Aggressive Treatment Prolongs Survival In Colon Cancer Metastases Patients

Aggressive local treatment can prolong long-term overall survival (OS) in patients with unresectable colorectal liver metastases, according to a recent phase II trial.

Although tumor ablation is a common procedure for unresectable colorectal liver metastases, few prospective randomized studies have been performed to examine the survival benefit. However, in their previous trial, the researchers reported that the primary outcome of 30-month OS was met with this type of aggressive approach.
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To further investigate the long-term benefits of more aggressive treatment, the researchers evaluated 119 patients with less than 10 unresectable colorectal metastases and no extrahepatic disease. Patients received either systemic treatment alone (n = 60) or systemic treatment plus aggressive local radiofrequency ablation with or without resection (n = 59).

All statistical tests were two-sided, and the analyses were based on intention-to-treat.

After a median follow-up of 9.7 years, 92 (77.3%) of 119 patients had died. Most deaths were due to progressive disease. A total of 39 patients who had died were receiving combined modality treatment, and 53 were receiving systemic treatment only.

The patients in the combined modality treatment group showed a significantly higher rate of OS than those receiving systemic treatment only. OS rates in the combined modality group were 56.9% for 3-year OS; 43.1% for 5-year OS; and 35.9% for 8-year OS. However, in the group receiving systemic treatment only, rates were 55.2% for 3-year OS; 30.3% for 5-year OS, and 8.9% for 8-year OS.

Median OS was 45.6 months in the combined modality group and 40.5 months in the group receiving systemic treatment only.

“This phase II trial is the first randomized study demonstrating that aggressive local treatment can prolong OS in patients with unresectable colorectal liver metastases,” the researchers concluded.

—Christina Vogt

Reference:

Ruers T, Van Coevorden F, Punt CJA, et al. Local treatment of unresectable colorectal liver metastases: results of a randomized phase II trial. J Natl Cancer Inst. 2017;109(9). doi:10.1093/jnci/djx015.