结直肠癌肝转移的转化治疗  

Conversion therapy for liver metastases of colorectal cancer

作　　者：陈佳琦[1] 翁姗姗 胡涵光[1] 宋永茂[2] 丁克峰[2] 袁瑛[1] Chen Jiaqi;Weng Shanshan;Hu Hanguang;Song Yongmao;Ding Kefeng;Yuan Ying(Department of Medical Oncology,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310000,China;Department of Colorectal Surgery,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310000,China)

机构地区：[1]浙江大学医学院附属第二医院肿瘤内科,杭州310000 [2]浙江大学医学院附属第二医院大肠外科,杭州310000

出　　处：《中华肝胆外科杂志》2020年第7期493-495,共3页Chinese Journal of Hepatobiliary Surgery

基　　金：国家科技部"十三五"国家重点研发计划(2017YFC0908200);国家自然科学基金(81872481);"十三五"浙江省中医药(中西医结合)重点学科(2017-XK-A40)。

摘　　要：通过化疗联合或不联合靶向药物进行转化治疗,使潜在可切除的结直肠癌肝转移患者获得手术治疗或其他局部治疗达到R0切除或无疾病状态。RAS/BRAF基因野生型左半结肠癌和直肠癌,奥沙利铂联合氟尿嘧啶(FOLFOX)或伊立替康联合氟尿嘧啶类(FOLFIRI)联合西妥昔单抗选择更佳;RAS/BRAF基因野生型右半结肠癌患者、RAS或BRAF基因突变的结直肠癌患者,选择相对复杂些。对于年轻、体力状态好的患者应首选奥沙利铂联合伊立替康联合氟尿嘧啶类联合贝伐珠单抗,FOLFOX/奥沙利铂联合卡培他滨/FOLFIRI联合贝伐珠单抗可作为次选方案。转化治疗过程中通常要求多学科团队每2个月评估1次疗效,一旦判断转化成功,即安排落实后续手术治疗方案。Colorectal cancer patients with potential resectable liver metastases may benefit from hepatectomy or other local treatment to achieve R0 resection or no evidence disease after conversion treatment by chemotherapy with or without target therapy.FOLFOX or FOLFIRI combined with cetuximab is appropriate for RAS and BRAF wide type and primary tumor at left-side colon cancer and rectal cancer.It is complex for RAS and BRAF wide type and primary tumor at right-side colon cancer or RAS or BRAF mutated patients.FOLFOXIRI combined with bevacizumab may be the first choice for those patients with young age and good performance score to achieve best conversion chance,while FOLFOX/CapeOx/FOLFIRI combined with bevacizumab could be the second choice.A surgical re-evaluation should be planned every 2 months after initiation of conversion treatment in multi-disciplinary treatment assessment.Once it is demonstrated conversion treatment is successful,surgery should be performed as soon as possible.

关 键 词：结直肠肿瘤 肝转移 转化治疗 

分 类 号：R735.34[医药卫生—肿瘤]