Skip to main content
SpringerLink
Log in

Treatment with 5-Fluorouracil/Folinic Acid, Oxaliplatin, and Irinotecan Enables Surgical Resection of Metastases in Patients With Initially Unresectable Metastatic Colorectal Cancer

  • Original Article
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The prognosis of unresectable metastatic colorectal cancer might be improved if a radical surgical resection of metastases could be performed after a response to chemotherapy.

Methods

We treated 74 patients with unresectable metastatic colorectal cancer (not selected for a neoadjuvant approach) with irinotecan, oxaliplatin, and 5-fluorouracil/leucovorin (FOLFOXIRI and simplified FOLFOXIRI). Because of the high activity of these regimens (response rate, 72%), a secondary curative operation could be performed in 19 patients (26%).

Results

Four patients underwent an extended hepatectomy, nine patients underwent a right hepatectomy, three patients underwent a left hepatectomy, and three patients had a segmental resection. In five patients, surgical removal of extrahepatic disease was also performed. In seven patients, surgical resection was combined with intraoperative radiofrequency ablation. The median overall survival of the 19 patients who underwent operation is 36.8 months, and the 4-year survival rate is 37%. The median overall survival of the 34 patients who were responsive to chemotherapy, but who did not undergo operation, is 22.2 months (P = .0114).

Conclusions

The FOLFOXIRI regimens we studied have significant antitumor activity and allow a radical surgical resection of metastases in patients with initially unresectable metastatic colorectal cancer not selected for a neoadjuvant approach and also those with extrahepatic disease. The median survival of patients with resected disease is promising.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Greenlee RT, Murray T, Bolden S, Wingo PA. Cancer statistics. CA Cancer J Clin 2000;50:7–33

    Article  CAS  Google Scholar 

  2. Strangl R, Alterdorf-Hofmann A, Charnley RM, Scheele J. Factors influencing the natural history of colorectal liver metastases. Lancet 1994;343:1405–10

    Article  Google Scholar 

  3. Jonker DJ, Maroun JA, Kocha W. Survival benefit of chemotherapy in metastatic colorectal cancer: a meta-analysis of randomized controlled trials. Br J Cancer 2000;82:1789–94

    Article  CAS  Google Scholar 

  4. Wilson SM, Adson MA. Surgical treatment of hepatic metastases from colorectal cancers. Arch Surg 1976;111:330–4

    Article  CAS  Google Scholar 

  5. Fong Y, Cohen AM, Fortner JG, et al. Liver resection for colorectal metastases. J Clin Oncol 1997;15:938–46

    Article  CAS  Google Scholar 

  6. Jaeck D, Bachellier P, Guiguet M, et al. Long-term survival following resection of colorectal hepatic metastases. Association Francaise de Chirurgie. Br J Surg 1997;84:977–80

    Article  CAS  Google Scholar 

  7. Ike H, Shimada H, Ohki S, Togo S, Yamaguchi S, Ichikawa Y. Results of aggressive resection of lung metastases from colorectal carcinoma detected by intensive follow-up. Dis Colon Rectum 2002;45:468–73

    Article  Google Scholar 

  8. Sakamoto T, Tsubota N, Iwanaga K, Yuki T, Matsuoka H, Yoshimura M. Pulmonary resection for metastases from colorectal cancer. Chest 2001;119:1069–72.

    Article  CAS  Google Scholar 

  9. Kobayashi K, Kawamura M, Ishihara T. Surgical treatment for both pulmonary and hepatic metastases from colorectal cancer. J Thorac Cardiovasc Surg 1999;118:1090–6.

    Article  CAS  Google Scholar 

  10. Mineo TC, Ambrogi V, Tonini G, et al. Longterm results after resection of simultaneous and sequential lung and liver metastases from colorectal carcinoma. J Am Coll Surg 2003;197:386–91.

    Article  Google Scholar 

  11. Elias D, Sideris L, Pocard M, et al. Results of R0 resection for colorectal liver metastases associated with extrahepatic disease. Ann Surg Oncol 2004;11:274–80

    Article  Google Scholar 

  12. Grothey A, Sargent D, Goldberg RM, et al. Survival of patients with advanced colorectal cancer improves with the availability of fluorouracil-leucovorin, irinotecan, and oxaliplatin in the course of treatment. J Clin Oncol 2004;22:1209–14

    Article  CAS  Google Scholar 

  13. Giacchetti S, Itzhaki M, Gruia G, et al. Long-term survival of patients with unresectable colorectal cancer liver metastases following infusional chemotherapy with 5-fluorouracil, leucovorin, oxaliplatin and surgery. Ann Oncol 1999;10:663–9.

    Article  CAS  Google Scholar 

  14. Adam R, Avisar E, Ariche A, et al. Five-year survival following hepatic resection after neoadjuvant therapy for nonresectable colorectal. Ann Surg Oncol 2001;8:347–53

    Article  CAS  Google Scholar 

  15. Folprecht G, Kohne CH. The role of new agents in the treatment of colorectal cancer (review). Oncology 2004;66:1–17

    Article  CAS  Google Scholar 

  16. Falcone A, Masi G, Allegrini G, et al. Biweekly chemotherapy with oxaliplatin, irinotecan, infusional fluorouracil, and leucovorin: a pilot study in patients with metastatic colorectal cancer. J Clin Oncol 2002;20:4006–14

    Article  CAS  Google Scholar 

  17. Masi G, Allegrini G, Cupini S, et al. First line treatment of metastatic colorectal cancer with irinotecan, oxaliplatin and 5-fluorouracil/leucovorin (FOLFOXIRI): results of phase II study with a simplified biweekly schedule. Ann Oncol 2004;15:1766–72

    Article  CAS  Google Scholar 

  18. Buyse M, Thirion P, Carlson RW, et al. Relation between tumour response to first-line chemotherapy and survival in advanced colorectal cancer: a meta-analysis. Lancet 2000;356:373–8.

    Article  CAS  Google Scholar 

  19. Sobrero AF. Scheduling of fluorouracil: a forget-me-not in the jungle of doublets. J Clin Oncol 2004;22:4–6

    Article  CAS  Google Scholar 

  20. Pozzo C, Basso M, Cassano A, et al. Neoadjuvant treatment of unresectable liver disease with irinotecan and 5-fluorouracil plus folinic acid in colorectal cancer patients. Ann Oncol 2004;15:933–9

    Article  CAS  Google Scholar 

  21. Negri F, Musolino A, Cunningham D, Pastorino U, Ladas G, Norman AR. Retrospective study of resection of pulmonary metastases in patients with advanced colorectal cancer: the development of a preoperative chemotherapy strategy. Clin Colorectal Cancer 2004;4:101–6

    Article  Google Scholar 

Download references

Acknowledgments

The authors thank Michele Andreuccetti (Division of Oncology, Livorno) for data analysis and technical assistance. This study was partially supported by Fondazione A.R.C.O.

Author information

Authors and Affiliations

  1. Department of Oncology, Division of Medical Oncology, Presidio Ospedaliero, Viale Alfieri 36, Livorno, 57124, Italy

    Gianluca Masi MD, Samanta Cupini MD, Lorenzo Marcucci MD, Elisa Cerri MD, Fotios Loupakis MD, Giacomo Allegrini MD & Alfredo Falcone MD

  2. Department of Oncology, Division of Medical Oncology, Ospedale Santa Chiara, Via Roma 67, Pisa, 56126, Italy

    Isa Maura Brunetti MD & Elisabetta Pfanner MD

  3. Department of Oncology, Division of Surgery, Presidio Ospedaliero, Viale Alfieri 36, Livorno, 57124, Italy

    Maurizio Viti MD

  4. Department of Oncology, Division of Surgery, Ospedale Lotti, Via Roma 180, Pontedera, 56025, Italy

    Orlando Goletti MD

  5. Division of Liver Transplantation, University of Pisa, Via Paradisa 2, Pisa, 56124, Italy

    Franco Filipponi MD

  6. Cattedra di Oncologia Medica, University of Pisa, Via Roma 55, Pisa, 56126, Italy

    Alfredo Falcone MD

Authors
  1. Gianluca Masi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Samanta Cupini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lorenzo Marcucci MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elisa Cerri MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fotios Loupakis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Giacomo Allegrini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Isa Maura Brunetti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Elisabetta Pfanner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Maurizio Viti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Orlando Goletti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Franco Filipponi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Alfredo Falcone MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gianluca Masi MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Masi, G., Cupini, S., Marcucci, L. et al. Treatment with 5-Fluorouracil/Folinic Acid, Oxaliplatin, and Irinotecan Enables Surgical Resection of Metastases in Patients With Initially Unresectable Metastatic Colorectal Cancer. Ann Surg Oncol 13, 58–65 (2006). https://doi.org/10.1245/ASO.2006.03.094

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/ASO.2006.03.094

Keywords

Search

Navigation