Pre-surgery chemo ups colon cancer survival

By Will Boggs, MD

NEW YORK (Reuters Health) - In patients with advanced colorectal cancer that has spread to the liver, the tumors may initially be impossible to remove adequately by surgery. In this situation, prior chemotherapy improves surgical outcomes, according to a new report.

This approach "increases the overall survival rate but not the disease-free survival rate," Dr. L. Capussotti told Reuters Health.

Capussotti from Istituto per la Ricerca e la Cura del Cancro, in Candiolo, Italy, and colleagues reviewed the outcomes for 150 patients who underwent surgery for colorectal tumors that had spread to the liver; 34 of the patients had chemotherapy before liver surgery, because their tumors were more advanced.

No patient died in-hospital after their liver resection, the investigators report in the British Journal of Surgery, and the overall rate of postoperative complications did not differ significantly between patients who had preoperative chemotherapy and those who did not.

Overall survival at 1 and 3 years was 95.3 percent and 62.8 percent, respectively, and did not differ significantly between the groups, the researchers note.

These survival rates were better than those experienced by patients who did not have liver surgery after chemotherapy -- 83.2 percent and 21.3 percent at 1 and 3 years, respectively.

Recurrence rates were high, the report indicates, and occurred in nearly three quarters of the patients who had surgery without chemotherapy and 94 percent of those who had chemotherapy before liver resection.

"Based on these data, it is clear that the combination of (pre-surgery) chemotherapy and liver resection greatly increases survival compared with chemotherapy alone, but rarely provides cure," the team concludes.

"Surgeons and oncologists should work together to increase the disease-free survival rate," Dr. Capussotti said, perhaps through "better selection of the patients for surgery (or) more aggressive chemotherapy."

SOURCE: British Journal of Surgery, August 2006.