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| |  Long-Duration Presurgical Chemotherapy Correlates With Higher Risk of Liver Toxicity for Patients With Colorectal Liver Metastasis: Presented at SSO By Gabe Waggoner PHOENIX, Ariz -- March 10, 2009 -- Extended preoperative chemotherapy increases the risk of hepatotoxicity after hepatic resection for colorectal liver metastases, according to researchers presenting here at the Society of Surgical Oncology (SSO) 62nd Annual Cancer Symposium. The disease response, however, depends more on the type of chemotherapy than on the regimen's duration, explained lead author Daria Zorzi, MD, University of Texas M. D. Anderson Cancer Center, Houston, Texas, speaking here at a session on gastrointestinal cancer on March 6. Dr. Zorzi and colleagues sought to determine how the length of chemotherapy before surgery affected pathologic response and liver function after surgery in patients with colorectal cancer that had metastasised to the liver. The team first identified 219 patients who had been treated with 5-fluorouracil and oxaliplatin (FOLFOX) either with or without bevacizumab between August 1999 and December 2007 before having liver surgery. Patients undergoing up to 8 cycles of chemotherapy were classified as the short-duration chemotherapy group (157 patients), whereas those who were treated with 9 or more cycles of chemotherapy were classified as the long-duration group (62 patients). The authors compared the 2 groups in terms of complete (no residual viable tumour cells) or major (1% to 49% of residual tumour cells that were viable) pathologic response, sinusoidal injury, and liver dysfunction (a peak serum bilirubin level in excess of 7 mg/dL). The 2 groups turned out to have similar clinical, surgical, and pathologic outcomes, Dr. Zorzi said. Fifty-seven percent of patients in the short-duration chemotherapy group had complete or major pathologic response, compared to 55% of patients in the long-duration chemotherapy group. Differences began to emerge, however, on the basis of whether the FOLFOX regimen included bevacizumab. For both the short- and long-duration chemotherapy groups, patients who were treated with FOLFOX and bevacizumab experienced complete or major pathologic response statistically significantly more often than patients treated with FOLFOX alone. Long-duration group patients, however, had statistically significantly more sinusoidal injury and liver dysfunction than patients in the short-duration group. The authors conducted a multivariate analysis indicating that taking 9 or more cycles of chemotherapy was the only independent factor that could predict liver insufficiency after surgery. "Our data suggest that the type of chemotherapy [FOLFOX plus bevacizumab] has more impact on pathologic response than does the duration of chemotherapy," Dr. Zorzi concluded. [Presentation title: Extended Preoperative Chemotherapy Does Not Improve Pathologic Response and Increases Postoperative Liver Insufficiency After Hepatic Resection for Colorectal Liver Metastases. Abstract 62]
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