Date of Award

2-11-2008

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Muhammad Wasif Saif

Abstract

While new treatments for metastatic colorectal cancer continue to be developed, the ideal neoadjuvant regimen prior to resection of liver metastases is still unknown. The primary goal of this study was to compare disease-free survival outcomes in patients who received oxaliplatin- or irinotecan-based neoadjuvant chemotherapy regimens prior to resection of colorectal liver metastases. A retrospective chart review was performed of all 27 patients who underwent liver resection of colorectal cancer metastases at Yale-New Haven Hospital between January 2003 and December 2005. Records were reviewed for details of initial diagnosis, treatment regimen(s) prior to resection of hepatic metastases, results of surgical liver resection, adjuvant treatment after liver resection, post-operative disease recurrence and overall survival. Median disease-free survival calculations were based on survival curves drawn according to Kaplan-Meier methods. Out of 15 patients with at least one year of follow-up, six were treated with neoadjuvant FOLFOX prior to liver resection, three with first-line FOLFOX followed by second-line FOLFIRI, two with FOLFIRI, one with IFL, and three patients had no neoadjuvant chemotherapy. Median disease-free survival was 15.5 months in patients treated with neoadjuvant FOLFOX, 16.3 months in patients treated with first-line FOLFOX followed by second-line FOLFIRI, 16.3 months in patients treated with irinotecan-based neoadjuvant therapy, and was not reached in the group who did not receive any neoadjuvant treatment (p=0.84). Actual one-year disease-free survival rate was 67% regardless of neoadjuvant treatment group. The sample size was too small to determine which patient, tumor, and treatment variables were associated with disease recurrence. The majority of patients undergoing liver resection of colorectal metastases at Yale-New Haven Hospital in recent years were treated with neoadjuvant FOLFOX. Median disease-free survival and actual one-year disease-free survival was almost identical among patients receiving FOLFOX, irinotecan-based regimens, or first-line FOLFOX followed by second-line FOLFIRI, although analysis was limited by a small sample size. Larger prospective trials are needed to compare oxaliplatin- and irinotecan-based neoadjuvant chemotherapy regimens for patients with either resectable or unresectable colorectal hepatic metastases.

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This is an Open Access Thesis.

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