Diane wrote:
No studies have shown chemo to help with prevention of recurrence after a successful hepatic resection as long as the surgeon got clear margins.
Maybe I misunderstand.. You say "
prevention of recurrence" and not overall survival.
To me it looks like the following study showed that for some (high risk score) patients adjuvant chemotherapy is benefitial. Quote: "
It improved survival markedly in high-risk patients"
From (2014)
http://bmccancer.biomedcentral.com/arti ... 407-14-174" A total of 297 patients with potentially curative resection of CRC liver metastases were analyzed. These patients had no neoadjuvant therapy, no extrahepatic disease and negative resection margins. The primary endpoint was overall survival. Patients’ risk status was evaluated using the Memorial Sloan-Kettering Cancer Center clinical risk score (MSKCC-CRS). Multivariable analyses were performed using Cox proportional hazard models.
ResultsA total of 137 (43%) patients had a MSKCC-CRS > 2. Adjuvant chemotherapy was administered to 116 (37%) patients. Patients who received adjuvant chemotherapy were of younger age (p = 0.03) with no significant difference in the presence of multiple metastases (p = 0.72) or bilobar metastases (p = 0.08). On multivariate analysis adjuvant chemotherapy was associated with improved survival in the entire cohort (Hazard ratio 0.69; 95% confidence interval 0.69–0.98). It improved survival markedly in high-risk patients with a MSKCC-CRS > 2 (HR 0.40; 95% CI 0.23–0.69), whereas it was of no benefit in patients with a MSKCC-CRS ≤ 2 (HR 0.90; 95% CI 0.57–1.43)."
On the other hand - in This Review paper from 2016
https://www.ncbi.nlm.nih.gov/pmc/articl ... rt=classic they say this: " The management of CRC patients after surgical resection of metastases is still debated. In these patients, the current international guidelines recommend an adjuvant strategy for 6 mo: postoperative adjuvant chemotherapy or peri-operative chemotherapy (3 mo before surgery and 3 mo after surgery)[3,5]. However, there is no standard treatment and the effective role of systemic adjuvant chemotherapy remains controversial."
When my DH was diagnosed I believe that these were the guidelines (in Europe). From (2014)
http://www.esmo.org/Guidelines/Gastroin ... tal-Cancer " There are two potential strategies for (neo-)adjuvant therapy in patients with resectable liver metastases: postoperative adjuvant chemotherapy with FOLFOX for 6 months or perioperative chemotherapy (3 months before and 3 months after resection of the metastases). In patients with resectable liver metastases, perioperative combination chemotherapy with the FOLFOX regimen improves the PFS by 7%–8% at 3 years, although the survival is not significantly longer [I, B] [52, 53]. The trials of modern postoperative adjuvant chemotherapy have many shortcomings, but it is suggested that an oxaliplatin-based chemotherapy for 6 months after resection of metastases improves the outcome, unless patients were failing an adjuvant treatment (oxaliplatin-based) for stage II or III diseases within 12 months. However, there are no data from randomised trials available to support this approach. The selection of perioperative chemotherapy or postoperative adjuvant chemotherapy may be influenced by the biology of the disease, the timing of metastases (synchronous versus metachronous) or the number and size of metastases. There is no evidence that adding a biological to a cytotoxic doublet improves the outcome in resectable metastases compared with a cytotoxic doublet alone in combination with resection of the metastases [51, 52, 57–60]. Recent data even suggest that the addition of cetuximab to FOLFOX may be harmful to patients with resectable metastases [II, D] [62]. " ... " In patients presenting synchronously with a primary colon cancer and metastases and suffering from symptoms of the primary tumour (e.g. occlusion and bleeding), a resection of the primary tumour should be considered before starting chemotherapy. In patients with metastatic rectal cancer with symptoms of the primary tumour, irradiation (possibly combined with chemotherapy) of the primary tumour should be considered after discussion with the radiation oncologist in order to obtain optimal symptom control of the primary tumour [51]."
It is the same text in the 2016 patient info version from ESMO (= EUROPEAN SOCIETY FOR MEDICAL ONCOLOGY )
http://www.esmo.org/content/download/15 ... tients.pdf "For patients who present liver and/or lung metastases* that can be operatively removed, the treatment consists of surgical resection of the metastases* and combination chemotherapy*. Chemotherapy* consists of a 6-month regimen of 5-FU/LV with oxaliplatin* (FOLFOX). FOLFOX can be given either perioperatively, meaning that it is given for 3 months before and for 3 months after surgery or, after the operation, for 6 months. "
However - The new 2016 Europian guidelines, (ESMO - for Professionals) are not that easy to interpret - maybe it has changed? At least it looks like they divide resectable patients in to many groups (see under headline '
liver metastases that are technically resectable up front') for example: "
In patients with favourable oncological and technical (surgical) criteria, who have not received perioperative chemotherapy, there is no strong evidence to support the use of adjuvant chemotherapy [II, C], whereas patients with unfavourable criteria may benefit from adjuvant treatment [III, B]."
https://oup.silverchair-cdn.com/oup/bac ... A4LVPAVW3Q
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a IVa 2/9 LN
MSS, KRAS-mut G13D
CEA &
CA19-9:
5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 294 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED->Jan-19 mets to lung NED again Oct-19
Steroid induced hyperglycemia dx after 3chemo
Surgeries 2016: 3/18 Emergency colostomy
5/23 Primary+gallbl+stoma reversal+port 9/1 Liver mets
RFA 2019: Feb & Oct lung mets