Can chemotherapy make inoperable cancer operable?

This study investigated the benefits of chemotherapy to treat inoperable (that cannot be removed through surgery) metastases from colorectal cancer (CRC).

When CRC is discovered early, the preferred method of treatment is surgery to remove the cancer along with some surrounding healthy tissue. Chemotherapy is often used after surgery to destroy any cancer cells which may not have been removed during surgery (adjuvant chemotherapy). When CRC progresses by spreading to the nearby organs, lymph nodes or distant organs and tissues, it often becomes inoperable. This means that surgery will likely leave cancerous tissue behind. This can be due to the size of the tumor, how it adheres to the colon or rectal wall, or if it has invaded the nearby structures such as other abdominal organs, nerves or blood vessels. Metastases (cancer spread to distant organs of the body), particularly when multiple, are also often classed as inoperable. Therefore, treatment in this stage of the disease often aims at treating symptoms and maintaining quality of life of the patient. However, newly discovered chemotherapy agents and targeted therapies have shown to improve survival in CRC, but their use for metastatic disease is still not clear. This study evaluated the benefits of chemotherapy before surgery in patients with metastatic, inoperable CRC. The aim of this treatment was to shrink the tumors to allow them to be surgically removed, as well as destroy any outlying cancerous cells on the edge of the tumors.

This study included 653 patients with inoperable metastatic CRC. 490 of these patients were treated with surgery of the primary tumor, followed by chemotherapy (surgical group), 124 patients had chemotherapy followed by surgery (neoadjuvant chemotherapy), while the remaining 39 patients had chemotherapy, but no additional surgery. Results showed that 57 of the 124 patients in the neoadjuvant chemotherapy group underwent successful curative surgery later on. Also, the average survival of the 163 patients treated with neoadjuvant chemotherapy and chemotherapy alone was longer than of patients in the surgical group (28.8 months versus 24.3 months). The 57 patients who had curative surgery had an average survival time of 36 months.

Overall, this study showed that chemotherapy before surgery in patients with inoperable metastatic CRC can improve survival and allow some cancers to be treated surgically. 

However, the groups included in this study were not similar in number. The number of patients treated with neoadjuvant chemotherapy was significantly smaller compared to patients in the surgical group. This might have influenced the results of the study.

Talk to your doctor whether chemotherapy might be a good treatment option in your situation.