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Conversion Chemotherapy With a Modified FLOX Regimen for Borderline or Unresectable Liver Metastases From Colorectal Cancer: An Alternative for Limited-Resources Settings
PURPOSE: Conversion chemotherapy is often used for borderline or unresectable (B/U) liver metastases from colorectal cancer (CRC) with the aim of achieving resectability. Although intensive and costly regimens are often used, the best regimen in this scenario remains unclear. We aimed to evaluate th...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Society of Clinical Oncology
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6733184/ https://www.ncbi.nlm.nih.gov/pubmed/31479339 http://dx.doi.org/10.1200/JGO.19.00180 |
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author | Bonadio, Renata Colombo Amor Divino, Paulo Henrique Obando, Jorge Santiago Madero Lima, Karolina Cayres Alvino Recchimuzzi, Débora Zachello Kruger, Jaime Arthur Pirola Saragiotto, Daniel Fernandes Capareli, Fernanda C. Hoff, Paulo M. |
author_facet | Bonadio, Renata Colombo Amor Divino, Paulo Henrique Obando, Jorge Santiago Madero Lima, Karolina Cayres Alvino Recchimuzzi, Débora Zachello Kruger, Jaime Arthur Pirola Saragiotto, Daniel Fernandes Capareli, Fernanda C. Hoff, Paulo M. |
author_sort | Bonadio, Renata Colombo |
collection | PubMed |
description | PURPOSE: Conversion chemotherapy is often used for borderline or unresectable (B/U) liver metastases from colorectal cancer (CRC) with the aim of achieving resectability. Although intensive and costly regimens are often used, the best regimen in this scenario remains unclear. We aimed to evaluate the outcomes of patients with B/U liver metastases from CRC treated with conversion chemotherapy with the modified fluorouracil, leucovorin, and oxaliplatin (mFLOX) regimen followed by metastasectomy. METHODS: We performed a single-center retrospective analysis of patients with B/U liver metastases from CRC treated with chemotherapy with the mFLOX regimen followed by surgery. B/U disease was defined as at least one of the following: more than four lesions, involvement of hepatic artery or portal vein, or involvement of biliary structure. RESULTS: Fifty-four consecutive patients who met our criteria for B/U liver metastases were evaluated. Thirty-five patients (64%) had more than four liver lesions, 16 (29%) had key vascular structure involvement, and 16 (29%) had biliary involvement. After chemotherapy, all patients had surgery and 42 (77%) had R0 resection. After a median follow-up of 37.2 months, median progression-free survival (PFS) was 16.9 months and median overall survival (OS) was 68.3 months. R1-R2 resections were associated with worse PFS and OS compared with R0 resection (PFS: hazard ratio, 2.65; P = .007; OS: hazard ratio, 2.90; P = .014). CONCLUSION: Treatment of B/U liver metastases from CRC with conversion chemotherapy using mFLOX regimen followed by surgical resection was associated with a high R0 resection rate and favorable survival outcomes. On the basis of our results, we consider mFLOX a low-cost option for conversion chemotherapy among other options that have been proposed. |
format | Online Article Text |
id | pubmed-6733184 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | American Society of Clinical Oncology |
record_format | MEDLINE/PubMed |
spelling | pubmed-67331842019-10-03 Conversion Chemotherapy With a Modified FLOX Regimen for Borderline or Unresectable Liver Metastases From Colorectal Cancer: An Alternative for Limited-Resources Settings Bonadio, Renata Colombo Amor Divino, Paulo Henrique Obando, Jorge Santiago Madero Lima, Karolina Cayres Alvino Recchimuzzi, Débora Zachello Kruger, Jaime Arthur Pirola Saragiotto, Daniel Fernandes Capareli, Fernanda C. Hoff, Paulo M. J Glob Oncol Original Report PURPOSE: Conversion chemotherapy is often used for borderline or unresectable (B/U) liver metastases from colorectal cancer (CRC) with the aim of achieving resectability. Although intensive and costly regimens are often used, the best regimen in this scenario remains unclear. We aimed to evaluate the outcomes of patients with B/U liver metastases from CRC treated with conversion chemotherapy with the modified fluorouracil, leucovorin, and oxaliplatin (mFLOX) regimen followed by metastasectomy. METHODS: We performed a single-center retrospective analysis of patients with B/U liver metastases from CRC treated with chemotherapy with the mFLOX regimen followed by surgery. B/U disease was defined as at least one of the following: more than four lesions, involvement of hepatic artery or portal vein, or involvement of biliary structure. RESULTS: Fifty-four consecutive patients who met our criteria for B/U liver metastases were evaluated. Thirty-five patients (64%) had more than four liver lesions, 16 (29%) had key vascular structure involvement, and 16 (29%) had biliary involvement. After chemotherapy, all patients had surgery and 42 (77%) had R0 resection. After a median follow-up of 37.2 months, median progression-free survival (PFS) was 16.9 months and median overall survival (OS) was 68.3 months. R1-R2 resections were associated with worse PFS and OS compared with R0 resection (PFS: hazard ratio, 2.65; P = .007; OS: hazard ratio, 2.90; P = .014). CONCLUSION: Treatment of B/U liver metastases from CRC with conversion chemotherapy using mFLOX regimen followed by surgical resection was associated with a high R0 resection rate and favorable survival outcomes. On the basis of our results, we consider mFLOX a low-cost option for conversion chemotherapy among other options that have been proposed. American Society of Clinical Oncology 2019-09-03 /pmc/articles/PMC6733184/ /pubmed/31479339 http://dx.doi.org/10.1200/JGO.19.00180 Text en © 2019 by American Society of Clinical Oncology https://creativecommons.org/licenses/by/4.0/ Licensed under the Creative Commons Attribution 4.0 License: https://creativecommons.org/licenses/by/4.0/ |
spellingShingle | Original Report Bonadio, Renata Colombo Amor Divino, Paulo Henrique Obando, Jorge Santiago Madero Lima, Karolina Cayres Alvino Recchimuzzi, Débora Zachello Kruger, Jaime Arthur Pirola Saragiotto, Daniel Fernandes Capareli, Fernanda C. Hoff, Paulo M. Conversion Chemotherapy With a Modified FLOX Regimen for Borderline or Unresectable Liver Metastases From Colorectal Cancer: An Alternative for Limited-Resources Settings |
title | Conversion Chemotherapy With a Modified FLOX Regimen for Borderline or Unresectable Liver Metastases From Colorectal Cancer: An Alternative for Limited-Resources Settings |
title_full | Conversion Chemotherapy With a Modified FLOX Regimen for Borderline or Unresectable Liver Metastases From Colorectal Cancer: An Alternative for Limited-Resources Settings |
title_fullStr | Conversion Chemotherapy With a Modified FLOX Regimen for Borderline or Unresectable Liver Metastases From Colorectal Cancer: An Alternative for Limited-Resources Settings |
title_full_unstemmed | Conversion Chemotherapy With a Modified FLOX Regimen for Borderline or Unresectable Liver Metastases From Colorectal Cancer: An Alternative for Limited-Resources Settings |
title_short | Conversion Chemotherapy With a Modified FLOX Regimen for Borderline or Unresectable Liver Metastases From Colorectal Cancer: An Alternative for Limited-Resources Settings |
title_sort | conversion chemotherapy with a modified flox regimen for borderline or unresectable liver metastases from colorectal cancer: an alternative for limited-resources settings |
topic | Original Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6733184/ https://www.ncbi.nlm.nih.gov/pubmed/31479339 http://dx.doi.org/10.1200/JGO.19.00180 |
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