潜在可切除结直肠癌肝转移转化治疗的研究进展
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摘要
转化治疗给潜在可切除的结直肠癌肝转移(colorectal liver metastases,CRLM)患者带来了治愈的希望.近年,一些研究表明转化治疗可以使肝转移灶出现缩小,使部分初始不可切除的CRLM患者的转化为可切除,从而使这部分患者获得长期生存.在治疗的选择上,除了全身化疗外,门静脉栓塞/结扎、分期肝叶切除等一些外科手段也运用其中这使得更多初始不可切除的CRLM患者获得手术切除的机会.本文将对转化治疗近期的发展近况作一介绍,以供临床在诊治时可以作为参考.
Conversion therapy brings hope of a cure for colorectal cancer patients with potentially resectable liver metastases. Recent studies demonstrated that conversion therapy could achieve shrinkage of liver metastases and thus render some for resection and offer the chance of longterm survival. Besides preoperative systemic chemotherapy, oncosurgical modalities are also available, primarily including liver resection following portal vein ligation/embolization and two-stage liver resection. In this article, we will review recent advances in conversion therapy for these patients.
Conversion therapy brings hope of a cure for colorectal cancer patients with potentially resectable liver metastases. Recent studies demonstrated that conversion therapy could achieve shrinkage of liver metastases and thus render some for resection and offer the chance of longterm survival. Besides preoperative systemic chemotherapy, oncosurgical modalities are also available, primarily including liver resection following portal vein ligation/embolization and two-stage liver resection. In this article, we will review recent advances in conversion therapy for these patients.
引文
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2 Sharma S,Camci C,Jabbour N.Management of hepatic metastasis from colorectal cancers:an update.J Hepatobiliary Pancreat Surg 2008;15:570-580[PMID:18987925 DOI:10.1007/s00534-008-1350-x]
3 Yang AD,Brouquet A,Vauthey JN.Extending limits of resection for metastatic colorectal cancer:risk benefit ratio.J Surg Oncol 2010;102:996-1001[PMID:21166004]
4 Askaroglu B,Akboru MH,Dincer ST,Hancilar T,Yoney A,Isikli L and Unsal M.Analysis of patients diagnosed as rectal carcinoma treated with neoadjuvant chemoradiotherapy and radiotherapy alone.J Clin Oncol 2007;25:a14582
5 Khne CH,van Cutsem E,Wils J,Bokemeyer C,ElSerafi M,Lutz MP,Lorenz M,Reichardt P,RückleLanz H,Frickhofen N,Fuchs R,Mergenthaler HG,Langenbuch T,Vanhoefer U,Rougier P,Voigtmann R,Müller L,Genicot B,Anak O,Nordlinger B.Phase III study of weekly high-dose infusional fluorouracil plus folinic acid with or without irinotecan in patients with metastatic colorectal cancer:European Organisation for Research and Treatment of Cancer Gastrointestinal Group Study 40986.J Clin Oncol 2005;23:4856-4865[PMID:15939923 DOI:10 .1200/JCO.2005.05.546]
6 Hind D,Tappenden P,Tumur I,Eggington S,Sutcliffe P,Ryan A.The use of irinotecan,oxaliplatin and raltitrexed for the treatment of advanced colorectal cancer:systematic review and economic evaluation.Health Technol Assess 2008;12:iii-ix,xi-162[PMID:18462574]
7 Alberts SR,Horvath WL,Sternfeld WC,Goldberg RM,Mahoney MR,Dakhil SR,Levitt R,Rowland K,Nair S,Sargent DJ,Donohue JH.Oxaliplatin,fluorouracil,and leucovorin for patients with unresectable liver-only metastases from colorectal cancer:a North Central Cancer Treatment Group phase II study.J Clin Oncol 2005;23:9243-9249[PMID:16230673 DOI:10.1200/JCO.2005.07.740]
8 Pozzo C,Basso M,Cassano A,Quirino M,Schinzari G,Trigila N,Vellone M,Giuliante F,Nuzzo G,Barone C.Neoadjuvant treatment of unresectable liver disease with irinotecan and 5-fluorouracil plus folinic acid in colorectal cancer patients.Ann Oncol2004;15:933-939[PMID:15151951 DOI:10.1093/annonc/mdh217]■应用要点化疗联合靶向药物的治疗已被证实较联合化疗带来更高的R0切除率;而对KRAS基因野生型的患者而言西妥昔单抗为主的方案较贝发单抗为主的方案有更高的转化切除率.
9 Barone C,Nuzzo G,Cassano A,Basso M,Schinzari G,Giuliante F,D'Argento E,Trigila N,Astone A,Pozzo C.Final analysis of colorectal cancer patients treated with irinotecan and 5-fluorouracil plus folinic acid neoadjuvant chemotherapy for unresectable liver metastases.Br J Cancer 2007;97:1035-1039[PMID:17895897 DOI:10.1038/sj.bjc.6603988]
10 Marcuello E,Páez D,ParéL,Salazar J,Sebio A,del Rio E,Baiget M.A genotype-directed phase I-IV dose-finding study of irinotecan in combination with fluorouracil/leucovorin as first-line treatment in advanced colorectal cancer.Br J Cancer 2011;105:53 -57[PMID:21654688 DOI:10.1038/bjc.2011.206]
11 Arkenau HT,Arnold D,Cassidy J,Diaz-Rubio E,Douillard JY,Hochster H,Martoni A,Grothey A,Hinke A,Schmiegel W,Schmoll HJ,Porschen R.Efficacy of oxaliplatin plus capecitabine or infusional fluorouracil/leucovorin in patients with metastatic colorectal cancer:a pooled analysis of randomized trials.J Clin Oncol 2008;26:5910-5917[PMID:19018087 DOI:10.1200/JCO.2008.16.7759]
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