Long-term survival of patients with unresectable colorectal cancer liver metastases following infusional chemotherapy with 5-fluorouracil, leucovorin, oxaliplatin and surgery

Context: Long-term survival of patients with metastatic colorectal cancer h as been achieved only in patients who underwent complete resection of metas tases. Such surgery could be performed in a greater proportion of patients if effective chemotherapy could downstage previously unresectable metastase s. This approach has been limited by the low tumor response rate achieved w ith conventional chemotherapy. Objective: We studied the outcome of patients with initially unresectable l iver metastases from colorectal cancer treated with a three-drug chemothera py regimen followed by liver metastases surgery whenever possible. Patients and methods: From March 1988 to June 1994, 151 patients with color ectal liver metastases were considered initially unresectable because of la rge tumor size (> 5 cm), multinodular (> 4) or ill-located metastases. All patients received fully ambulatory chemotherapy with 5-fluorouracil, leucov orin and oxaliplatin (chronotherapy in 83% of them). They were periodically reassessed for surgery by a joint medico-surgical team. Results: In 151 patients, the size of liver metastases decreased by > 50% i n 89 patients (59%) and median overall survival was 24 months (95% confiden ce interval (95% CI): 19-28 months), with 28% surviving at five years (20%- 35%). Surgery with curative intent was attempted in 77 patients (51%), comp lete resection of liver metastases was achieved in 58 patients (38%). The m edian survival of the 77 operated patients was 48 months (25-71), with a fi ve-year survival rate of 50% (38-61). Conclusion: This new strategy of combining effective chemotherapy with surg ery apparently altered the natural history of unresectable colorectal cance r metastases.