Медицинская литература. Новинки

 

 

 

 

 

 

Комбинированное лечение метастазов колоректального рака печени у больных с неблагоприятным прогнозом

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Проведен анализ результатов обширных резекций печени с периоперационной регионарной химиотерапией у 101 больного метастазами колоректального рака. У 48 (48%) больных были множественные метастазы в печени, у 62 (61%) метастазы локализовались в обеих долях, у 21 (21%) больного выявлены внепеченочные метастазы. Использование на дооперационном этапе бевацизумаба (авастина) для регионарной внутриартериаль ной химиотерапии сопровождалось ростом объективного эффекта до 47% по сравнению с группой без бевацизумаба (10%) и частоты III степени лекарственного патоморфоза в опухоли до 56% по сравнению с 7% без бевацизумаба. Однако это не привело к достоверному увеличению выживаемости: пятилетняя выживаемость составила 12 ± 7% (медиана – 33 мес) по сравнению с 14 ± 6% (медиана – 29 мес) без бевацизумаба. У 5-больных радикальная операция стала возможной благодаря дооперационной регионарной химиотерапии. Дооперационная регионарная внутриартериальная химиотерапия не привела к ухудшению переносимости больны ми обширной резекции печени

Ключевые слова:
метастазы колоректального рака, регионарная химиотерапия, отдаленные результаты, прогноз.

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Combined Management of Poor Prognosis Colorectal Cancer Liver Metastasis Patients

An analysis of 101cases of extended liver resection accompanied with peroperative regional chemotherapy in colorectal metastasis patients. 48 (48%) of them had multiple liver metastases, 62 (61%) – had bilobar lesions, 21 (21%) had extrahepatic metastases. Application of bevacizumab (avastin) in preoperative regional intraarterial chemotherapy improved (increased) objective response rate up to 47% vs 10% in group without bevacizumab and grade III morphological response rate up to 56% vs 7% in group without bevacizumab. However, it did not lead to statistically significant difference in overall survival: 5year survival was 12 ± 7% and median survival – 33 months vs 14 ± 6 % and 29 months in groups without bevacizumab, correspondingly. A curative surgery was provided in 5% of cases due to the preoperative regional chemotherapy. Preoperative regional intraarterial chemotherapy did not lead to decreased tolerance of extended liver resection.

Keywords:
colorectal cancer liver metastases, preoperative regional chemotherapy, remote results, prognosis factors