Jeyarajah D Rohan, Doyle Maria B Majella, Espat N Joseph, Hansen Paul D, Iannitti David A, Kim Joseph, Thambi-Pillai Thavam, Visser Brendan C
Methodist Richardson Medical Center, Richardson, TX, USA.
Washington University School of Medicine in St. Louis, St. Louis, MI, USA.
J Gastrointest Oncol. 2020 Apr;11(2):443-460. doi: 10.21037/jgo.2020.01.09.
Surgical resection of colorectal liver metastases is associated with greater survival compared with non-surgical treatment, and a meaningful possibility of cure. However, the majority of patients are not eligible for resection and may require other non-surgical interventions, such as liver-directed therapies, to be converted to surgical eligibility. Given the number of available therapies, a general framework is needed that outlines the specific roles of chemotherapy, surgery, and locoregional treatments [including selective internal radiation therapy (SIRT) with Y-90 microspheres]. Using a data-driven, modified Delphi process, an expert panel of surgical oncologists, transplant surgeons, and hepatopancreatobiliary (HPB) surgeons convened to create a comprehensive, evidence-based treatment algorithm that includes appropriate treatment options for patients stratified by their eligibility for surgical treatment. The group coined a novel, more inclusive phrase for targeted locoregional tumor treatment (a blanket term for resection, ablation, and other emerging locoregional treatments): . The expert panel proposed new nomenclature for 3 distinct disease categories of liver-dominant metastatic colorectal cancer that is consistent with other tumor types: (I) surgically treatable (resectable); (II) surgically untreatable (borderline resectable); (III) advanced surgically untreatable (unresectable) disease. Patients may present at any point in the algorithm and move between categories depending on their response to therapy. The broad intent of therapy is to transition patients toward individualized treatments where possible, given the survival advantage that resection offers in the context of a comprehensive treatment plan. This article reviews what is known about the role of SIRT with Y-90 as neoadjuvant, definitive, or palliative therapy in these different clinical situations and provides insight into when treatment with SIRT with Y-90 may be appropriate and useful, organized into distinct treatment algorithm steps.
与非手术治疗相比，结直肠癌肝转移的手术切除与更高的生存率以及有意义的治愈可能性相关。然而，大多数患者不适合进行手术切除，可能需要其他非手术干预措施，如肝靶向治疗，以转变为适合手术的状态。鉴于可用治疗方法的数量，需要一个总体框架来概述化疗、手术和局部区域治疗（包括使用钇-90微球的选择性内照射治疗[SIRT]）的具体作用。通过数据驱动的改良德尔菲法，外科肿瘤学家、移植外科医生和肝胆胰（HPB）外科医生组成的专家小组召开会议，创建了一个全面的、基于证据的治疗算法，其中包括针对根据手术治疗适用性分层的患者的适当治疗选择。该小组为靶向局部区域肿瘤治疗创造了一个新颖、更具包容性的术语（切除、消融和其他新兴局部区域治疗的统称）： 。专家小组为肝转移为主的转移性结直肠癌的3种不同疾病类别提出了新的命名法，这与其他肿瘤类型一致：（I）可手术治疗（可切除）；（II）不可手术治疗（边缘可切除）；（III）晚期不可手术治疗（不可切除）疾病。患者可能在算法的任何阶段出现，并根据对治疗的反应在不同类别之间转换。治疗的总体目标是在可能的情况下，使患者转向个体化治疗，因为在综合治疗方案中，切除具有生存优势。本文回顾了关于钇-90 SIRT作为新辅助、确定性或姑息性治疗在这些不同临床情况下的作用的已知信息，并深入探讨了何时钇-90 SIRT治疗可能是合适且有用的，内容按照不同的治疗算法步骤进行组织。
