Does (neo)adjuvant or perio perative chemotherapy improve disease-free survival and overall survival in patients with resec table colorectal liver metastases?

Objective: Colorectal cancer is the second most common cause of cancer related death in Europe. More than 50% of the patients will develop liver metastases. We wanted to determine if recent chemotherapy regimens (since 2006) in adjuvant, neoadjuvant or both settings increases disease-free survival (DFS) and overall survival (OS) in patients with resectable colorectal liver metastasis compared to surgery only. Methods: We used Pubmed to find articles for this review. We only included studies after 2006, which used 5-FU, leucoverin and oxaliplatin (FOLFOX) or 5-FU, leucoverin and irinotecan (FOLFIRI) as chemotherapy. Liver metastases had to be surgically removed. Studies reported DFS and OS as primary or secondary endpoint. Results: We found seven articles on neoadjuvant and adjuvant chemotherapy and two articles on perioperative chemotherapy. Neoadjuvant chemotherapy did not significantly improve 3-year DFS and OS. Adjuvant chemotherapy showed higher 3-year DFS and OS compared to surgery alone. One study showed that perioperative chemotherapy improves 3-year DFS and 5-year OS, but not significantly more than adjuvant chemotherapy. Conclusions: Some of our studies showed an improved 3-year DFS and OS in the adjuvant chemotherapy setting compared to surgery alone. However, these were all retrospective studies, which may have caused a bias in our results. Therefore we do not recommend using (neo)adjuvant or perioperative chemotherapy in the treatment of colorectal liver metastases (CRLM).