The pathological response to neoadjuvant chemotherapy with FOLFOX-4 for colorectal liver metastases : a comparative study

• Published in: Virchows Archiv : an international journal of pathology 2007-11, Vol.451 (5), p.943-948
• Main Authors: ALOYSIUS, Mark M, ZAITOUN, Abed M, BECKINGHAM, Ian J, NEAL, Keith R, AITHAL, Guruprasad P, BESSELL, Eric M, LOBO, Dileep N
• Format: Article
• Language: English
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Cancer; Chemotherapy; Chemotherapy, Adjuvant - adverse effects; Colorectal Neoplasms - drug therapy; Colorectal Neoplasms - pathology; Comparative studies; Fatty Liver - chemically induced; Female; Fibrosis; Fluorouracil - adverse effects; Fluorouracil - therapeutic use; Gastroenterology. Liver. Pancreas. Abdomen; Hepatectomy; Humans; Investigative techniques, diagnostic techniques (general aspects); Leucovorin - adverse effects; Leucovorin - therapeutic use; Liver; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Neoplasm Metastasis - drug therapy; Organoplatinum Compounds - adverse effects; Organoplatinum Compounds - therapeutic use; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Retrospective Studies; Tumors
• ISSN: 0945-6317; 1432-2307
• DOI: 10.1007/s00428-007-0497-1

FOLFOX-4 (folinic acid/5-fluorouracil/oxaliplatin) chemotherapy is used to treat patients with colorectal liver metastases. We aimed to assess hepatic histopathological responses to neoadjuvant FOLFOX-4 chemotherapy in patients with colorectal liver metastases. We selected all patients (n = 54) treated with FOLFOX-4 for colorectal liver metastases between June 2002 and June 2005. Only 25 underwent hepatectomy and formed the study group. Histological responses were assessed in the study group and a matched control group (n = 25) that did not receive neoadjuvant chemotherapy. The median (IQR) body mass index in the study and control groups was 24 (22-26) and 24 (23-25) kg/m(2), respectively, (P = NS). Complete histological resolution of tumour occurred in six (24%) patients in the study group. Median residual tumour cellularity was less (35 vs 70%) and fibrosis greater (50 vs 5%) in patients in the study group when compared with controls (P < 0.001). The liver surrounding the tumour was steatotic in 17 (68%) patients in the study group and five (20%) controls (P = 0.001). Hepatic sinusoidal dilatation was more pronounced in patients in the study group than in controls (P < 0.001). The response to FOLFOX-4 was associated with tumour necrosis, fibrosis and inflammation. More than two thirds of patients undergoing hepatectomy after FOLFOX-4 had steatosis despite being non-obese.