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RESEARCH PRODUCT

Secondary technical resectability of colorectal cancer liver metastases after chemotherapy with or without selective internal radiotherapy in the randomized SIRFLOX trial

Christoph BenckertRobert C.g. MartinMax SeidenstickerMax SeidenstickerHauke LangDerek ManasJens RickeVincent DonckierG. Van HazelA. M. De La CuestaMichael SchoenDiane GoéréBenjamin GarlippWolf O. BechsteinJohann PratschkeChristiane BrunsFernando PardoShola AdeyemiRohan JeyarajahGiuseppe Maria EttorrePeter GibbsT.m. Van Gulik

subject

Malemedicine.medical_specialtyTime FactorsHepatic resectionTreatment outcomeAntineoplastic Agents030230 surgeryMicrosphereClinical study03 medical and health sciences0302 clinical medicinemedicineHepatectomyHumansNeoplasm MetastasisChirurgieLiver imagingRetrospective Studiesbusiness.industryIndividual participant dataLiver NeoplasmsFollow up studiesPatient dataOriginal ArticlesMiddle AgedTreatment Outcome030220 oncology & carcinogenesisFamily medicineHPBLower GISurgeryOriginal ArticleFemaleRadiotherapy AdjuvantbusinessColorectal NeoplasmsTomography X-Ray Computed:Ciencias de la Salud::Oncología [Materias Investigacion]Follow-Up Studies

description

Background: Secondary resection of initially unresectable colorectal cancer liver metastases (CRLM) can prolong survival. The added value of selective internal radiotherapy (SIRT) to downsize lesions for resection is not known. This study evaluated the change in technical resectability of CRLM with the addition of SIRT to FOLFOX-based chemotherapy. Methods: Baseline and follow-up hepatic imaging of patients who received modified FOLFOX (mFOLFOX6: fluorouracil, leucovorin, oxaliplatin) chemotherapy with or without bevacizumab (control arm) versus mFOLFOX6 (with or without bevacizumab) plus SIRT using yttrium-90 resin microspheres (SIRT arm) in the phase III SIRFLOX trial were reviewed by three or five (of 14) expert hepatopancreatobiliary surgeons for resectability. Reviewers were blinded to one another, treatment assignment, extrahepatic disease status, and information on clinical and scanning time points. Technical resectability was defined as at least 60 per cent of reviewers (3 of 5, or 2 of 3) assessing a patient's liver metastases as surgically removable. Results: Some 472 patients were evaluable (SIRT, 244; control, 228). There was no significant baseline difference in the proportion of technically resectable liver metastases between SIRT (29, 11·9 per cent) and control (25, 11·0 per cent) arms (P = 0·775). At follow-up, significantly more patients in both arms were deemed technically resectable compared with baseline: 159 of 472 (33·7 per cent) versus 54 of 472 (11·4 per cent) respectively (P = 0·001). More patients were resectable in the SIRT than in the control arm: 93 of 244 (38·1 per cent) versus 66 of 228 (28·9 per cent) respectively (P < 0·001). Conclusion: Adding SIRT to chemotherapy may improve the resectability of unresectable CRLM.

yearjournalcountryeditionlanguage
2019-12-01
10.1002/bjs.11283https://pure.amc.nl/en/publications/secondary-technical-resectability-of-colorectal-cancer-liver-metastases-after-chemotherapy-with-or-without-selective-internal-radiotherapy-in-the-randomized-sirflox-trial(f04db82a-4a9e-4948-a580-fd293c0ea25a).html