大肠癌肝转移综合治疗分析

Analysis on comprehensive treatment in patients with colorectal liver metastases

目的探讨新辅助化疗、手术治疗、射频治疗、术后化疗对大肠癌肝转移的疗效。方法对21例确诊为大肠癌肝转移的患者进行术前新辅助化疗，其中12例行FOLFOX4方案，9例行FOLFORI方案，化疗2～3个周期后手术或手术＋射频治疗，术后以同方案再次化疗2～3个周期。结果21例患者中有3例因化疗无效而未获得手术机会，住院2～4个月后死亡，剩余18例患者中有11例完成原发灶及转移灶的切除术，其余7例因有残余病灶而加射频治疗，手术时间140～215min（平均180min），术中射频治疗时间20～60min（平均42min）；随访3～5年（平均4．2年），10例复发，其中6例死亡，其余8例未见复发及转移，总生存率（0s）为57．1％，无瘤生存率（FRS）为38．1％。结论新辅助化疗能够使部分大肠癌肝转移患者重新获得根治性治疗机会；同手术期化疗加全部病灶的切除手术及术中射频治疗是晚期大肠癌的有效治疗手段。

Objective To discuss the effect of the comprehensive treatment combining with the neoadjuvant chemotherapy, operation, radiofrequency ablation （RFA） and postoperative chemotherapy on eolorectal liver metastases （CRLM）. Methods Two or three courses of neoadjuvant chemotherapy with FOLFOX4 and FOLFORI protocol were undergone on the 21 patients prior to the surgery. After the combined surgery and RFA, the same protocol went on for another two to three courses. Results Of the 21 patients, three of them died of the inefficient neoadjuvant chemotherapy; 11 received operation to get the primary cancer and metastatic lesions removed in which seven of them also underwent RFA to treat unremovat;le lesions. The operation lasted between 140 and 215minutes. The RFA lasted between 20 and 60minutes. In the three-to-five-year follow up visits, six of them died of recurrence. The overall survival rate was 57.1%, and the relapse free survival rate was 38.1%. Conclusion Partial CRLM patients were benefited from the neoadjuvant chemotherapy and treated by radical operation. The combination of lesions removal, RFA and perioperative chemotherapy is considered as the efficient treatment to CRLM.