Successful neoadjuvant chemotherapy of nonresectable colorectal liver metastases: An interdisciplinary approach

Background: Colorectal carcinomas are among the most frequent malignant dis eases in Western countries. In 40-50% of all patients, synchronous or metac hronous metastases develop. in more than 80% of the patients liver metastas es are nonresectable. Under special circumstances a curative resection of n onresectable metastases appears to be possible after down-staging with neoa djuvant chemotherapy. Case Report: Two years after low anterior resection o f rectum carcinoma, a 58-year-old patient developed 5 liver metastases. An experienced liver surgeon determined primary metastatic resection as unwarr anted because of the location of the metastases and the small remaining lef t liver lobe. After neoadjuvant chemotherapy with 5-fluorouracil (5-FU) and folinic acid ('Ardalan regimen) a partial remission was achieved and a cur ative resection was subsequently performed. Two years after chemo therapy t he patient remains disease-free. Conclusion: Tn selected cases initially no nresectable liver metastases can be curatively resected after down-staging with neoadjuvant chemotherapy. This hitherto rarely applied interdisciplina ry approach may be promising in previously palliative situations and merits further evaluation.