Clinical Research Papers:
Preoperative chemotherapy prior to pulmonary metastasectomy in surgically resected primary colorectal carcinoma
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Ishwaria M. Subbiah1, Shanda H. Blackmon2,4, Arlene M. Correa2, Bryan Kee3, Ara A. Vaporciyan2, Stephen G. Swisher2 and Cathy Eng3
1 Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
2 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
3 Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
4 Department of Surgery, The Methodist Hospital and Weill Cornell College of Medicine, Houston, Texas
Cathy Eng, email:
Keywords: colorectal, carcinoma, neoadjuvant, chemotherapy, metastasectomy
Received: May 10, 2014 Accepted: July 7, 2014 Published: July 8, 2014
Background: The benefit of preoperative chemotherapy prior to pulmonary metastasectomy for patients with colorectal carcinoma (CRC) is unknown. Here, we identify outcomes of preoperative chemotherapy in patients with resected primary CRC who then underwent pulmonary metastasectomy.
Methods: We queried a prospective database to identify treatment characteristics. Multivariate analyses identified predictors of overall survival (OS) and progression-free survival (PFS).
Results: 229 patients underwent lung metastasectomy, of whom 115 proceeded to surgery without chemotherapy while 114 received preoperative regimen based on oxaliplatin (32%), irinotecan (46%), capecitabine (16%), or other (6%). Median PFS in preoperative chemotherapy vs. surgery alone arms were comparable (p=0.004). Patients on oxaliplatin-based therapy had an improved OS vs. an irinotecan, capecitabine, or alternate regimen (p=.019). On multivariate analysis, the irinotecan subset had a worse OS (HR 1.846; 95% CI 1.070, 3.185) vs. surgery alone arm (p=0.028). The OS of an oxaliplatin-based regimen vs. no chemotherapy was inconclusive (HR 0.57; 95% CI 0.237 to 1.389, p=0.218). Multivariate analysis demonstrated a worse PFS and OS for the male gender and an incomplete resection (R2).
Conclusion: Prospective trials on specific preoperative regimens and criteria for patient selection may identify a role for preoperative chemotherapy prior to a curative pulmonary metastasectomy.
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