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Ann Coloproctol > Volume 24(3); 2008 > Article
Journal of the Korean Society of Coloproctology 2008;24(3):184-191.
DOI: https://doi.org/10.3393/jksc.2008.24.3.184   
Curative Resection Following Neoadjuvant Chemotherapy Including a Molecularly Targeted Agent in Patients with Unresectable Colorectal Distant Metastases.
Kim, Jin Soo , Min, Byung Soh , Hur, Hyuk , Kim, Nam Kyu , Choi, Jin Sub , Sohn, Seung Kook , Cho, Chang Hwan , Ahn, Joong Bae , Roh, Jae Kyung
1Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. namkyuk@yuhs.ac
2Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Abstract
PURPOSE
A colorectal carcinoma is the fourth most common malignancy in the world. Unfortunately, only approximately 20% of the liver metastases are resectable at the initial presentation. Neoadjuvant chemotherapy has been used for downsizing in unresectable disease. In addition, the use of newer biologic agents, such as cetuximab and bevacizumab, has much improved responses in patients with unresectable colorectal liver metastases. The aim of this study was to report on patients who had received a curative resection following neoadjuvant chemotherapy including a molecularly targeted agent for unresectable colorectal liver metastases.
METHODS
Following the neoadjuvant chemotherapy using cetuximab plus FOLFIRI (irinotecan and infused fluorouracil plus leucovorin) or bevacizumab plus FOLFOX (oxaliplatin and infused fluorouracil plus leucovorin), 10 patients with initially unresectable colorectal liver metastases underwent a curative surgical resection between September 2005 and June 2007.
RESULTS
One patient underwent a right lobectomy, three patients a segmentectomy and five a wedge resection with or without radiofrequency ablation. With a median postoperative follow-up of 14 months (range, 1 to 22 months), five recurrences (50%) occurred. The common toxic effects were grade 2/3 skin toxicity (60%), grade 4 hematologic toxicity (20%), grade 3 gastrointestinal toxicity (10%), and grade 3 neurologic toxicity (10%).
CONCLUSIONS
Our preliminary data suggests that neoadjuvant chemotherapy including a molecularly targeted agent may improve resectability in patients with initially unresectable colorectal liver metastases although a high recurrence rate exists. Randomized prospective studies comparing neoadjuvant chemotherapy including a targeted agent in cases of unresectable colorectal liver metastases are warranted.
Key Words: Colorectal cancer, Liver metastasis, Molecularly targeted agent, Curative resection


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