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Комбинированное лечение больных с метастазами колоректального рака в печени

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Обзор литературы посвящен анализу основных методов лечения больных с метастазами колоректального рака в печени. Проведен анализ результатов клинических исследований за последние 10 лет. Колоректальный рак является распространенным злокачественным новообразованием. При постановке диагноза порядка 20% больных имеют отдаленные метастазы. Печень является наиболее частым органом-мишенью, метастазы в ней выявляют у 14,5% больных. Несмотря на обнадеживающие результаты лечения отдельных групп больных этой категории, тактика лечения в большинстве ситуаций ограничена проведением паллиативной химиотерапии. В течение последних лет выживаемость больных с метастатическим колоректальным раком значительно улучшилась благодаря успехам системной терапии, а медиана общей выживаемости достигла 2 лет за счет комбинированной химиотерапии на основе фторпиримидинов, оксалиплатина, иринотекана в сочетании с моноклональными антителами. Оптимальное сочетание и последовательность применения противоопухолевых препаратов до сих пор не определены. Хирургическое лечение является стандартом лечения этой категории больных. Вместе с тем по-прежнему нет четких и общепринятых показаний к выбору оптимального объема хирургического вмешательства, назначению химиотерапии 1-й линии и использованию других методов противоопухолевого лечения.

Ключевые слова:
колоректальный рак, метастазы, печень, резекция, гемигепатэктомия, химиотерапия, выживаемость, colorectal cancer, metastases, liver, resection, hepatectomy, chemotherapy, survival

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Combined treatment of patients with liver colorectal cancer metastases

The literature review is devoted to the analysis of the main methods of treatment of patients with colorectal cancer liver metastases. The analysis of the clinical trials results over the past 10 years has been carried out. Colorectal cancer is the common malignant neoplasm. About 20% of patients have distant metastases in the diagnosing. Liver is the most frequent targeted organ, liver metastases are detected in 14,5% of patients with colorectal cancer. Despite the encouraging results of treatment of certain groups of patients with metastatic colorectal cancer, the treatment tactics for most patients is limited to palliative chemotherapy. In recent years, the survival of patients with metastatic colorectal cancer has significantly improved due to the success of systemic therapy. The median overall survival has reached for 2 years due to combination chemotherapy based on fluoropyrimidines, oxaliplatin, irinotecan in combination with monoclonal antibodies (bevacizumab, cetuximab and panitumumab). The optimal combination and sequence of using these anticancer agents in the treatment of metastatic colorectal cancer has not yet been determined. Surgery is the standard of care for this category of patients. At the same time, until nowdays there are no clear and generally accepted criteria for choosing the optimal volume of surgical intervention, prescribing first-line chemotherapy and using other methods of antitumor treatment.

Keywords:
колоректальный рак, метастазы, печень, резекция, гемигепатэктомия, химиотерапия, выживаемость, colorectal cancer, metastases, liver, resection, hepatectomy, chemotherapy, survival