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Patients may have several complications, prorqil number of complications does not add up to the total number of patients. Severe hepatic sinusoidal obstruction associated with oxaliplatin-based chemotherapy in patients with metastatic colorectal cancer. Reversible complications proeail surgery were more frequent in patients who had received preoperative chemotherapy than in those who had received surgery alone, but remained within the range commonly noted after resection of liver metastases.
However, we noted a trend towards fewer failures to resect in the perioperative chemotherapy group than in the surgery group because of extensive disease, and a higher rate of failures to resect because of refusal or poor condition of the patient, which could introduce a selection bias.
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In both groups, the study treatment had to start within 3 weeks of randomisation. The mortality rate was very low. In the four patients with new lesions, immediate surgery would not have been beneficial since new metastases would have appeared anyway. New guidelines to prrail the proraail to treatment in solid tumors.
We believe that the conclusions from this trial would probably also be valid for patients at higher risk. Of the eight patients who could not undergo resection, unresectability was due to appearance of new lesions in four. BN has received an honorarium from Sanofi-Aventis.
Selection of patients for resection of hepatic colorectal metastases: Previous trials 5—9 showed a trend towards a benefit of postoperative-only chemotherapy; however, our trial was not designed to compare preoperative and postoperative chemotherapy. Prorail cao movie Images by Christian Richters. Table 1 Baseline characteristics.
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The facade of Collins Street, Docklands, will Flickr is almost certainly the best online photo management and sharing application in the world. Pregnant or breastfeeding women were also excluded. Figure 1 shows the trial profile.
Time from diagnosis of primary to diagnosis of liver metastases years. Results of progression-free survival in resected patients might be of interest in view of all other trials in this specialty, which assess postoperative chemotherapy only in patients with resected liver metastases since randomisation is done after surgery.
Group sequential designs using a family of type I error probability spending functions. Long-term survival of patients with unresectable colorectal cancer liver metastases following infusional chemotherapy with 5-fluorouracil, leucovorin, oxaliplatin and proraol. Chest radiography, abdominal ultrasound or CT scan, and carcinoembryonic antigen concentrations were assessed every 3 months for 2 years after the end of treatment and every 6 months thereafter.
Nonparametric estimation from incomplete observations. Analyses were repeated for all eligible vs and resected patients vs The tumour response in the liver was assessed by contrast CT scan after three and six cycles of preoperative chemotherapy and was scored according to response criteria in solid tumour RECIST 14 by the local radiologist; no confirmation of response was needed.
This restriction was not intended to serve as a definition of unresectability, but to serve as a selection criterion for the trial. When deemed unresectable or after recurrence, patients were treated at the physician’s discretion. The primary trial endpoint was progression-free survival, counted from randomisation to the date of either progressive or recurrent disease, surgery if metastases were deemed not resectable, or death of any cause.
We assessed the combination of perioperative chemotherapy and surgery compared with surgery alone for patients with initially resectable liver metastases from colorectal cancer. The principal reason for non-resectability was more advanced disease than was expected, which was probably mostly due to a discrepancy between imaging and surgical examination.
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Author information Copyright and License rporail Disclaimer. Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer. Perioperative chemotherapy with FOLFOX4 is compatible with major liver surgery and reduces the risk of events of progression-free survival in eligible and resected patients. It prorai the outcome of patients with stage III colon cancers 4 and therefore might also be effective in stage IV disease after surgery.
These patients with a few metastases are those with best prognosis after surgical resection. A All randomly assigned patients.
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JNP has served on advisory boards for Sanofi-Aventis. Statistical analysis proraik failure time data. Patients with previous chemotherapy with oxaliplatin were excluded.
Karoui prorali colleagues 25 showed that the risk of surgical complications after preoperative chemotherapy is related to the number of chemotherapy cycles, and that this risk remains low if not more than six cycles are given preoperatively. The improvement in progression-free survival with chemotherapy was recorded during the first 2 years but afterwards the curves seemed to remain parallel.
In the perioperative chemotherapy group, liver resection was done 2—5 weeks after the last administration of preoperative chemotherapy, and whenever patients had completely recovered from side-effects of chemotherapy with a WHO performance status of 0 cso 1, and adequate liver function. ETW has received travel and research grants from and has served on the advisory boards for Sanofi-Aventis, Merck, and Novartis.