HR 0·79 [0·62–1·02]; p=0·058) in randomised patients; 8·1% (from 28·1% [21·2–36·6] to 36·2% [28·7–43·8]; HR 0·77 [0·60–1·00]; p=0·041) in eligible patients; and 9·2% (from 33·2% [25·3–41·2] to 42·4% [34·0–50·5]; HR 0·73 [0·55–0·97]; p=0·025) in patients undergoing resection. 139 patients died (64 in perioperative chemotherapy group vs 75 in surgery group). Reversible postoperative complications occurred more often after chemotherapy than after surgery (40/159 [25%] vs 27/170 [16%]; p=0·04). After surgery we recorded two deaths in the surgery alone group and one in the perioperative chemotherapy group. Interpretation Perioperative chemotherapy with FOLFOX4 is compatible with major liver surgery and reduces the risk of events of progression-free survival in eligible and resected patients. Funding Swedish Cancer Society, Cancer Research UK, Ligue Nationale Contre le Cancer, US National Cancer Institute, Sanofi-Aventis.
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              Initial therapy with FOLFOXIRI and bevacizumab for metastatic colorectal cancer.

              FOTIOS LOUPAKIS, CHIARA CREMOLINI, Gianluca Masi … (2014)
              A fluoropyrimidine plus irinotecan or oxaliplatin, combined with bevacizumab (a monoclonal antibody against vascular endothelial growth factor), is standard first-line treatment for metastatic colorectal cancer. Before the introduction of bevacizumab, chemotherapy with fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) showed superior efficacy as compared with fluorouracil, leucovorin, and irinotecan (FOLFIRI). In a phase 2 study, FOLFOXIRI plus bevacizumab showed promising activity and an acceptable rate of adverse effects.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Oncol Rev
                Journal ID (iso-abbrev): Oncol Rev
                Journal ID (publisher-id): ONCOL
                Title: Oncology Reviews
                Publisher: PAGEPress Publications, Pavia, Italy
                ISSN (Print): 1970-5565
                ISSN (Electronic): 1970-5557
                Publication date (Electronic): 31 July 2017
                Publication date Collection: 14 June 2017
                Volume: 11
                Issue: 2
                Electronic Location Identifier: 331
                Affiliations
                Department of Surgery, University of Buea , Cameroon
                Author notes
                Department of Surgery (BASO Raven Fellow), Faculty of Health Sciences, University of Buea, PO Box 126, Limbe, S.W. Region, Cameroon. elroypat@ 123456yahoo.co.uk
                Article
                DOI: 10.4081/oncol.2017.331
                PMC ID: 5538223
                SO-VID: 0f2baa1e-c5b7-4c42-bd77-9b8d5585067f
                Copyright © ©Copyright E.P. Weledji et al.
                License:

                This work is licensed under a Creative Commons Attribution NonCommercial 4.0 License (CC BY-NC 4.0).

                History
                Date received : 07 December 2016
                Date revision received : 15 December 2016
                Date accepted : 17 July 2017
                Page count
                Figures: 0, Tables: 2, Equations: 0, References: 79, Pages: 7
                Categories
                Subject: Review

                Keywords: advanced (joint) multidisciplinary team,centralization,synchronous colorectal liver metastases,surgery,systemic therapy,ablation
                Data availability:
                Keywords: advanced (joint) multidisciplinary team, centralization, synchronous colorectal liver metastases, surgery, systemic therapy, ablation

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