Cohen A M, Kemeny N E, Köhne C H, Wils J, de Takats P G, Kerr D J
Department of Surgery, Memorial Sloan-Kettering Cancer Center, Cornell University Medical College, New York, New York 10021-6007, USA.
Eur J Cancer. 1996 Dec;32A(13):2195-205. doi: 10.1016/s0959-8049(96)00393-0.
Regional chemotherapy, from a theoretical and pharmacological stand point, would seem to offer significant advantage over systemic therapy for the treatment of hepatic metastatic colorectal cancer patients. Clinical experience has shown us that the technique itself is fraught with practical problems, but over the years, specialist centres have learned to overcome many of these, making the technique safer and minimising the possibility of complications and toxicity. As a consequence, there is no doubt that high response rates can be achieved with HAI fluoropyrimidines. However, randomised data have only been obtained from small numbers of patients in suboptimally designed trials and, to date, true patient benefit in terms of either survival or quality of life has not been adequately demonstrated. In parallel with the U.S. Intergroup study, the U.K.-based MRC phase III clinical trial of regional versus systemic 5-FU/FA warrants urgent support and we would welcome collaboration with interested European and American centres. The outcome of this trial will fully define the role of HAI chemotherapy in the management of unresectable hepatic metastatic colorectal cancer, in the context of modern, modulated 5-FU.
从理论和药理学角度来看，区域化疗似乎比全身治疗在治疗肝转移性结直肠癌患者方面具有显著优势。临床经验告诉我们，该技术本身充满实际问题，但多年来，专业中心已学会克服其中许多问题，使该技术更安全，并将并发症和毒性的可能性降至最低。因此，毫无疑问，肝动脉灌注氟嘧啶可实现高缓解率。然而，随机数据仅来自设计欠佳的试验中的少数患者，迄今为止，在生存或生活质量方面真正的患者获益尚未得到充分证明。与美国肿瘤协作组的研究并行，英国医学研究理事会开展的关于区域化疗与全身5-氟尿嘧啶/亚叶酸钙对比的III期临床试验亟待支持，我们欢迎与感兴趣的欧美中心合作。在现代的、调整后的5-氟尿嘧啶背景下，该试验的结果将全面界定肝动脉灌注化疗在不可切除的肝转移性结直肠癌治疗中的作用。
