Rougier Philippe, Guimbaud Rosine, Mitry Emmanuel, Vaillant Jean-Nicolas
Fédération des spécialités digestives, Hôpital Ambroise Paré-92100 Boulogne.
Bull Acad Natl Med. 2003;187(5):881-92.
The 5-year risk of progression after complete resection of liver metastases is of 50% to 75%. Trials which have evaluated adjuvant systemic chemotherapy using 5FU--folinic acid, sometimes in association with intra-arterial chemotherapy, are not powerful and did not demonstrate a clear survival benefit. It is strongly recommended to participate to clinical trials. An adjuvant chemotherapy with the LV5FU2 regimen during 6 months is a reasonable option if the patient has not been included in a trial (professional agreement). A preoperative chemotherapy is not recommended if liver metastases are considered as right away resectable but it should be discussed if resectability is uncertain and/or in case of pejorative factors (professional agreement). If metastases resection has been facilitated or made possible by pre-operative chemotherapy, post-operative resumption of this chemotherapy should also been discussed (professional agreement).
肝转移灶完全切除术后5年进展风险为50%至75%。评估使用5-氟尿嘧啶(5FU)-亚叶酸钙进行辅助全身化疗的试验,有时联合动脉内化疗,这些试验力度不足,未显示出明显的生存获益。强烈建议参加临床试验。如果患者未纳入试验(专业共识),采用LV5FU2方案进行6个月的辅助化疗是一个合理选择。如果肝转移灶被认为可立即切除,则不建议进行术前化疗,但如果切除的可能性不确定和/或存在不良因素时(专业共识),则应进行讨论。如果术前化疗使转移灶的切除变得更容易或成为可能,术后是否继续这种化疗也应进行讨论(专业共识)。