Follow-Up Ct Evaluation Of Hepatic Steatotic Changes In Patients Undergoing 5-Fu (Folfox And Folfiri) Chemotherapy For Colorectal Cancer

INTRODUCTION: Chemotherapy regimens used in the management of metastatic colorectal cancer consist of 5-fluorouracil and folinic acid in combination with either oxaliplatin (FOLFOX) or irinotecan (FOLFIRI). Chemotherapy-associated liver injury is a concern when treating patients with metastatic colorectal cancer. This liver injury usually manifests as hepatic steatosis. Contrast-enhanced computed tomography (CT) imaging can be used to identify hepatic steatosis. A previous study showed that a difference of at least 18 Hounsfield Units (HU) of liver less than spleen attenuation had a sensitivity of 93% and a specificity of 93% identifying hepatic steatosis. The purpose of this study is to evaluate the effect of FOLFOX and FOLFIRI on liver attenuation relative to spleen attenuation in patients with and without baseline hepatic steatosis. METHODS: In this retrospective study, patients with metastatic colorectal cancer who received chemotherapy with FOLFOX or FOLFIRI from a single oncologist at our institution in 2018 were recruited. Inclusion criteria included CT abdomen and pelvis with intravenous contrast pre-chemotherapy and 3 month post-chemotherapy. Patients were categorized into 2 groups: those with hepatic steatosis at baseline and those without hepatic steatosis at baseline. Presence of hepatic steatosis at baseline was defined as a difference of the liver attenuation minus spleen attenuation less than or equal to -18 HU. Degree of hepatic steatosis was defined as the decrease of liver attenuation relative to spleen. RESULTS: A total of 38 patients were included in the statistical analyses, of which 25 patients (14 males and 11 females; mean age 54) had no hepatic steatosis on CT imaging prior to chemotherapy while the remainder 13 patients (7 males and 6 females; mean age 57) had hepatic steatosis on CT imaging prior to chemotherapy. In the patient without hepatic steatosis before chemotherapy (23 FOLFOX and 2 FOLFIRI), the liver minus spleen attenuation was -2.6 ± 8.36, which decreased to -9.3 ± 14.36 (P = 0.04) at three months after chemotherapy, indicating more steatosis. In the patients with hepatic steatosis at baseline (11 FOLFOX and 2 FOLFIRI), the baseline liver minus spleen attenuation was -40.4 ± 22.27, which increased to -25.2 ± 25.00 (P = 0.02) at 3-months post-chemotherapy, indicating less steatosis. CONCLUSION: Patients without prior hepatic steatosis became more steatotic after 5-FU based chemotherapy, while patient with prior hepatic steatosis became less steatotic by CT imaging.