结直肠癌肝转移新辅助化疗的共识与争议.pptx

结直肠癌肝转移新辅助化疗的共识与争议第1页/共78页 结直肠癌肝转移新辅助化疗的共识与争议第2页/共78页 Epidemiology of colorectal cancer(CRC)第3页/共78页 Results of Hepatic Resection for Metastatic Colorectal Cancer第4页/共78页 Liver metastases of CRC第5页/共78页 Management of MCRC:An Evolving Treatment Algorithm第6页/共78页 Neoadj:where is the most controversy第7页/共78页 Concept of resectability手术的关注重点由“哪些可以切除”转变为“哪些可以保留”Timothy M. Pawlik 2008第8页/共78页 只要能够完全切除，转移灶的个数与长期生存率无关Altendorf-Hofmann A, Scheele J. A critical review of the major indicators of prognosis after resection of hepatic metastases from colorectal carcinoma. Surg Oncol Clin N Am 2003;12:165–192 No.of met and resectability第9页/共78页 (A): 不完全性切除患者的MST只有 14 月，而完全切除患者的MST为44 月。Altendorf-Hofmann A, et al. Surg Oncol Clin N Am 2003;12:165–192.(B): 只要能够完全切除，切除边界的宽度对生存时间无明显影响。Pawlik TM, et al. Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg 2005;241:715–722; discussion 722–724Margin and resectability第10页/共78页 Neoadjuvant chemotherapy for resectable liver metastases of CRCresectable第11页/共78页 Preoperative chemotherapywhat are possible benefits?Tumor shrinkage may facilite resection whith a hope for higher survival ratesTest chemoresponsiveness of matastasesSelect candidates for resection -Exclude tumors progressing while on chemotherapy -Be more aggressive on responding tumors第12页/共78页 EORTC 40983:Peri-operative chemotherapy第13页/共78页 Size of lesions after pre-op chemotherapy第14页/共78页 Phase 3 Trial of Perioperative FOLFOX4 and Surgery for Resectable CRC Liver Metastases (EORTC 40983):PFS第15页/共78页 Rationale AGAINST neoadjuvant CTRisk that metastases become unresectable if they progress during chemotherapyUncertainty about how to deal with “complete response” to chemotherapyLiver damage induced by chemotherapy第16页/共78页 Preoperative chemotherapy:potential problems Lost window of opportunity Tumor growth in a critical area may render metastase