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Original Investigation |

Chemotherapy After Portal Vein Embolization to Protect Against Tumor Growth During Liver Hypertrophy Before Hepatectomy

Catha Fischer, MD1; Laleh G. Melstrom, MD1; Dean Arnaoutakis, MD1; William Jarnagin, MD1; Karen Brown, MD2; Michael D’Angelica, MD1; Anne Covey, MD2; Ronald DeMatteo, MD1; Peter Allen, MD1; T. Peter Kingham, MD1; Scott Tuorto1; Nancy Kemeny, MD3; Yuman Fong, MD1,2
[+] Author Affiliations
1Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
2Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York
3Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
JAMA Surg. 2013;148(12):1103-1108. doi:10.1001/jamasurg.2013.2126.
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Importance  Portal vein embolization improves the safety of liver resection by increasing the size of residual liver, but the embolization may increase tumor growth during the waiting period before definitive hepatectomy.

Objective  To determine whether the administration of chemotherapy mitigates tumor growth after portal vein embolization (PVE) performed before major hepatectomy for metastatic colorectal cancer.

Design, Setting, and Participants  Review of prospectively collected data at Memorial-Sloan Kettering Cancer Center was conducted. The database included patients subjected to PVE before major hepatectomy for metastatic colorectal cancer.

Main Outcomes and Measures  Lesions in both the embolized and nonembolized lobes of the liver before and 1 month after PVE were measured and Response Evaluation Criteria in Solid Tumors were applied to assess disease status. Assessment of survival was based on receipt of post-PVE chemotherapy and then stratified by subsequent resectability.

Results  Two hundred eight tumors were measured in 64 patients; 53 tumors were in patients undergoing post-PVE chemotherapy. Approximately one-third of the lesions progressed after PVE when no chemotherapy was administered. This did not differ significantly according to whether tumors were ipsilateral or contralateral to the PVE. When chemotherapy was administered, there was a significantly lower rate of progression (18.9%, P = .03). In long-term follow-up, treatment with post-PVE chemotherapy was also independently associated with improved survival (P < .006).

Conclusions and Relevance  Chemotherapy does not retard growth of the liver after PVE and may prevent cancer progression. Thus, the combination of PVE and chemotherapy may enhance both oncologic and operative safety.

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Figure 1.
Box Plots for Changes of Tumor Size

Results are shown for the tumors in patients who did and did not undergo chemotherapy after portal vein embolization (PVE) (P < .001). Boxes represent upper and lower quartiles of data; horizontal line in the box, median value; limit lines, maximum and minimum values excluding outliers; and solid circles, outliers (more or less than 3/2 times the upper or lower quartiles).

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Figure 2.
Kaplan-Meier Overall Survival Curves

Results are shown for patients after liver resection analyzed according to whether they received or did not receive chemotherapy after portal vein embolization (PVE) (P < .006).

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Figure 3.
Analysis of Survival According to Post–Portal Vein Embolization Chemotherapy (PVE) Stratified by Subsequent Resectability

Results are shown for patients’ survival according to whether they received or did not receive chemotherapy after PVE(P < .007).

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