Sinusoidal Obstruction Syndrome and Nodular Regenerative Hyperplasia Are Major Hepatic Lesions Associated with Oxaliplatin Based Chemotherapy for Colorectal Liver Metastases and Partially Prevented by Bevacizumab
L Rubbia-Brandt, GY Lauwers, H Wang, PE Majno, K Tanabe, A Zhu, C Brezault, O Soubrane, EK Abdalla, J-N Vauthey, G Mentha, B Terris. University Hospital, Geneva, Switzerland; Massachusetts General Hospital, Boston, MA; M.D. Anderson Cancer Center, University of Texas, Houston, TX; University Hospital, Geneva, Switzerland; Hopital Cochin, Paris, France; Hopital Cochin, Paris, France
Background: Surgical resection of hepatic colorectal cancer metastases (HCRM) is the only curative treatment available. Preoperative chemotherapy is used to downsize HCRM and achieve respectability. Oxaliplatin (OX) is commonly used because of its tumor efficacy. We performed a detailed assessment of non-tumoral hepatic lesions associated to OX, assessed histological effects of bevacizumab (anti-VEGF antibody ) recently introduced to OX, and proposes a histological scoring system.
Design: A multiinstitutional series of surgically resected HCRM (n = 385) was reviewed. Type and grade of hepatic lesions were analyzed.
Results: Amongst 274 resection treated by OX, 54% had moderate to severe sinusoidal obstruction syndrome (SOS), related to rupture of the sinusoidal barrier. Peliosis, centrilobular perisinusoidal/venular fibrosis and NRH developed in 10.6%, 47%, 24.5% respectively, directly related to severity of SOS. In contrast, the 111 livers treated by surgery alone remained normal. Hepatic lesions were lower in the group treated with OX with bevacizumab compared to the one treated by OX alone, including lower incidence of SOS (31.4% vs. 62.2% respectively; p<0.05), of peliosis (4.3% vs. 14.6% respectively), of NRH (11.4% vs. 28.9% respectively), of centrilobular/venular fibrosis (31.4% vs. 52% respectively) (p<0.001).
Conclusions: Pathologists should have a high index of suspicion that non tumorous liver of patients treated with OX may display distinctive lesions involving SOS, NRH and fibrosis that may potentially impact on clinical outcomes. Bevacizumab may partially prevent these lesions.
Category: Liver & Pancreas
Tuesday, March 10, 2009 9:30 AM
Poster Session III # 180, Tuesday Morning