Power Derek G, Healey-Bird Brian R, Kemeny Nancy E
Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Clin Colorectal Cancer. 2008 Jul;7(4):247-59. doi: 10.3816/CCC.2008.n.032.
This review examines the development of hepatic arterial infusion (HAI) of chemotherapy over the past 40 years. Liver metastases are mainly supplied by the hepatic artery, and high levels of intratumoral drug delivery are achievable with the use of HAI. Floxuridine, 5-fluorodeoxyuridine is commonly used, but intra-arterial oxaliplatin and mitomycin- C also have advantages. The dramatic responses observed with HAI plus systemic therapy offer the possibility of resection and cure in select patients. Resectability of liver-limited colorectal cancer metastases should be considered as an endpoint for all patients. Hepatic arterial infusion may be used in palliative, neoadjuvant, and adjuvant settings. Herein, combinations of systemic chemotherapy with HAI are discussed, along with the role of newer cytotoxic and biologic agents. The first-pass extraction of some drugs given by regional perfusion in the liver limits systemic side effects. Toxicity includes catheter-related complications and biliary and gastrointestinal ulcers. The role of HAI therapy for the treatment of unresectable and resectable disease, as well as the use of other regional strategies such as embolization and ablation, are discussed.
本综述探讨了过去40年中肝动脉灌注化疗（HAI）的发展情况。肝转移瘤主要由肝动脉供血，通过肝动脉灌注可实现肿瘤内高药物递送水平。氟尿苷，即5-氟脱氧尿苷是常用药物，但动脉内奥沙利铂和丝裂霉素-C也有优势。肝动脉灌注联合全身治疗所观察到的显著反应为部分患者提供了切除和治愈的可能性。对于所有患者，应将肝局限性结直肠癌转移灶的可切除性视为一个终点。肝动脉灌注可用于姑息、新辅助和辅助治疗。本文讨论了全身化疗与肝动脉灌注的联合应用，以及新型细胞毒性和生物制剂的作用。肝脏区域灌注给药时某些药物的首过提取限制了全身副作用。毒性包括与导管相关的并发症以及胆管和胃肠道溃疡。还讨论了肝动脉灌注治疗在不可切除和可切除疾病治疗中的作用，以及栓塞和消融等其他区域治疗策略的应用。
