Kemeny N E
Cornell University Medical College, New York, New York 10021, USA.
Eur J Cancer. 1995 Jul-Aug;31A(7-8):1271-6. doi: 10.1016/0959-8049(95)00162-c.
Hepatic metastases are a major cause of mortality in patients with colorectal carcinoma. The rationale for hepatic arterial chemotherapy has an anatomical and pharmacological basis as presented below. The randomised studies are reviewed and demonstrate a significantly higher response rate with hepatic arterial therapy versus systemic therapy. Survival information is difficult to evaluate because some of the studies are small, and some had a crossover design, but two studies demonstrate a significant improvement in 2-year survival after hepatic arterial therapy compared with systemic therapy. New combinations of 5-fluoro-2-deoxyuridine with dexamethasone and/or leucovorin have produced response rates as high as 72%, median survivals of 22-27 months, and a 2-year survival of 66%. More recent studies on patients who have failed previous systemic chemotherapy have produced response rates around 50%. Hepatic toxicity, especially biliary sclerosis, is the dose limiting toxicity, occurring in 6-25% of patients. To truly define the role of regional therapy, a more accurate randomised study will have to be conducted, to determine if hepatic arterial infusion improves the quality of life and, or survival in patients with hepatic metastases from colorectal cancer.
肝转移是结直肠癌患者死亡的主要原因。肝动脉化疗的理论依据有解剖学和药理学基础，具体如下。对随机研究进行了综述，结果表明与全身治疗相比，肝动脉治疗的缓解率显著更高。生存信息难以评估，因为一些研究规模较小，且一些采用了交叉设计，但有两项研究表明，与全身治疗相比，肝动脉治疗后2年生存率有显著提高。5-氟-2-脱氧尿苷与地塞米松和/或亚叶酸的新联合方案产生了高达72%的缓解率、22至27个月的中位生存期以及66%的2年生存率。对先前全身化疗失败的患者进行的最新研究产生了约50%的缓解率。肝毒性，尤其是胆汁性硬化，是剂量限制性毒性，发生在6%至25%的患者中。为了真正确定区域治疗的作用，必须进行更准确的随机研究，以确定肝动脉灌注是否能改善结直肠癌肝转移患者的生活质量和/或生存率。
