Prediction of Treatment Outcome after Adjuvant Loco-regional Chemotherapy Following Liver Resection for Colorectal Metastases – Preliminary Results

Czech version

Authors: R. Strnad; M. Ryska; F. Bělina; D. Langer; J. Novotný ^*; M. Ludvíková ^**
Authors‘ workplace: Chirurgická klinika 2. LF UK a ÚVN Praha, přednosta prof. MUDr. M. Ryska, CSc. ; Klinika onkologie Všeobecné fakultní nemocnice Praha, přednosta doc. MUDr. L. Petruželka, CSc. ^*; Šiklův patologicko-anatomický ústav FN Plzeň, přednosta prof. MUDr. M. Michal, CSc. ^**
Published in: Rozhl. Chir., 2006, roč. 85, č. 3, s. 124-128.
Category: Monothematic special - Original

Overview

Introduction and aim of study:
Czech Republic leads the worldwide league in colorectal cancer’s occurrence. Colorectal liver metastases are detected in about a half of patients with colorectal cancer. Liver resection of colorectal metastases is currently the only potentially curative treatment with a chance for a long-term survival rate. Until now there has remained a question of whether adjuvant HAIC can improve the treatment results of radical resection. The aim of our study is to verify predictive efficiency of thymidylátsyntasis (TS), dihydropyrimidindehydrogenasis (DPD) and thymidinfosforylasis (TP) in patients undergoing adjuvant hepatic artery infusion chemotherapy (HAIC) following radical liver resection for colorectal metastases.

Methods:
From 1990 to 2005 80 patients underwent 84 liver resections for colorectal metastases. R0 resection was achieved in 60 events. Ten patients who underwent R0 resection both for primary cancer and for colorectal liver metastases and who were given portcatheter for HAIC were included in this study. Adjuvant chemotherapy contained 5-fluorourycil (1200 mg/m²) combined with oxyliplatinum and leukovorin. Whole dose was administered via hepatic artery. The samples were procured both from healthy liver tissue and from metastases for imunohistochemical and molecular biological analysis.

Results:
The recurrence of disease was verified in 2 of 10 included patients (20%). We detected neither occurrence of death nor serious complication in early postoperative course in none of ten patients. Low expression of TS was found in both events and very high expression of DPD in one event was detected.

Discussion:
High expression of DPD in one of these patients could contribute to lower outcome of adjuvant chemotherapy. Low expression of TS in both patients responds to the written statement regarding contribution of adjuvant chemotherapy only in patients with high TS level.

Conclusion:
The expression of TS and DPD responds to expected outcome of HAIC. Low number of patient does not permit statistic evaluation.

Key words:
colorectal cancer – liver metastases – loco-regional chemotherapy – prediction of treatment outcome