PREOPERATIVE CHEMOTHERAPY FOR COLORECTAL CANCER LIVER METASTASES: SHORT-TERM RESULTS

Background. At present liver resection combined with chemotherapy is the only treatment for isolated resectable colorectal cancer liver metastases that potentially can achieve cure. Effective preoperative chemotherapy allows us to evaluate chemoresponsiveness of the tumor and increase metastases resectability.Materials and methods. Between 2006 and 2011, 60 patients with potentially resectable colorectal cancer liver metastases were included in the study. All patients received preoperative oxaliplatin- or irinotecan-based chemotherapy; average duration of treatment was 3.6 ± 0.11 months. Liver resection was performed after chemotherapy: 29 (48.3 %) pts underwent hemihepatectomy, 11 (18.3 %) pts – extended hemihepatectomy and 20 (33.4 %) pts – segmentectomy. Pathologic response in liver metastases was assessed to analyze efficacy of preoperative chemotherapy.Results. Objective response to preoperative chemotherapy was observed in 33 (55 %) pts. 23 (38.3 %) patients had stable disease. The maximum effect of preoperative chemotherapy was achieved in patients with bilobar liver metastases, receiving combination with oxaliplatin – in 23 (63.9 %) cases. Side effects of 334 cycles of preoperative chemotherapy were assessed. In most cases, adverse events were not clinically significant. Side effects of grade III/IV in 18 (5.4 %) cycles were observed in 12 (20 %) patients. 52 (86.7 %) patients underwent R0-resections; 8 pts had R1 (n = 5) и R2 (n = 3) resections of metastases. There were no postoperative deaths. Pathologic response was observed in 55/60 (91.7 %) cases: grade I was seen in 17 (28.3 %) cases; grade II – in 14 (23.3 %); grade III – in 20 (33.3 %) and grade IV – in 4 (6.8 %) cases. Pathologic response of grade III/IV occurred in 63.6 % patients with partial treatment response and 13 % pts – with stable disease (р = 0.01).Conclusions. Highest efficacy of preoperative chemotherapy in combined treatment of colorectal cancer was achieved in patients with bilobar liver metastases. Safety of two-component chemotherapy regimens was confirmed. This study presents significant correlation between preoperative chemotherapy efficacy and pathologic response in liver metastases

НЕПОСРЕДСТВЕННАЯ ЭФФЕКТИВНОСТЬ ПРЕДОПЕРАЦИОННОЙ ХИМИОТЕРАПИИ ПРИ МЕТАСТАЗАХ КОЛОРЕКТАЛЬНОГО РАКА В ПЕЧЕНИ

Background. At present liver resection combined with chemotherapy is the only treatment for isolated resectable colorectal cancer liver metastases that potentially can achieve cure. Effective preoperative chemotherapy allows us to evaluate chemoresponsiveness of the tumor and increase metastases resectability.Materials and methods. Between 2006 and 2011, 60 patients with potentially resectable colorectal cancer liver metastases were included in the study. All patients received preoperative oxaliplatin- or irinotecan-based chemotherapy; average duration of treatment was 3.6 ± 0.11 months. Liver resection was performed after chemotherapy: 29 (48.3 %) pts underwent hemihepatectomy, 11 (18.3 %) pts – extended hemihepatectomy and 20 (33.4 %) pts – segmentectomy. Pathologic response in liver metastases was assessed to analyze efficacy of preoperative chemotherapy.Results. Objective response to preoperative chemotherapy was observed in 33 (55 %) pts. 23 (38.3 %) patients had stable disease. The maximum effect of preoperative chemotherapy was achieved in patients with bilobar liver metastases, receiving combination with oxaliplatin – in 23 (63.9 %) cases. Side effects of 334 cycles of preoperative chemotherapy were assessed. In most cases, adverse events were not clinically significant. Side effects of grade III/IV in 18 (5.4 %) cycles were observed in 12 (20 %) patients. 52 (86.7 %) patients underwent R0-resections; 8 pts had R1 (n = 5) и R2 (n = 3) resections of metastases. There were no postoperative deaths. Pathologic response was observed in 55/60 (91.7 %) cases: grade I was seen in 17 (28.3 %) cases; grade II – in 14 (23.3 %); grade III – in 20 (33.3 %) and grade IV – in 4 (6.8 %) cases. Pathologic response of grade III/IV occurred in 63.6 % patients with partial treatment response and 13 % pts – with stable disease (р = 0.01).Conclusions. Highest efficacy of preoperative chemotherapy in combined treatment of colorectal cancer was achieved in patients with bilobar liver metastases. Safety of two-component chemotherapy regimens was confirmed. This study presents significant correlation between preoperative chemotherapy efficacy and pathologic response in liver metastases.Введение. В настоящее время резекция печени является единственным методом, позволяющим вместе с химиотерапией (ХТ) потенциально достичь излечения больных колоректальным раком (КРР) с изолированными резектабельными метастазами в печени. Предоперационная ХТ позволяет повысить резектабельность метастазов в печени и оценить химиочувствительность опухоли.Материалы и методы. С 2006 по 2011 г. в исследование включено 60 больных КРР с потенциально резектабельными метастазами в печени. Всем больным проведена предоперационная ХТ с включением фторпиримидинов и оксалиплатина или иринотекана; средняя продолжительность лечения составила 3,6 ± 0,11 мес. После завершения лекарственной терапии выполнена резекция печени: гемигепатэктомия – 29 (48,3 %) больным; расширенная гемигепатэктомия – 11 (18,3 %) и экономные резекции – 20 (33,4 %) больным. Для анализа эффективности предоперационной ХТ оценена выраженность лечебного патоморфоза в метастазах печени.Результаты. Объективный эффект предоперационной ХТ установлен у 33 (55 %) больных. Стабилизация заболевания отмечена в 23 (38,3 %) случаях. Максимальный эффект предоперационной ХТ достигнут у больных с билобарным поражением печени, получавших комбинации с оксалиплатином, – в 23 (63,9 %) случаях. Оценены побочные эффекты 334 курсов предоперационной ХТ. В большинстве случаев нежелательные явления были клинически незначимы. Побочные эффекты III–IV степени сопровождали 18 (5,4 %) курсов лечения у 12 (20 %) больных. У 52 (86,7 %) больных выполнены R0-резекции; у 8 больных – R1 (n = 5) и R2 (n = 3) резекции метастазов. В послеоперационном периоде летальных исходов не отмечено. При морфологическом исследовании у 55/60 (91,7 %) больных выявлены признаки лечебного патоморфоза. Патоморфоз I степени отмечен в 17 (28,3 %) случаях; II степени – в 14 (23,3 %) случаях; III степени – в 20 (33,3 %) и IV степени – в 4 (6,8 %). При частичном эффекте патоморфоз III–IV степени отмечен в 63,6 %; при стабилизации – в 13 % (р = 0,01).Выводы. Предоперационная ХТ как этап комбинированного лечения больных КРР продемонстрировала наибольшую эффективность при билобарных метастазах в печени. Подтверждена безопасность двухкомпонентных режимов ХТ. Степень лечебного патоморфоза достоверно коррелировала с эффективностью предоперационной ХТ

The role of erythropoietins in cancer therapy

Anemia is a common hematological complication in cancer patients receiving chemotherapy. Reduction of hemoglobin level is accompanied by a significant deterioration in the patients’ life quality. A transfusion of erythrocyte mass is used to rapidly increase the hemoglobin level in case of development of a symptomatic anemia. However, a large range of risks limit the wide use of blood transfusions. Erythropoiesis-stimulating proteins are the drugs that reduce the need for blood transfusions. Treatment with erythropoietins provides a smooth and prolonged rise in the hemoglobin level, the release of fully functional red blood cells into the blood. The use of erythropoietins can significantly improve the quality of life of cancer patients without reducing the effectiveness of chemotherapy