Neoadjuvant with Folfox 6 in Initially Unresectable Liver Metastasis in Colorectal Cancer

Abstract

Background : Colorectal cancer is one of the commonest solid tumors. The liver is the commonest site of distant metastasis. Hepatic resection is the only form of treatment that offers a chance of long-term survival. Recently Folfox regimen (5 FU, Ieucoverin and oxaliplatin) showed benefit in stage 4 colorectal cancers and was recommended to be one of standard regimen.

Patients and methods : From January 2005 to December 2006, 63 patients with unresectable liver metastases from colorectal cancer were treated with chemotherapy, Folfox regimen (Oxaliplatin 85 mg/ m²  Leucoverin 200 mg/m²  5 FU 400 mg/ m²  lV bolus and 5 FU 1200 mg/m² /day x 2 days continuous infusion and repeat every 2 weeks (Folfox6)} and measured response. Hepatic resection was reconsidered when technically possible.

Results : Sixty three patients who received Folfox6 could convert to resectable tumors in 12 (19%) patients and underwent hepatectomy. In hepatectomy cases, 3 (25% underwent a minor hepatectomy and 9 (75%) had a major hepatectomy. Associated lung resections were done in 2 cases. Complication rate was 33.3%. Hepatic recurrence was observed in 1 patient (8.3%) after a mean follow-up of 12 months. At 1 year median follow up time, 11 patients survived without disease.

Conclusions :  Neoadjuvant with Folfox6 improved hepatic resection in previously unresectable liver metastases from colorectal cancer. An aggressive surgical approach in these patients may provide a reasonable hope of long-term survival.