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Key Words

Colorectal cancer, liver metastases. (Definitions of many terms related to cancer can be found in the Cancer.gov Dictionary.)

Summary

In patients with colorectal cancer that had spread to the liver, recurrence of disease was delayed longer in those who received chemotherapy in addition to surgery than in those who had surgery alone, a new study has found. However, the study did not definitively show that adding chemotherapy to surgery lengthened patients’ lives overall.

Source

Journal of Clinical Oncology, November 1, 2006 (see the journal abstract).
(J Clin Oncol. 2006 Nov 1;24(31):4976-82)

Background

Cancerous tumors that spread from their original site to other organs are called metastases. When colorectal cancer has spread to the liver, surgery that completely removes the liver metastases offers the only hope of cure. About 25 percent of patients who have the surgery survive for five years. It is not clear whether additional (adjuvant) chemotherapy after surgery improves patients’ survival.

The Study

This study involved 173 patients in France and Switzerland who had had surgery to remove liver metastases of colorectal cancer. Most of the patients were aged 55 and older. They enrolled in the study between 1991 and 2001.

After surgery, the patients were randomly assigned either to receive six months of chemotherapy with the drugs fluorouracil and folinic acid or simply to be observed by their doctors. Patients were then followed for a median of just over seven years.

The study’s principal investigator was Guillaume Portier, M.D., of University Hospital in Toulouse, France.

Results

After five years, 33.5 percent of patients who recieved post-surgery chemotherapy were alive and had not had a recurrence of colorectal cancer. This compared with 26.7 percent of patients in the surgery alone arm. The disease-free survival benefit for the chemotherapy group was statistically significant (that is, it was unlikely to have occurred by chance).

Overall five-year survival was 51.1 percent for patients in the chemotherapy group and 41.1 percent for those in the observation group. Although this difference suggested a trend toward better survival for patients treated with chemotherapy, it was not statistically significant.

About a quarter of the patients treated with chemotherapy had serious side effects. The most common side effects were low blood counts, mouth sores, nausea, diarrhea, and weakness or numbness in the hands and feet. Roughly a third of patients in the chemotherapy group were switched to a lower dose of the drugs or stopped treatment early, in most cases because of side effects.

Limitations

The study took 10 years to complete because of difficulty recruiting patients. The chemotherapy drugs used, fluorouracil and folinic acid, were standard treatment in 1991 when the study began. However, compared with newer drugs such as oxaliplatin and bevacizumab, they are only modestly effective and have a lot of side effects, the authors note.

Comments

Despite the use of older, only modestly effective drugs, adjuvant chemotherapy delayed disease recurrence in patients who had had surgery to remove liver metastases of colorectal cancer, the authors conclude.

Writing in an accompanying editorial, Steven R. Alberts of the Mayo Clinic in Rochester, Minn., says the results show that “[t]he addition of chemotherapy to surgery has the potential of enhancing outcome and reducing the risk of recurrence.”

James F. Pingpank Jr., M.D., of the National Cancer Institute’s (NCI’s) Center for Cancer Research, agrees, saying, “It’s reasonable to conclude that patients may benefit from this approach when they can tolerate the chemotherapy and its side effects. It should be considered for all patients who have surgically resectable liver metastases from colorectal cancer.”

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