Problem of disappearing liver metastases during combined treatment of patients with colorectal cancer

Objective . Comparative analysis of the frequency of complete clinical, radiological, and pathomorphological response of liver metastases in patients with colorectal cancer and assessment of the possibility of dynamic observation after combined chemo- and targeted therapy without surgical intervention on the liver. Material and methods . Since 2020, the authors have been conducting a pilot prospective study involving 41 patients with colorectal cancer and liver metastases. Perioperative chemotherapy was administered according to the FOLFOXIRI regimen (three courses of neoadjuvant chemotherapy and three courses of adjuvant chemotherapy) with the addition of bevacizumab or cetuximab as targeted drugs in the preoperative stage. The surgical stage of treatment involved simultaneous resection of the intestine with the primary tumor and removal of metastases. Results. Complete regression of liver metastases was detected in 7 (17%) patients. In 2 (4.9%) of them, regression was confirmed histologically after surgery. In 5 (12.2%) patients, regression was established before surgery by CT and MRI, as well as intraoperatively by ultrasound; therefore, liver resection in this group was not performed. The observation period was 17 months (11–26), with no signs of recurrence or progression being detected during this time in any of the patients. Conclusion . In cases of colorectal cancer metastases with isolated liver involvement, the use of perioperative chemotherapy according to the FOLFOXIRI regimen in combination with targeted therapy is a safe and effective option for combined treatment. In cases of disappearing metastases in the liver, active dynamic observation may be an alternative to liver resection, provided that regular comprehensive examinations are performed at a specialized oncological center.