Annals of Oncology Advance Access originally published online on January 19, 2009
Annals of Oncology 2009 20(6):985-992; doi:10.1093/annonc/mdn735
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Combination of surgery and chemotherapy and the role of targeted agents in the treatment of patients with colorectal liver metastases: recommendations from an expert panel
1 Department of Digestive Surgery, Ambroise Paré Hospital, Boulogne, France
2 Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium
3 Department of General Surgery, University of Vienna, Vienna, Austria
4 Department of Oncology, Radiology and Clinical Immunology, University of Uppsala, Uppsala
5 Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
6 Department of Surgery, University Hospital Aintree, Liverpool, UK
7 Medical Oncology, San Martino Hospital, Genova, Italy
8 CRLC Val d'Aurelle, Montpellier Cedex 05, France
* Correspondence to: Prof. B. Nordlinger, Hôpital Ambroise Paré, CHU Paris Ouest, 92100 Boulogne Cedex, France. Tel: +33-1-4909-5594; Fax: +33-1-4909-5869; E-mail: bernard.nordlinger{at}apr.aphp.fr
The past 5 years have seen the clear recognition that the administration of chemotherapy to patients with initially unresectable colorectal liver metastases can increase the number of patients who can undergo potentially curative secondary liver resection. Coupled with this, recent data have emerged that show that perioperative chemotherapy confers a disease-free survival advantage over surgery alone in colorectal cancer (CRC) patients with initially resectable liver disease. The purpose of this paper is to build on the existing knowledge and review the issues surrounding the use of chemotherapy ± targeted agents combined with surgery in the treatment of CRC patients with liver metastases, with a view to providing clinical recommendations. An international panel of 21 experts in colorectal oncology comprising liver surgeons and medical oncologists reviewed the available evidence. In a major change to clinical practice, the panel's recommendation was that the majority of patients with CRC liver metastases should be treated up front with chemotherapy, irrespective of the initial resectability status of their metastases.
Key words: bevacizumab, cetuximab, colorectal, liver metastases, neo-adjuvant, resection rate, targeted agents
Both authors contributed equally. Received for publication July 31, 2008. Revision received November 4, 2008. Accepted for publication November 5, 2008.
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