Effects of oxaliplatin-based chemotherapy on liver function--an analysis of impact and functional recovery using the LiMAx test.

ABSTRACT

PURPOSE: Chemotherapy-associated liver injury of patients undergoing therapy for colorectal liver metastases stimulates concerns on surgical safety. No common guidelines for the optimal timing of liver surgery after the application of systemic chemotherapy (chemotherapy-free interval) have been established and effects on individual liver function remain unexplored. METHODS: Maximum liver function capacity (LiMAx) and indocyanine green plasma disappearance rate (ICG-PDR) were measured in 20 patients with colorectal cancer receiving adjuvant oxaliplatin-based chemotherapy (OBC) prior to the first and after the last treatment course as well as 4 and 8 weeks thereafter. RESULTS: Comparison of pre- and post-chemotherapy test results demonstrated a significant decrease of LiMAx to 73.2 % ± 19.0 % (p = 0.001) and ICG-PDR to 78.2 % ± 21.3 % (p = 0.001) after cessation of OBC. The dynamics of LiMAx indicate an interindividual effect on vulnerability to systemic chemotherapy with subsequent functional regeneration after 8 weeks (pre-OBC 530 ± 144 µg/kg/h vs. 4 weeks post-OBC 463 ± 111 µg/kg/; p = 0.012 and vs. 8 weeks post-OBC 494 ± 138 µg/kg/h; p = 0.134). An analysis of individual regeneration after chemotherapy yielded a highly different course of functional recovery with patients regaining pre-chemotherapy function within 4 weeks, whereas others still showed deterioration after 8 weeks after cessation of chemotherapy. DISCUSSION AND CONCLUSION: Enzymatic liver function (LiMAx) is significantly reduced after oxaliplatin-based chemotherapy and subsequently recovers within 8 weeks after cessation of chemotherapy. However, pace of regeneration appears to be highly different among patients suggesting patient individual chemotherapy-free interval monitored by LiMAx.