Peri-Operative Chemotherapy for the Treatment of Resectable Liver Metastases from Colorectal Cancer: A Systematic Review and Meta-Analysis of Randomized Trials
The role of peri-operative chemotherapy in patients with resected stage IV colorectal cancer (CRC) remains to be defined. This study was aimed at evaluating the effectiveness of peri-operative chemotherapy in patients with resected stage IV CRC by performing a meta-analysis of relevant trials. The study was published this month in the BMC Cancer Journal. The study was done by performing a literature search to identify trials comparing patients with stage IV CRC receiving peri-operative chemotherapy and surgery with patients undergoing surgery alone. The hazard ratio (HR) was estimated to assess any survival advantage of peri-operative chemotherapy. The authors found eight trials conducted on a total of 1174 patients by a literature search. In these trials, HR estimates suggested that peri-operative chemotherapy yielded no survival advantage over surgery alone (HR, 0.94; 95% CI, 0.8-1.10; p = 0.43). In a subset analysis on intra-arterial chemotherapy, no survival benefit was evident (HR, 1.0; 95% CI, 0.84-1.21; p = 0.96; I^2= 30%), whereas in the 3 trials involving systemic chemotherapy, the difference between the groups approached statistical significance (HR, 0.74; 95% CI, 0.53-1.04; p = 0.08; I^2= 0%). Both peri-operative treatment groups had a significant recurrence-free survival benefit (HR, 0.78; 95% CI, 0.65-0.95; P= 0.01 for hepatic arterial infusion; and HR, 0.75; 95% CI, 0.62-0.91; p = 0.003 for systemic therapy). The toxicities of chemotherapy were acceptable in most trials. From the above findings the authors concluded that this first meta-analysis demonstrated the importance of peri-operative chemotherapy in the treatment of resected stage IV CRC. Although the results must be carefully interpreted because of some limitations, critical issues were identified that must be resolved by future studies.
REFERENCE:
Martina Wieser, Stefan Sauerland, Dirk Arnold, Wolff Schmiegel and Anke Reinacher-Schick. Peri-operative chemotherapy for the treatment of resectable liver metastases from colorectal cancer: A systematic review and meta-analysis of randomized trials. BMC Cancer 2010, 10:309
