Background

Five year survival with resected liver metastases in mCRC (metastatic colorectal cancer) is 30% and 2% with inoperable metastases. Converting liver metastases to operable is an attractive treatment aim improving 5 year survival to 16%. We assessed population data for patients discussed at a regional MDT who received neoadjuvant chemotherapy +/- a biological agent prior to progressing to liver surgery.

Method

All patients with colorectal adenocarcinoma discussed at the Brighton MDT in 2011 were reviewed. We included patients with liver metastases whose first treatment was chemotherapy (excluding a defunctioning colostomy). Data was collected from the electronic MDT database, electronic chemotherapy prescribing system, clinic letters and imaging reports.

Results

414 patients were discussed at the Brighton MDT in 2011, 34 patients were included. Twenty nine patients received chemotherapy.

All 29 patients received oxaliplatin and capecitabine as first line treatment. Twenty five percent (4/16) of operable patients received a biological agent, 70% (9/13) inoperable patients received a biological agent with initial therapy.

Of 16 operable patients, 3 had a complete radiological response, 13 proceeded to liver resection. Of 13 who were initially assessed as inoperable, 4 proceeded to liver resection, 2 underwent embolisation, 5 had progressive disease and 1 patient died of bowel obstruction. Median number of liver metastases resected was 2 (range 1-8) and median size of largest metastasis resected per patient was 31mm (range 10mm-52mm)

Conclusion

All 16 patients with operable disease had curative treatment. 13 patients had inoperable disease, 6 patients had true incurable liver disease with more than 10 liver metastases. Four (57%) of the remaining 7 inoperable patients proceeded to liver surgery.

A liver surgeon attends the MDT, but data is not skewed by outside referrals. Conversion therapy is rarely needed, 7 patients (1.6%) of patients discussed at the MDT had conversion therapy.