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Surgery after neoadjuvant chemotherapy for colorectal liver metastases is safe and feasible in elderly patients
Author(s) -
Tamandl Dietmar,
Gruenberger Birgit,
Herberger Beata,
Kaczirek Klaus,
Gruenberger Thomas
Publication year - 2009
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.21259
Subject(s) - medicine , oxaliplatin , colorectal cancer , chemotherapy , oncology , multivariate analysis , neoadjuvant therapy , capecitabine , fluorouracil , surgery , cancer , breast cancer
Background Surgery for colorectal liver metastases is part of the endeavor to cure metastatic colorectal cancer (mCRC). Neoadjuvant chemotherapy increases progression free survival in resectable patients. The safety and feasibility of this concept has not been investigated in elderly patients. Methods We performed a comparative analysis of data from 244 patients who were resected for colorectal liver metastases between 1999 and 2004 at our institution. Seventy patients were aged 70 or older; they form the basis of this analysis. Results Twenty‐nine patients received neoadjuvant chemotherapy (oxaliplatin‐based chemotherapy (XELOX), 19; 5‐fluorouracil (5‐FU), 10) prior to surgery. XELOX was associated with higher response rates to chemotherapy (CR + PR: XELOX 68% vs. 5‐FU 0%, P = 0.001), and responding patients had a better overall (OS, P < 0.001) and recurrence free survival (RFS, P < 0.001) compared to others. Response to neoadjuvant chemotherapy was the only factor on multivariate analysis predicting longer OS and RFS ( P = 0.01 and P = 0.001). Conclusion Neoadjuvant chemotherapy can be administered safely in patients older than 70 years and appears to be effective in prolonging long‐term outcome. Patients responding to neoadjuvant treatment have a significantly better prognosis after liver resection. J. Surg. Oncol. 2009;100:364–371. © 2009 Wiley‐Liss, Inc.