Can Indocyanine Green Clearance Testing Be A Useful Tool for Evaluation of Chemotherapy-Associated Liver Injury in Patients with Colorectal Cancer Liver Metastases?

Letter to the Editor

By Meifang Yang

State Key Laboratory of Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital of Zhejiang University, Hangzhou, China

To the Editors:

We read with interest the article in this Journal by Peter-Michael Krieger and colleagues,[1] in which they advocate ICG clearance measurement as a simple test to helps to assess chemotherapy induced liver damage. We agree that ICG test is useful to identify patients with impaired liver function, including after neoadjuvant chemotherapy, and are appreciative of the researchers' sharing their results. However, there are other problems to be considered.

First, the clinical worth of the ICG R15 has been illustrated in various studies, based on the results of previous reports, the dosage of ICG should based on the body weight of patients, the most applied dosage is 0.25mg/kg or 0.5mg/kg.[2] But in this study, the researchers use a fixed dose of ICG (20mg) regardless of body weight. Does this influence the results?

Second, this report does not mention the underling liver disease in the patients, such as viral hepatitis, liver cirrhosis, NASH, et al. If a patient had underlying chronic liver disease, the liver Reserve function will obviously different from those had no. Third, White RR et al[3] report surgical resection should be considered within 2-4 months of chemotherapy, when most patients have achieved maximal response. Takeshi Takamoto et al[4] found that the ICG R15 value in patients with 6 or more cycles of chemotherapy was significantly higher than that in patients with fewer than 6 cycles. In this research, neoadjuvant chemotherapy was administered for a mean of 4.7 months. So we believe the prolonged neoadjuvant chemotherapy in this research damaged the patient's liver function, if researcher can provide ICG clearance before chemotherapy, that will be better to help to assess chemotherapy induced liver damage.

References

1. Krieger PM, Tamandl D, Herberger B, Faybik P, Fleischmann E, Maresch J, Gruenberger T.Evaluation of chemotherapy-associated liver injury in patients with colorectal cancer liver metastases using indocyanine green clearance testing. Ann Surg Oncol. 2011 Jun;18(6):1644-50.

2. Sakka SG, Koeck H, Meier-Hellmann A. Measurement of indocyanine green plasma disappearance rate by two different dosages. Intensive Care Med 2004: 30: 506.

3. White RR, Schwartz LH, Munoz JA, Raggio G, Jarnagin WR, Fong Y, D'Angelica MI, Kemeny NE. Assessing the optimal duration of chemotherapy in patients with colorectal liver metastases. J Surg Oncol. 2008 Jun 1;97(7):601-4.

44. Takamoto T, Hashimoto T, Sano K, Maruyama Y, Inoue K, Ogata S, Takemura T, Kokudo N, Makuuchi M.Recovery of liver function after the cessation of preoperative chemotherapy for colorectal liver metastasis.Ann Surg Oncol. 2010 Oct;17(10):2747-55. Epub 2010 Apr 28.


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