Tumor response and outcome after reverse treatment for patients with synchronous colorectal liver metastasis: a cohort study
Abstract Background The reverse treatment of patients with synchronous colorectal liver metastases (CRLM) is a sequential approach with systemic chemotherapy first, followed by liver resection, and finally, primary tumor resection. The aim of this study was to assess the feasibility, the radiologica...
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| Format: | Article |
| Language: | English |
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BMC
2020-04-01
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| Series: | BMC Surgery |
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| Online Access: | http://link.springer.com/article/10.1186/s12893-020-00738-3 |
| _version_ | 1811223908336009216 |
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| author | Céline Du Pasquier Didier Roulin Pierre Bize Christine Sempoux Caterina Rebecchini Michael Montemurro Markus Schäfer Nermin Halkic Nicolas Demartines |
| author_facet | Céline Du Pasquier Didier Roulin Pierre Bize Christine Sempoux Caterina Rebecchini Michael Montemurro Markus Schäfer Nermin Halkic Nicolas Demartines |
| author_sort | Céline Du Pasquier |
| collection | DOAJ |
| description | Abstract Background The reverse treatment of patients with synchronous colorectal liver metastases (CRLM) is a sequential approach with systemic chemotherapy first, followed by liver resection, and finally, primary tumor resection. The aim of this study was to assess the feasibility, the radiological and pathological tumor response to neoadjuvant therapy, recurrence rates and long-term survival after reverse treatment in a cohort study. Methods Data from patients with CRLM who underwent a reverse treatment from August 2008 to October 2016 were extracted from our prospective hepato-biliary database and retrospectively analyzed for response rates and survival outcomes. Radiological tumor response was assessed by RECIST (Response Evaluation Criteria In Solid Tumor) criteria and pathological response according to TRG (Tumor Regression Grade). Disease-free and overall survival were estimated with Kaplan-Meier survival curves. Results There were 44 patients with 19 rectal and 25 colonic tumors. The reverse treatment was fully completed until primary tumor resection in 41 patients (93%). Radiological assessment after chemotherapy showed 61% of complete/partial response. Pathological tumor response was major or partial in 52% of patients (TRG 1–3). Median disease-free survival after primary tumor resection was 10 months (95% CI 5–15 months). Disease-free survival at 3 and 5 years was 25% and 25%, respectively. Median overall survival was 50 months (95% CI 42–58 months). Overall survival at 3 and 5 years was 59% and 39%, respectively. Conclusion The reverse treatment approach was feasible with a high rate of patients with complete treatment sequence and offers promising long-term survival for selected patients with advanced simultaneous colorectal liver metastases. |
| first_indexed | 2024-04-12T08:41:33Z |
| format | Article |
| id | doaj.art-48797e61e2064a93a03f377cf5a6734b |
| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-04-12T08:41:33Z |
| publishDate | 2020-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Surgery |
| spelling | doaj.art-48797e61e2064a93a03f377cf5a6734b2022-12-22T03:39:52ZengBMCBMC Surgery1471-24822020-04-012011810.1186/s12893-020-00738-3Tumor response and outcome after reverse treatment for patients with synchronous colorectal liver metastasis: a cohort studyCéline Du Pasquier0Didier Roulin1Pierre Bize2Christine Sempoux3Caterina Rebecchini4Michael Montemurro5Markus Schäfer6Nermin Halkic7Nicolas Demartines8Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of LausanneDepartment of Visceral Surgery, Lausanne University Hospital (CHUV), University of LausanneDepartment of Radiology, Lausanne University Hospital (CHUV), University of LausanneDepartment of Pathology, Lausanne University Hospital (CHUV), University of LausanneDepartment of Pathology, Lausanne University Hospital (CHUV), University of LausanneDepartment of Medical Oncology, Lausanne University Hospital (CHUV), University of LausanneDepartment of Visceral Surgery, Lausanne University Hospital (CHUV), University of LausanneDepartment of Visceral Surgery, Lausanne University Hospital (CHUV), University of LausanneDepartment of Visceral Surgery, Lausanne University Hospital (CHUV), University of LausanneAbstract Background The reverse treatment of patients with synchronous colorectal liver metastases (CRLM) is a sequential approach with systemic chemotherapy first, followed by liver resection, and finally, primary tumor resection. The aim of this study was to assess the feasibility, the radiological and pathological tumor response to neoadjuvant therapy, recurrence rates and long-term survival after reverse treatment in a cohort study. Methods Data from patients with CRLM who underwent a reverse treatment from August 2008 to October 2016 were extracted from our prospective hepato-biliary database and retrospectively analyzed for response rates and survival outcomes. Radiological tumor response was assessed by RECIST (Response Evaluation Criteria In Solid Tumor) criteria and pathological response according to TRG (Tumor Regression Grade). Disease-free and overall survival were estimated with Kaplan-Meier survival curves. Results There were 44 patients with 19 rectal and 25 colonic tumors. The reverse treatment was fully completed until primary tumor resection in 41 patients (93%). Radiological assessment after chemotherapy showed 61% of complete/partial response. Pathological tumor response was major or partial in 52% of patients (TRG 1–3). Median disease-free survival after primary tumor resection was 10 months (95% CI 5–15 months). Disease-free survival at 3 and 5 years was 25% and 25%, respectively. Median overall survival was 50 months (95% CI 42–58 months). Overall survival at 3 and 5 years was 59% and 39%, respectively. Conclusion The reverse treatment approach was feasible with a high rate of patients with complete treatment sequence and offers promising long-term survival for selected patients with advanced simultaneous colorectal liver metastases.http://link.springer.com/article/10.1186/s12893-020-00738-3Colorectal liver metastasesReverse treatmentLiver-firstLiver surgeryNeoadjuvant chemotherapy |
| spellingShingle | Céline Du Pasquier Didier Roulin Pierre Bize Christine Sempoux Caterina Rebecchini Michael Montemurro Markus Schäfer Nermin Halkic Nicolas Demartines Tumor response and outcome after reverse treatment for patients with synchronous colorectal liver metastasis: a cohort study BMC Surgery Colorectal liver metastases Reverse treatment Liver-first Liver surgery Neoadjuvant chemotherapy |
| title | Tumor response and outcome after reverse treatment for patients with synchronous colorectal liver metastasis: a cohort study |
| title_full | Tumor response and outcome after reverse treatment for patients with synchronous colorectal liver metastasis: a cohort study |
| title_fullStr | Tumor response and outcome after reverse treatment for patients with synchronous colorectal liver metastasis: a cohort study |
| title_full_unstemmed | Tumor response and outcome after reverse treatment for patients with synchronous colorectal liver metastasis: a cohort study |
| title_short | Tumor response and outcome after reverse treatment for patients with synchronous colorectal liver metastasis: a cohort study |
| title_sort | tumor response and outcome after reverse treatment for patients with synchronous colorectal liver metastasis a cohort study |
| topic | Colorectal liver metastases Reverse treatment Liver-first Liver surgery Neoadjuvant chemotherapy |
| url | http://link.springer.com/article/10.1186/s12893-020-00738-3 |
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