de Baere Thierry, Deschamps Frederic
Interventional Radiology, Institut Gustave Roussy, Villejuif, France.
Abdom Imaging. 2011 Dec;36(6):661-70. doi: 10.1007/s00261-011-9768-z.
Intra-arterial therapies directed to the liver take advantage that liver tumors are fed by the hepatic artery while the liver vascularization is 30% arterial. Most common techniques of intra-arterial therapies for colorectal cancer liver metastases (CRLM) include intra-arterial hepatic chemotherapy (IAHC), transarterial chemoembolization (TACE), and radioembolization. Such treatments are used as salvage therapies because they provide response when systemic therapies are inefficient. They are also used as a first line therapy to produce maximal response in order to convert the patient from non-surgical to surgical. IAHC with FUDR or oxaliplatinum allow 90% response rate and conversion to surgery of 40% to 50% of initially inoperable patients. TACE is used in CRLM with promising response rate, namely due to the use of drug eluting beads that can be loaded with irinotecan which can elute the drug they contain after embolization in liver tumor. Radioembolization is a unique way of delivering a high tumoricidal dose of radiation (>100 Gy) to liver tumor without harming the healthy liver, and provided interesting results in salvage therapy, enough to be evaluated today in a randomized control trial in first line therapy where FOLFOX is proposed with and without additional radioembolization.
针对肝脏的动脉内治疗利用了肝脏肿瘤由肝动脉供血而肝脏血管化 30%为动脉血供这一特点。用于治疗结直肠癌肝转移（CRLM）的动脉内治疗的最常见技术包括动脉内肝化疗（IAHC）、经动脉化疗栓塞（TACE）和放射性栓塞。这些治疗用作挽救疗法，因为当全身治疗无效时它们能产生疗效。它们也用作一线治疗以产生最大疗效，从而将患者从不适合手术转变为适合手术。使用氟尿苷或奥沙利铂的 IAHC 可使 90%的患者产生疗效，40%至 50%最初无法手术的患者可转变为适合手术。TACE 用于 CRLM，疗效有望，这主要归功于使用了可装载伊立替康的药物洗脱微球，这些微球在肝脏肿瘤栓塞后可释放其中所含的药物。放射性栓塞是一种向肝脏肿瘤输送高剂量杀肿瘤辐射（>100 Gy）而不损害健康肝脏的独特方法，并且在挽救治疗中取得了令人感兴趣的结果，足以在一项一线治疗的随机对照试验中进行评估，该试验中提出了使用或不使用额外放射性栓塞的 FOLFOX 方案。
