O'Toole D, Maire F, Ruszniewski P
Medical-Surgical Federation of Hepato-Gastroenterology, Hôpital Beaujon and University of Paris VII, 100, Bd du Général Leclerc, Clichy 92110, France.
Endocr Relat Cancer. 2003 Dec;10(4):463-8. doi: 10.1677/erc.0.0100463.
Hepatic metastases are frequently encountered in patients with digestive endocrine tumors and their presence plays an important role in quality of life and overall prognosis. Surgery is the treatment method of choice for hepatic metastases but this is frequently impossible due to the extent of disease. Systemic chemotherapy is offered to patients with diffuse and/or progressive liver metastases but results are disappointing especially in patients with metastases of midgut origin. In the latter patients with carcinoid syndrome, somatostatin analogs are frequently initially effective but their efficacy wanes due to disease progression and development of tachyphylaxis. Other therapeutic options in the treatment of hepatic metastases are locoregional strategies where vascular occlusion induces ischemia in these highly vascular tumors using either surgical or radiological techniques. Available methods include surgical ligation of the hepatic artery, transient hepatic ischemia or sequential hepatic arterialization. Trans-catheter arterial chemoembolization has proven effective in terms of long palliation and objective tumor responses. Other treatments aimed at regional destruction either alone or in combination with surgery include radiofrequency ablation and cryotherapy. The latter are usually important adjuncts to surgery and are usually reserved for limited disease.
肝转移在消化内分泌肿瘤患者中很常见，其存在对生活质量和总体预后起着重要作用。手术是肝转移的首选治疗方法，但由于疾病范围，这通常无法实现。对于弥漫性和/或进行性肝转移患者，会提供全身化疗，但结果令人失望，尤其是对于中肠起源转移的患者。在后者患有类癌综合征的患者中，生长抑素类似物通常最初有效，但由于疾病进展和快速耐受性的发展，其疗效会减弱。治疗肝转移的其他治疗选择是局部区域策略，即使用手术或放射技术通过血管闭塞在这些高血管肿瘤中诱导缺血。可用方法包括肝动脉手术结扎、短暂性肝缺血或序贯肝动脉灌注。经导管动脉化疗栓塞在长期缓解和客观肿瘤反应方面已被证明是有效的。其他旨在单独或与手术联合进行区域破坏的治疗方法包括射频消融和冷冻疗法。后者通常是手术的重要辅助手段，通常仅用于局限性疾病。
