Virchows Archiv

, Volume 451, Issue 5, pp 943–948 | Cite as

The pathological response to neoadjuvant chemotherapy with FOLFOX-4 for colorectal liver metastases: a comparative study

  • Mark M. Aloysius
  • Abed M. Zaitoun
  • Ian J. Beckingham
  • Keith R. Neal
  • Guruprasad P. Aithal
  • Eric M. Bessell
  • Dileep N. Lobo
Original Article


FOLFOX-4 (folinic acid/5-fluorouracil/oxaliplatin) chemotherapy is used to treat patients with colorectal liver metastases. We aimed to assess hepatic histopathological responses to neoadjuvant FOLFOX-4 chemotherapy in patients with colorectal liver metastases. We selected all patients (n = 54) treated with FOLFOX-4 for colorectal liver metastases between June 2002 and June 2005. Only 25 underwent hepatectomy and formed the study group. Histological responses were assessed in the study group and a matched control group (n = 25) that did not receive neoadjuvant chemotherapy. The median (IQR) body mass index in the study and control groups was 24 (22–26) and 24 (23–25) kg/m2, respectively, (P = NS). Complete histological resolution of tumour occurred in six (24%) patients in the study group. Median residual tumour cellularity was less (35 vs 70%) and fibrosis greater (50 vs 5%) in patients in the study group when compared with controls (P < 0.001). The liver surrounding the tumour was steatotic in 17 (68%) patients in the study group and five (20%) controls (P = 0.001). Hepatic sinusoidal dilatation was more pronounced in patients in the study group than in controls (P < 0.001). The response to FOLFOX-4 was associated with tumour necrosis, fibrosis and inflammation. More than two thirds of patients undergoing hepatectomy after FOLFOX-4 had steatosis despite being non-obese.


Chemotherapy Colorectal liver metastases Complications FOLFOX-4 Hepatectomy Neoadjuvant Outcome Oxaliplatin Steatosis 


Conflict of interest

None of the authors has a conflict of interest to declare.


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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Mark M. Aloysius
    • 1
  • Abed M. Zaitoun
    • 2
  • Ian J. Beckingham
    • 1
  • Keith R. Neal
    • 3
  • Guruprasad P. Aithal
    • 4
  • Eric M. Bessell
    • 5
  • Dileep N. Lobo
    • 1
  1. 1.Division of Gastrointestinal SurgeryWolfson Digestive Diseases Centre, Nottingham University Hospitals, Queen’s Medical CentreNottinghamUK
  2. 2.Department of PathologyNottingham University Hospitals, Queen’s Medical CentreNottinghamUK
  3. 3.Department of Public Health Medicine and EpidemiologyNottingham University Hospitals, Queen’s Medical CentreNottinghamUK
  4. 4.Department of HepatologyWolfson Digestive Diseases Centre, Nottingham University Hospitals, Queen’s Medical CentreNottinghamUK
  5. 5.Department of Clinical OncologyNottingham University Hospitals, Nottingham City HospitalNottinghamUK

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