Arciero Cletus A, Sigurdson Elin R
Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
Semin Oncol. 2008 Apr;35(2):147-59. doi: 10.1053/j.seminoncol.2007.12.004.
A number of cancers present with synchronous or metachronous hepatic metastases. Historically, many of these patients were considered unresectable and were treated with either systemic chemotherapy or supportive care. Today, a variety of options exist for the management of hepatic metastases. Newer agents for systemic therapy continue to be introduced and are providing improved progression-free and overall survival and increased resectability of liver metastases. However, complete surgical resection of isolated hepatic metastases remains the optimal management for these patients. Surgical interventions can be offered to patients with hepatic-only metastases. Hepatic artery chemotherapy represents an adjunct for those patients undergoing resection and can improve survival. This benefit may be even more pronounced when combined with systemic chemotherapy. Newer generation biologic agents can improve results. New therapeutic modalities to treat lesions that are unresectable include ablative techniques such as radiofrequency ablation (RFA) and cryoablation. This article will examine modalities of diagnosis of hepatic metastases and highlight the data regarding hepatic resection for metastases of several types of primary cancers, the rationale for, and efficacy of, hepatic arterial chemotherapy, in both the postoperative adjuvant setting and in unresectable liver disease, and review the current literature for ablative techniques in the treatment of liver metastases.
许多癌症会出现同时性或异时性肝转移。从历史上看，这些患者中的许多人被认为无法切除，接受全身化疗或支持治疗。如今，肝转移的治疗有多种选择。新型全身治疗药物不断问世，可改善无进展生存期和总生存期，并提高肝转移灶的可切除性。然而，孤立性肝转移灶的完全手术切除仍是这些患者的最佳治疗方法。对于仅肝转移的患者可进行手术干预。肝动脉化疗是接受切除术患者的一种辅助治疗方法，可提高生存率。与全身化疗联合使用时，这种益处可能更为明显。新一代生物制剂可改善治疗效果。治疗不可切除病灶的新治疗方式包括射频消融（RFA）和冷冻消融等消融技术。本文将探讨肝转移的诊断方式，重点介绍几种原发性癌症转移灶肝切除的相关数据、肝动脉化疗在术后辅助治疗和不可切除性肝病中的理论依据及疗效，并综述当前关于肝转移灶治疗中消融技术的文献。
