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Annals of Oncology Advance Access originally published online on January 27, 2005
Annals of Oncology 2005 16(3):425-429; doi:10.1093/annonc/mdi092
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© 2005 European Society for Medical Oncology

Chemotherapy permits resection of metastatic colorectal cancer: experience from Intergroup N9741

T. Delaunoit1, S. R. Alberts1, D. J. Sargent2,*, E. Green2, R. M. Goldberg3, J. Krook4, C. Fuchs5, R. K. Ramanathan6, S. K. Williamson7, R. F. Morton8 and B. P. Findlay9

1 Department of Oncology, 2 Cancer Center Statistics, Mayo Clinic, Rochester, MN; 3 Division of Hematology/Oncology, University of North Carolina, Chapel Hill, NC; 4 Duluth Clinic, Duluth, MN; 5 Dana-Farber Cancer Institute, Boston, MA; 6 University of Pittsburgh Cancer Institute, Pittsburgh, PA; 7 University of Kansas Medical Center, Kansas City, KS; 8 Iowa Oncology Research Association CCOP, Des Moines, IA, USA; 9 National Cancer Institute of Canada, St Catharines, Canada

* Correspondence to: Dr. D. J. Sargent, Cancer Center Statistics, Mayo Clinic, Kahler 1A, 200 First St Southwest, Rochester, MN 55905, USA. Tel: +1-507-284-5380; Fax: +1-507-266-2477; Email: sargent.daniel{at}mayo.edu

Background: Fluorouracil (5-FU), oxaliplatin and irinotecan combinations improve time to tumor progression (TTP), objective response and overall survival (OS) in patients with metastatic colorectal cancer (MCRC). Here we identify and describe patients treated on Intergroup study N9741 who initially had inoperable MCRC, but who obtained sufficient chemotherapeutic benefit to allow removal of their metastatic disease.

Patients and methods: Patient research records in study arms (A) irinotecan/5-FU/leucovorin (LV) (IFL, n=264), (F) oxaliplatin/5-FU/LV (FOLFOX4, n=267) and (G) oxaliplatin/irinotecan (IROX, n=265) were reviewed. TTP and median OS were calculated.

Results: Twenty-four (3.3%) of 795 randomized patients underwent curative metastatic disease resection [hepatectomy, 16; radiofrequency-ablation (RFA), six; lung resection, two]. Twenty-two out of 24 (92%) resected patients received an oxaliplatin-based regimen (FOLFOX4, 11; IROX, 11). Seven patients (29.2%) remain disease-free; relapses occurred mainly in the resected organ. Median OS in resected patients is 42.4 months, and median TTP is 18.4 months. All six patients treated with RFA have recurred. Four out of five (80%) patients who received chemotherapy following resection are disease-free.

Conclusions: Resection of metastatic disease after chemotherapy is possible in a small but important subset of patients with MCRC, particularly after receiving an oxaliplatin-based chemotherapy regimen, with encouraging OS and TTP observed in these highly selected patients.

Key words: chemotherapy, colorectal cancer, resection


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