中国实用外科杂志

中国实用外科杂志

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不可切除结直肠癌肝转移的转化性治疗策略

朱德祥，任    黎，许剑民   

  1. 复旦大学附属中山医院普外科 复旦大学普通外科研究所 复旦大学大肠癌研究中心，上海 200032
  • 出版日期:2013-08-01 发布日期:2013-07-24

  • Online:2013-08-01 Published:2013-07-24

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摘要：

手术是治疗结直肠癌肝转移最有效的也是惟一有可能治愈的手段，但是大多数结直肠癌肝转移病人并不能够行肝转移灶切除手术。近些年，用各种细胞毒药物和（或）靶向药物等使不可切除的肝转移病灶缩小，转化为可切除，继而行手术切除，从而获得治愈的可能。转化性治疗的目的是获得最佳反应率，而不是获得最大反应率。术前转化性化疗应选择高效化疗方案，并尽量缩短疗程。具体方案选择方面，KRAS野生型病人推荐西妥昔单抗联合FOLFOX/FOLFIRI，其中5-氟尿嘧啶持续给药，而KRAS突变型病人考虑贝伐珠单抗联合两药化疗或者三药化疗方案。在行转化性治疗时，一旦转移灶转化为可切除，应积极手术切除。

关键词: 结直肠癌肝转移, 不可切除, 转化性治疗, 化疗, 靶向治疗

Abstract:

Convertible therapy for unresectable colorectal liver metastases        ZHU De-xiang, REN Li, XU Jian-min. Department of General Surgery, Zhongshan Hospital, Fudan University; Institute of General Surgery, Fudan University; Colorectal Cancer Research Center, Fudan University, Shanghai 200032, China
Corresponding author：XU Jian-min, E-mail：xujmin@aliyun.com
Abstract    Surgery is the most effective and the only potentially curative treatment for colorectal liver metastases (CRLM). However, most patients with CRLM are not suitable for liver resection. In recent years, a variety of cytotoxic drugs and/or targeted drugs were used to shrink unresectable liver metastases, and some patients were converted to resectable. Thereby they might be cured following surgical resection. Therefore the purpose of convertible chemothrapy is to get the best response rate, not the maximum response rate. It should choose efficient convertible chemotherapy with short courses for preoperative chemotherapy. For KRAS wild-type patients, cetuximab combined with FOLFOX/FOLFIRI, in which 5-fluorouracil is continuous infused, is recommended, and for KRAS-mutant patients, bevacizumab combined with two-drug chemotherapy regimen or three-drug chemotherapy regimen is considered. They should be operated as soon as the metastases become resectable.

Key words: colorectal liver metastases, unresectable, convertible therapy, chemotherapy, targeted therapy