Zervoudakis Alice, Boucher Taryn, Kemeny Nancy E
Department of Medicine, Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Visc Med. 2017 Mar;33(1):47-53. doi: 10.1159/000454693. Epub 2017 Feb 3.
The liver is the most common site for metastases from colorectal cancer (CRC) with the majority of these patients having unresectable disease.
This is a retrospective review of studies using hepatic arterial infusion (HAI) therapy to treat liver metastasis from CRC. A PubMed search of randomized controlled trials and retrospective studies from 2006 to present was conducted using the search terms 'hepatic arterial infusion (HAI) therapy', 'colorectal cancer', and 'treatment of liver metastases'.
The first randomized studies comparing HAI to systemic therapy with 5-fluorouracil/leucovorin produced significantly higher response rates of 41 versus 14%. Systemic therapy has improved with the addition of irinotecan and oxaliplatin; however, the responses with HAI and these modern agents have also increased, with responses as high as 80%. For patients with wild-type KRAS, HAI and systemic therapy produced a median survival of 68 months. In patients with refractory disease, response rates are in the 30% range with a median survival of 20 months. Adjuvant HAI after liver resection has shown an increase of hepatic disease-free survival and overall disease-free survival when compared to systemic therapy alone in three of four randomized trials. A recent update of the adjuvant trials after liver resection at Memorial Sloan Kettering Cancer Center has shown a 5-year survival of 78%.
HAI therapy has a role in treating hepatic metastases from CRC in both the resectable and unresectable setting.
肝脏是结直肠癌（CRC）转移最常见的部位，这些患者中的大多数患有不可切除的疾病。
这是一项对使用肝动脉灌注（HAI）疗法治疗CRC肝转移的研究的回顾性分析。使用搜索词“肝动脉灌注（HAI）疗法”、“结直肠癌”和“肝转移的治疗”对2006年至今的随机对照试验和回顾性研究进行了PubMed搜索。
第一项比较HAI与5-氟尿嘧啶/亚叶酸钙全身治疗的随机研究显示，HAI的缓解率显著更高，分别为41%和14%。随着伊立替康和奥沙利铂的加入，全身治疗有所改善；然而，HAI与这些现代药物的缓解率也有所提高，高达80%。对于野生型KRAS患者，HAI和全身治疗的中位生存期为68个月。对于难治性疾病患者，缓解率在30%左右，中位生存期为20个月。在四项随机试验中的三项中，肝切除术后辅助HAI与单纯全身治疗相比，肝无病生存期和总体无病生存期有所增加。纪念斯隆凯特琳癌症中心最近对肝切除术后辅助试验的更新显示，5年生存率为78%。
HAI疗法在可切除和不可切除情况下治疗CRC肝转移中均发挥作用。
