Secondary technical resectability of colorectal cancer liver metastases after chemotherapy with or without selective internal radiotherapy in the randomized SIRFLOX trial

Garlipp, B.; Gibbs, P.; Van Hazel, G. A.; Jeyarajah, R.; Martin, R. C. G.; Bruns, C. J.; Lang, H.; Manas, D. M.; Ettorre, G. M.; Pardo, F.; Donckier, V.; Benckert, C.; van Gulik, T. M.; Goere, D.; Schön, M.; Pratschke, J.; Bechstein, W. O.; de la Cuesta, A. M.; Adeyemi, S.; Ricke, J. und Seidensticker, M. (2019): Secondary technical resectability of colorectal cancer liver metastases after chemotherapy with or without selective internal radiotherapy in the randomized SIRFLOX trial. In: British Journal of Surgery, Bd. 106, Nr. 13: S. 1837-1846

Abstract

Background Secondary resection of initially unresectable colorectal cancer liver metastases (CRLM) can prolong survival. The added value of selective internal radiotherapy (SIRT) to downsize lesions for resection is not known. This study evaluated the change in technical resectability of CRLM with the addition of SIRT to FOLFOX-based chemotherapy. Methods Baseline and follow-up hepatic imaging of patients who received modified FOLFOX (mFOLFOX6: fluorouracil, leucovorin, oxaliplatin) chemotherapy with or without bevacizumab (control arm) versus mFOLFOX6 (with or without bevacizumab) plus SIRT using yttrium-90 resin microspheres (SIRT arm) in the phase III SIRFLOX trial were reviewed by three or five (of 14) expert hepatopancreatobiliary surgeons for resectability. Reviewers were blinded to one another, treatment assignment, extrahepatic disease status, and information on clinical and scanning time points. Technical resectability was defined as at least 60 per cent of reviewers (3 of 5, or 2 of 3) assessing a patient's liver metastases as surgically removable. Results Some 472 patients were evaluable (SIRT, 244;control, 228). There was no significant baseline difference in the proportion of technically resectable liver metastases between SIRT (29, 11 center dot 9 per cent) and control (25, 11 center dot 0 per cent) arms (P = 0 center dot 775). At follow-up, significantly more patients in both arms were deemed technically resectable compared with baseline: 159 of 472 (33 center dot 7 per cent) versus 54 of 472 (11 center dot 4 per cent) respectively (P = 0 center dot 001). More patients were resectable in the SIRT than in the control arm: 93 of 244 (38 center dot 1 per cent) versus 66 of 228 (28 center dot 9 per cent) respectively (P < 0 center dot 001). Conclusion Adding SIRT to chemotherapy may improve the resectability of unresectable CRLM.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0007-1323
• Sprache: Englisch