Management of colorectal cancer patients after resection of liver metastases: can we offer a tailored treatment?

Surgical resection remains the only option of cure for patients with colorectal liver metastases, and no patient should be precluded from surgery. There is much controversy not only regarding the most appropriate therapeutic approach in the neoadjuvant setting but also after surgery is performed. Ma...

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Bibliographic Details
Published in:Clinical & translational oncology 2012-09, Vol.14 (9), p.641-658
Main Authors: López-Gómez, Miriam, Cejas, Paloma, Merino, María, Fernández-Luengas, David, Casado, Enrique, Feliu, Jaime
Format: Article
Language:English
Subjects:
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Biomarkers, Tumor - metabolism
Chemotherapy, Adjuvant
Colorectal Neoplasms - drug therapy
Colorectal Neoplasms - pathology
Educational Series – Red Series
Humans
Liver Neoplasms - secondary
Liver Neoplasms - surgery
Lymph Nodes - pathology
Medicine
Medicine & Public Health
Oncology
Precision Medicine
Prognosis
Treatment Outcome
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Summary:Surgical resection remains the only option of cure for patients with colorectal liver metastases, and no patient should be precluded from surgery. There is much controversy not only regarding the most appropriate therapeutic approach in the neoadjuvant setting but also after surgery is performed. Many patients will experience early relapses but others will be long survivors. We need to establish reliable prognostic and predictive factors to offer a tailored treatment. Several prognostic factors after metastasectomy have been identified: high C-reactive protein levels, a high neutrophil–lymphocyte ratio, elevated neutrophil count and low serum albumin are related to a worst outcome. Elevated CEA and Ki 67 levels, intrahepatic and perihepatic lymph node invasion are also some of the markers related to a worst outcome. In contrast, the administration of preoperative chemotherapy has been associated with a better prognosis after hepatectomy. The administration of adjuvant chemotherapy should be done taking in consideration these factors. Regarding predictive factors, determination of ERCC1, TS, TP and DPD and UGT1 polymorphisms assessment could be considered prior to chemotherapy administration. This would avoid treatment related toxicities and increase this population quality of life.
ISSN:1699-048X
1699-3055
DOI:10.1007/s12094-012-0853-8