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Colorectal liver metastases contract centripetally with a response to chemotherapy†

A histomorphologic study

  1. Jennica K.S. Ng MD1,
  2. Stefan J. Urbanski MD2,
  3. Naurang Mangat PhD3,
  4. Andrew McKay MD1,
  5. Francis R. Sutherland MD1,
  6. Elijah Dixon MD1,
  7. Scot Dowden MD3,
  8. Scott Ernst MD4,
  9. Oliver F. Bathe MD1,3,‡,*

Article first published online: 26 NOV 2007

DOI: 10.1002/cncr.23184

Issue

Cancer

Cancer

Volume 112, Issue 2, pages 362–371, 15 January 2008

Additional Information

How to Cite

Ng, J. K.S., Urbanski, S. J., Mangat, N., McKay, A., Sutherland, F. R., Dixon, E., Dowden, S., Ernst, S. and Bathe, O. F. (2008), Colorectal liver metastases contract centripetally with a response to chemotherapy. Cancer, 112: 362–371. doi: 10.1002/cncr.23184

Author Information

  1. 1

    Department of Surgery, University of Calgary, Calgary, Alberta, Canada

  2. 2

    Department of Pathology, University of Calgary, Calgary, Alberta, Canada

  3. 3

    Department of Oncology, University of Calgary, Calgary, Alberta, Canada

  4. 4

    Department of Oncology, London Regional Cancer Centre, London, Ontario, Canada

  1. ‡

    Fax: (403) 283-1651.

*Tom Baker Cancer Centre, Division of Surgical Oncology, 1331-29th St. NW, Calgary, Alberta, Canada T2N 4N2

  1. †

    The study was reviewed and approved by the Conjoint Health Research Ethics Board of the University of Calgary.

Publication History

  1. Issue published online: 4 JAN 2008
  2. Article first published online: 26 NOV 2007
  3. Manuscript Accepted: 21 AUG 2007
  4. Manuscript Revised: 15 AUG 2007
  5. Manuscript Received: 9 MAY 2007

Funded by

  • Pfizer Canada Inc.

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Keywords:

  • colorectal cancer;
  • neoadjuvant chemotherapy;
  • response;
  • liver metastases;
  • resection

Abstract

BACKGROUND.

Recently, there has been considerable interest in neoadjuvant chemotherapy for colorectal liver metastases. However, there is little information that defines how much liver should be removed after a favorable response.

METHODS.

Liver metastases from 2 groups of patients were analyzed: 25 metastases were evaluated from a group that did not receive chemotherapy and 26 lesions were studied from patients who had received systemic chemotherapy before resection. All patients except for 1 had 5-fluorouracil (5-FU), leucovorin (LV), and irinotecan (CPT-11); 1 had 5-FU and LV alone. The average duration of chemotherapy was 2.9 ± 0.7 months. Separate assessments of the histopathologic features of the central and peripheral portions of each tumor were made. The pathologist was blinded to all clinical information.

RESULTS.

All of the untreated metastases had well-circumscribed borders. Irregular borders were seen in 6 of the postchemotherapy lesions (26%), which was particularly prominent in lesions that had significantly contracted. After chemotherapy, discrete islands of viable tumor cells outside of the main tumor mass were seen in 4 patients, but all were close to the peripheral margin of the tumor mass. Viable tumor cells were more frequent in the periphery of metastases, regardless of chemotherapy exposure. Central necrosis was prominent in untreated metastases, but disappeared after chemotherapy. In lesions treated with chemotherapy, central fibrosis was greater compared with untreated lesions.

CONCLUSIONS.

After a partial response to chemotherapy, liver metastases shrank in a generally concentric fashion. These findings support the practice of removing less liver after downsizing with chemotherapy. Cancer 2008. © 2007 American Cancer Society.

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