Division of Surgical Oncology, Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292, USA.
HPB (Oxford). 2010 Feb;12(1):31-6. doi: 10.1111/j.1477-2574.2009.00117.x.
Neoadjuvant chemotherapy for potentially resectable metastatic colorectal cancer (MCC) is becoming a more common treatment algorithm. The aim of the present study was to evaluate the efficacy of precision hepatic arterial Irinotecan therapy in unresectable MCC.
An open-label, multi-centre, multi-national single arm study of MCC patients, who received hepatic arterial irinotecan. Primary endpoints were safety, tolerance and metastatic tumour resection.
Fifty-five patients with metastatic colorectal to the liver underwent a total of 90 hepatic arterial irinotecan treatments. The extent of liver involvement was < 25% in 75% of the patients (n= 41), between 26 and 50% in 15% of the patients (n= 11) and >50% in 10% of the patients (n= 24). The median number of hepatic lesions was four (range 1-20), with a median total size of all target lesions of 9 cm (range 5.5-28 cm) with 50% of patients having bilobar tumour distribution. The median number of irinotecan treatments was two (range 1-5). The median treatment dose was 100 mg (range 100-200) with a median total hepatic treatment of 200 mg (range 200-650). The majority of treatments (86%) were performed as lobar infusion treatments, and 30% of patients were treated with concurrent simultaneous chemotherapy. Eleven (20%) patients demonstrated significant response and downstage of their disease or demonstrated stable disease without extra-hepatic disease progression allowing resection, ablation or resection and ablation. There were no post-operative deaths. Post-operative complications morbidity occurred in 18% of patients, with none of them hepatic related. Non-tumorous liver resected demonstrated no evidence of steatohepatitis from the irinotecan arterial infusion.
Hepatic arterial infusion irinotecan drug-eluting beads is safe and effective in pre-surgical therapy and helpful in evaluating the biology of metastatic colorectal cancer to the liver prior to planned hepatic resection.
新辅助化疗治疗潜在可切除转移性结直肠癌（MCC）已成为一种更为常见的治疗方案。本研究旨在评估不可切除 MCC 患者行精准肝动脉伊立替康治疗的疗效。
一项 MCC 患者接受肝动脉伊立替康治疗的开放性、多中心、多国单臂研究。主要终点为安全性、耐受性和转移性肿瘤切除情况。
55 例转移性结直肠癌肝转移患者共接受了 90 次肝动脉伊立替康治疗。75%（n=41）的患者肝脏受累程度<25%，15%（n=11）的患者肝脏受累程度为 26%至 50%，10%（n=24）的患者肝脏受累程度>50%。中位肝转移病灶数为 4 个（范围 1-20 个），所有靶病灶的总大小为 9cm（范围 5.5-28cm），50%的患者存在双侧肿瘤分布。中位伊立替康治疗次数为 2 次（范围 1-5 次）。中位治疗剂量为 100mg（范围 100-200mg），中位肝总治疗剂量为 200mg（范围 200-650mg）。大多数治疗（86%）采用叶间输注治疗，30%的患者同时接受联合化疗。11 名（20%）患者的疾病明显缓解和降级，或疾病稳定且无肝外疾病进展，允许进行切除、消融或切除和消融。无术后死亡病例。18%的患者发生术后并发症，无肝相关并发症。非肿瘤性肝切除标本未见伊立替康动脉输注引起的脂肪性肝炎证据。
肝动脉灌注伊立替康载药微球在术前治疗中安全有效，有助于评估计划行肝切除的转移性结直肠癌肝转移患者的生物学特性。
