Hepatobiliary and Surgical Oncology Unit, Department of Surgery, University of New South Wales, St. George Hospital, Sydney, NSW, Australia.
J Cancer Res Clin Oncol. 2011 May;137(5):865-73. doi: 10.1007/s00432-010-0948-y. Epub 2010 Sep 22.
To evaluate the role of radioembolization and systemic chemotherapy as a combined modality therapy for unresectable colorectal liver metastases.
Prospective database of a major yttrium-90 microsphere radioembolization treatment center in Sydney, Australia, that included 140 patients with unresectable colorectal liver metastases was analyzed. Tumor response, overall survival, treatment-related complications and an evaluation of its role as a combined modality therapy with systemic chemotherapy were performed.
One hundred and thirty-three patients (95%) had a single treatment, and seven patients (5%) had repeated treatments. Response following treatment was complete in two patients (1%), partial in 43 patients (31%), stable in 44 patients (31%), and 51 patients (37%) developed progressive disease. Combining chemotherapy with radioembolization was associated with a favorable treatment response (P = 0.007). The median overall survival was 9 (95% CI 6.4-11.3) months with a 1-, 2-, and 3-year survival rate of 42, 22, and 20%, respectively. Primary tumor site (P = 0.019), presence of extrahepatic disease (P = 0.033), and a favorable treatment response (P < 0.001) were identified as independent predictors for survival.
Combined modality therapy appears to improve tumor response rates. Survival is influenced by tumor site, presence of extrahepatic disease, and response to therapy. Yttrium-90 microsphere radioembolization is safe and may best be combined with systemic chemotherapy for patients with unresectable colorectal liver metastases.
评估放射性栓塞联合全身化疗作为不可切除结直肠癌肝转移的综合治疗方法的作用。
分析澳大利亚悉尼一家主要钇-90 微球放射性栓塞治疗中心的前瞻性数据库，该数据库纳入了 140 例不可切除的结直肠癌肝转移患者。对肿瘤反应、总生存率、治疗相关并发症进行评估，并评估其作为联合治疗方法与全身化疗联合应用的作用。
133 例患者（95%）接受了单次治疗，7 例患者（5%）接受了重复治疗。治疗后完全缓解 2 例（1%），部分缓解 43 例（31%），稳定 44 例（31%），51 例（37%）出现进展性疾病。联合化疗与放射性栓塞治疗具有良好的治疗反应（P = 0.007）。中位总生存期为 9 个月（95%CI 6.4-11.3），1、2、3 年生存率分别为 42%、22%和 20%。原发肿瘤部位（P = 0.019）、存在肝外疾病（P = 0.033）和治疗反应良好（P < 0.001）是生存的独立预测因素。
联合治疗方法似乎可以提高肿瘤反应率。生存受肿瘤部位、肝外疾病存在及对治疗的反应影响。钇-90 微球放射性栓塞是安全的，对于不可切除的结直肠癌肝转移患者，最好与全身化疗联合应用。
