Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD.
Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany.
Am Soc Clin Oncol Educ Book. 2021 Mar;41:133-146. doi: 10.1200/EDBK_320519.
Colorectal cancer was the third most common malignancy worldwide in 2018, and most patients present with or develop distant metastases. Colorectal liver metastases are most commonly observed because of the vascular drainage of the colon and superior rectum. Current guidelines recommend surgical resection as first-line treatment; however, 80% to 90% of patients with colorectal liver metastases are ineligible for primary resection. For patients with unresectable disease, a multidisciplinary treatment approach is favored, incorporating systemic therapy and a toolbox of local ablative therapies. These treatments either aim at cytoreduction to enable a conversion to surgical resectability or control of disease progression and spread. Each of these treatments carries unique outcomes and risk profiles, thereby contributing to an individualized treatment strategy for patients with colorectal liver metastases. This review summarizes evidence on hepatic artery infusion, stereotactic body radiation therapy, thermal ablation, transarterial chemoembolization with drug-eluding beads, and transarterial radioembolization for treatment of colorectal liver metastases. Results of large-scale prospective and retrospective studies and international guidelines are discussed to provide detailed background on the current and prospective use of local ablative techniques in management of colorectal liver metastases.
2018 年，结直肠癌是全球第三大常见恶性肿瘤，大多数患者表现为或发展为远处转移。由于结肠和直肠上段的血管引流，结直肠肝转移最为常见。目前的指南建议将手术切除作为一线治疗方法；然而，80%至 90%的结直肠肝转移患者不符合原发性切除的条件。对于不可切除疾病的患者，倾向于采用多学科治疗方法，包括全身治疗和局部消融治疗的工具包。这些治疗方法要么旨在进行细胞减灭以实现手术可切除性的转化，要么控制疾病的进展和扩散。这些治疗方法各有独特的结果和风险特征，从而为结直肠肝转移患者制定个体化治疗策略。这篇综述总结了肝动脉灌注、立体定向体部放射治疗、热消融、载药微球动脉化疗栓塞和经肝动脉放射栓塞治疗结直肠肝转移的证据。讨论了大规模前瞻性和回顾性研究以及国际指南的结果，为局部消融技术在结直肠肝转移管理中的当前和潜在应用提供了详细的背景。
