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Survival Benefit of Repeat Local Treatment in Patients Suffering From Early Recurrence of Colorectal Cancer Liver Metastases

, Babette I. Kuiper, Laurien M. Buffart, Martijn R. Meijerink, , Rutger-Jan Swijnenburg, Otto M. van Delden, , Jan J.J. de Vries, Jan Hein T.M. van Waesberghe,
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Published: 25 July 2021

Abstract: Background A uniform treatment strategy for patients suffering from early recurrence after local treatment of colorectal cancer liver metastases (CRLM) is currently lacking. The aim of this observational cohort study was to assess the potential survival benefit of repeat local treatment compared to systemic therapy in patients suffering from early recurrence of CRLM. Patients and Methods Patients who developed recurrent CRLM within twelve months after initial local treatment with curative intent were retrospectively identified in Amsterdam University Medical Centers between 2009-2019. Differences in overall and progression-free survival among treatment strategies were assessed using multivariable Cox regression analyses. Results A total of 135 patients were included. Median overall survival of 41 months [range 4 - 135] was observed in patients who received repeat local treatment, consisting of upfront or repeat local treatment after neoadjuvant systemic therapy, compared to 24 months [range 1 - 55] in patients subjected to systemic therapy alone (adjusted HR = 0.42 [95%-CI: 0.25 – 0.72]; p = 0.002). Prolonged progression-free survival was observed after neoadjuvant systemic therapy followed by repeat local treatment, as compared to upfront repeat local treatment in patients with recurrent CRLM within four months following initial local treatment of CRLM (adjusted HR = 0.36 [95%-CI: 0.15 – 0.86]; p = 0.021). Conclusion Patients with early recurrence of CRLM should be considered for repeat local treatment strategies. A multimodality approach, consisting of neoadjuvant systemic therapy followed by repeat local treatment, appeared favorable in patients with recurrence within four months following initial local treatment of CRLM. MicroAbstract Repeat local treatment should be considered in patients suffering from early recurrence of CRLM. A multimodality approach, consisting of neoadjuvant systemic therapy followed by repeat local treatment of CRLM, appeared favorable in patients with recurrence within four months. The optimal sequence and the role of systemic therapy in patient selection should be further clarified in prospective studies.
Keywords: hepatectomy / ablation / systemic therapy / treatment strategy / survival analysis

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