EORTC 40983

EORTC 40983 randomised 364 patients with up to four resectable colorectal liver metastases to perioperative FOLFOX4 (six cycles before and six after surgery) or surgery alone. The earlier report showed better progression-free survival. At a median 8.5 years, 107 of 182 patients in the chemotherapy group had died against 114 of 182 with surgery alone (hazard ratio 0.88, 95% CI 0.68 to 1.14, p=0.34); median overall survival was 61.3 against 54.3 months and five-year survival 51.2 against 47.8 percent. The authors kept perioperative FOLFOX4 as the reference treatment because of the progression-free survival gain, but the trial is the honest measure of how much chemotherapy adds to a well-done liver resection: not demonstrably any life.