Burke D, Allen-Mersh T G
Department of Surgery, Chelsea and Westminister Hospital, London, UK.
Postgrad Med J. 1996 Aug;72(850):464-9. doi: 10.1136/pgmj.72.850.464.
Each year in the UK, between 12-14,000 people develop liver metastases from colorectal cancer. These metastases will contribute to the death of the patient in about 80% of cases. Treatments aimed at these tumours are best administered when the tumour is small. Current investigative methods allow tumours as small as 0.5 mm to be detected, and should be offered to all colorectal cancer patients at risk of developing liver metastases. Surgery remains the only curative treatment for these tumours, but, unfortunately, only 20% of those who have tumour excision will survive five years. In those patients unsuitable for surgery, chemotherapy with fluoropyrimidines produces the best tumour response. This may be administered systemically or regionally, via a catheter placed within the hepatic artery. The latter approach reduces systemic toxicity, but may produce hepatotoxicity. The results of other forms of systemic chemotherapy currently undergoing clinical trials are awaited. The vast majority of patients will benefit from suitable palliative treatment delivered either locally or systemically. With the wide range of treatments now available for liver metastases, these patients are best assessed in a unit with a special interest in the problem.
在英国，每年有1.2万至1.4万人因结直肠癌发生肝转移。这些转移瘤在约80%的病例中会导致患者死亡。针对这些肿瘤的治疗，在肿瘤较小时进行效果最佳。目前的检查方法能够检测出小至0.5毫米的肿瘤，应提供给所有有发生肝转移风险的结直肠癌患者。手术仍然是这些肿瘤唯一的治愈性治疗方法，但遗憾的是，只有20%接受肿瘤切除的患者能存活五年。对于那些不适合手术的患者，使用氟嘧啶进行化疗能产生最佳的肿瘤反应。这种化疗可以通过全身给药，也可以通过置于肝动脉内的导管进行区域给药。后一种方法可降低全身毒性，但可能会产生肝毒性。目前正在进行临床试验的其他形式全身化疗的结果有待观察。绝大多数患者将从局部或全身的适当姑息治疗中受益。鉴于目前有多种针对肝转移的治疗方法，这些患者最好在对该问题有专门研究的科室进行评估。
