Nordlinger B, Van Cutsem E, Gruenberger T, Glimelius B, Poston G, Rougier P, Sobrero A, Ychou M
Department of Digestive Surgery, Ambroise Paré Hospital, Boulogne, France.
Ann Oncol. 2009 Jun;20(6):985-92. doi: 10.1093/annonc/mdn735. Epub 2009 Jan 19.
The past 5 years have seen the clear recognition that the administration of chemotherapy to patients with initially unresectable colorectal liver metastases can increase the number of patients who can undergo potentially curative secondary liver resection. Coupled with this, recent data have emerged that show that perioperative chemotherapy confers a disease-free survival advantage over surgery alone in colorectal cancer (CRC) patients with initially resectable liver disease. The purpose of this paper is to build on the existing knowledge and review the issues surrounding the use of chemotherapy +/- targeted agents combined with surgery in the treatment of CRC patients with liver metastases, with a view to providing clinical recommendations. An international panel of 21 experts in colorectal oncology comprising liver surgeons and medical oncologists reviewed the available evidence. In a major change to clinical practice, the panel's recommendation was that the majority of patients with CRC liver metastases should be treated up front with chemotherapy, irrespective of the initial resectability status of their metastases.
在过去5年中，人们已清楚认识到，对最初无法切除的结直肠癌肝转移患者进行化疗，可增加能够接受潜在根治性二次肝切除的患者数量。与此同时，最近的数据表明，在最初可切除肝脏疾病的结直肠癌（CRC）患者中，围手术期化疗比单纯手术具有无病生存优势。本文旨在基于现有知识，回顾在CRC肝转移患者治疗中使用化疗+/-靶向药物联合手术的相关问题，以期提供临床建议。一个由21名包括肝脏外科医生和医学肿瘤学家在内的结直肠肿瘤学国际专家小组对现有证据进行了审查。在临床实践的一项重大变革中，该小组的建议是，大多数CRC肝转移患者应首先接受化疗，无论其转移灶最初的可切除状态如何。
