SS  Vol.3 No.3 , March 2012
Volumetric Modifications of Metastatic Liver Volumes after Dramatic Responses under Chemotherapy
Objective: To analyze the volumetric modifications of the non tumourous part of the liver when liver metastases (LM) decrease under chemotherapy. Methods: Patients were highly selected based on the following criteria: multiple bilateral large colorectal LM, response of LM attaining at least 85% under chemotherapy. The volumes and ratios of the whole liver, of the LM, and mainly of the non tumourous (normal) part of the liver, were measured on CT scan before and after chemotherapy. Results: Only ten (5%) among 198 treated patients were eligible. Nine of them had received intra-arterial chemotherapy. Metastatic involvement was initially 34% before chemotherapy (range: 13% - 75%), and was 5% (range: 1% - 25%) after chemotherapy. The whole liver volume decreased by 41% (range: 23% - 68%) after chemotherapy. The non metastatic liver (volume and ratio) decreased after chemotherapy in 6 patients and increased in 4 patients. The volume and ratio increased in the 4 patients whose disease initially exhibited the highest metastatic involvement (p = 0.01). Conclusion: The volume of the non metastatic part of the liver varied slightly under standard chemotherapy. Intra-arterial chemotherapy induces dramatic responses, but also liver injury which impairs liver regeneration. However increasing volumes were observed when initial tumour involvement was major.

Cite this paper
D. Elias, L. Maggiori, P. Misitano, F. Deschamps, F. Dumont, M. Ducreux and D. Goéré, "Volumetric Modifications of Metastatic Liver Volumes after Dramatic Responses under Chemotherapy," Surgical Science, Vol. 3 No. 3, 2012, pp. 126-130. doi: 10.4236/ss.2012.33025.

[1]   G. Torzilli, A. Palmisano, F. Procopio, M. Cimino, F. Botea, M. Donadon, et al., “A New Systematic Small for Size Resection for Liver Tumors Invading the Middle Hepatic Vein at Its Caval Confluence,” Annals of Surgery, Vol. 251, 2010, pp. 33-39. doi:10.1097/SLA.0b013e3181b61db9

[2]   D. Elias, D. Goéré, G. Leroux, C. Dromain, S. Leboulleux, T. H. de Baere, et al., “Combined Liver Surgery and RFA for Patients with Gastroenteropancreatic Endocrine Tumors Presenting with More than 15 Metastases to the Liver,” EJSO, Vol. 35, No. 10, 2009, pp. m1092-1097.

[3]   S. Kopetz, G. J. Chang, M. J. Overman, C. Eng, D. J. Sargent, D. W. Larson, et al., “Improved Survival in Metastatic Colorectal Cancer Is Associated with Adoption of Hepatic Resection and M Proved Chemotherapy,” Journal of Clinical Oncology, Vol. 27, No. 22, 2009, pp. 3677-3683. doi:10.1200/JCO.2008.20.5278

[4]   D. Elias, D. Goéré, V. Boige, N. Kohneh-Sharhi, D. Malka, G. Tomasic, et al., “Outcome of Posthepatectomy Missing Colorectal Liver Metastases after Complete Response to Chemotherapy: Impact of Adjuvant Intra-Arterial Hepatic Oxaliplatin,” Annals of Surgical Oncology, Vol. 14, No. 11, 2007, pp. 3188-3194. doi:10.1245/s10434-007-9482-9

[5]   R. C. Auer, R. R. White, N. Kemeny, L. H. Schwartz, J. Shia, L. Blumgart, et al., “Predictors of a True Complete Response among Disappearing Liver Metastases from Colorectal Cancer after Chemotherapy,” Cancer, Vol. 116, No. 6, 2010, pp. 1502-1509. doi:10.1002/cncr.24912

[6]   S. K. Reddy, A. S. Barbas and B. M. Lary, “Synchronous Colorectal Liver Metastases: Is It Time to Reconsider Traditional Paradigms of Management?” Annals of Surgical Oncology, Vol. 16, No. 9, 2009, pp. 2395-2410. doi:10.1245/s10434-009-0372-1PMid:19506963

[7]   R. C. Martin, M. J. Edwards and K. M. McMasters, “Morbidity of Adjuvant Hepatic Arterial Infusion Pump Chemotherapy in the Management of Colorectal Cancer Metastatic to the Liver,” American Journal of Surgery, Vol. 188, No. 6, 2004, pp. 714-721. doi:10.1016/j.amjsurg.2004.08.042

[8]   C. Bognel, C. Degott, P. Rougier, D. Elias, S. Grandjoan, P. Duvillard, et al., “Etude Pathologique de la Toxicité héPatique de la Chimiothérapie Intra-artéRielle Hépatique,” Gastroenterologie Clinique Et Biologique, Vol. 13, 1989, pp. 125-131.

[9]   H. Kinoshita, K. Sakai, K. Hirohashi, et al., “Preoperative Portal Vein Embolization for Hepatocellular Carcinoma,” World Journal of Surgery, Vol. 10, No. 5, 1986, pp. 803-808. doi:10.1007/BF01655244

[10]   D. Elias, D. Goere, N. Kohneh-Sahrhi and T. De Baere, “Strategies for Resection Using Portal vein Embolization: Metastatic Liver Cancer,” Seminars in Interventional Radiology, Vol. 25, No. 2, 2008, pp. 123-131. doi:10.1055/s-2008-1076680

[11]   D. Elias, T. De Baere, A. Roche, S. Bonvallot and P. Lasser, “Preoperative Selective Portal Vein Embolizations Are an Effective Means of Extending the Indications of Major Hepatectomy in the Normal and Injured Liver,” Hepato-Gastroenterology, Vol. 45, No. 19, 1998, pp. 170-177.

[12]   O. Farges, J. Belghii, R. Kianmanesh, M. Regimbeau, R. Santoro, V. Vilgrain, et al., “Portal Vein Embolization before Right Hepatectomy: Prospective Clinical Trial,” Annals of Surgery, Vol. 237, No. 2, 2003, pp. 208-217. doi:10.1097/00000658-200302000-00010

[13]   S. Ogata, J. Belghiti, O. Farges, D. Varma, A. Sibert and V. Vilgrain, “Sequential Arterial and Portal Vein Embolizations before Right Hepatectomy in Patients with Cirrhosis and Hepatocellular Carcinoma,” British Journal of Surgery, Vol. 93, No. 9, 2006, pp. 1091-1098. doi:10.1002/bjs.5341

[14]   D. Correa, L. Schwartz, W. R. Jarnagin, S. Tuorto, R. De Matteo, M. D’angelica, et al., “Kinetics of Liver Volume Changes in the First Year after Portal Vein Embolization,” Archives of Surgery, Vol. 145, No. 4, 2010, pp. 351-354. doi:10.1001/archsurg.2010.42