结直肠癌肝转移经导管转化治疗

名词和定义：

Conversion -convert unresectable to resectable

Conversion： Randomized Studies using Chemo +/- Anti-EGRF，Cetuximab or Panitumumab

	Pt	Chemo	Surv. Mos+	Resp%	Resection%
Coin*	727	oxal+C/-C	17/18	64/57	15%/13**
Nordic	194	oxal+C/-C	20/20	49/41	11/8**
Crystal*	1063	CPT+C/-C	23/20	57 /40	8/4.6
Opus	179	oxal+C/-C	23/18	57/34	5/2.4
Prime *	656	Oxal+P/-P	24/20	55/48	27/17
Okines	418	Oxal+B/Oxali	20/19	49/47	12/11.5**

C =Cetuximab
P= Panitumumab
*kras wild type
**only liver pt
Red=significant

研究之一【1】

研究之二【2】

Unresectable liver metastases: HAI FUDR + systemic

Conversion with HAI + SYS (n=107) Waterfall Graph

研究之三：Resection after Chemotherapy

	# Pts	Resected	Median survival (mos) of entire group	Why Unresectable
FOLFIRI	40	33%	-	61% >6 mets or size
FOLFOXIRI	59	32%	31	85% >4 or size
HAI + systemic	107	50%		Diffuse bilateral disease where resection would require resection of 3 hepatic veins or both portal veins
Chemo Naïve	44	57%	51
Previously Treated	63	44%	32

Conversion Therapy What Do We Know ?

1. 术前治疗3个月的期限限制

2. 不追求最好的治疗反应，而是切除性

3. 如果应用贝伐单抗，外科术前6周停止使用

4. 抗EGFR药物和肝动脉灌注可能是最好的选择

1. Falcone A. ASCO June 2013.

2. Nancy E. Kemeny, Fidel D. Huitzil Melendez, Marinela Capanu, Philip B. Paty, Yuman Fong, Lawrence H. Schwartz, William R. Jarnagin, Dina Patel, and Michael D'Angelica. Conversion to Resectability Using Hepatic Artery Infusion Plus Systemic Chemotherapy for the Treatment of Unresectable Liver Metastases From Colorectal Carcinoma. JCO Jul 20, 2009:3465-3471;

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结直肠癌肝转移经导管转化治疗