Viewing Metastatic Colorectal Cancer as a Curable Chronic Disease
Viewing Metastatic Colorectal Cancer as a Curable Chronic Disease
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DOI：
10.1097/coc.0b013e3181fe4444
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发表时间：
2012-02-01
影响因子：
2.6
通讯作者：
Morris, David L.
中科院分区：
文献类型：
--
作者：
Chua, Terence C.;Liauw, Winston;Morris, David L.
在过去的30年里，结直肠癌的存活率有所提高；原因可能是通过筛查早期发现，以及更好的治疗选择。现代结直肠癌全身化疗的进展包括以奥沙利铂和伊立替康为基础的联合化疗，以及贝伐单抗和西妥昔单抗等生物制剂的引入。系统性治疗需要用于高风险II期和III期结直肠癌患者以及转移性疾病患者。肝切除和消融，肺转移切除和/或射频消融，以及细胞减少手术联合腹腔内高温化疗分别转移到肝脏，肺和腹膜的证据已经得到证实。最大的挑战是选择合适的患者进行转移性切除术，并将转移性疾病作为慢性疾病进行治疗，以确保适当的个性化治疗，寻求二线治疗或重复手术，并尽量减少治疗的毒性。
Improved survival of colorectal cancer has been made over the last 3 decades; reasons may be attributed to early detection through screening, and better treatment options. Advancements in modern systemic chemotherapy for colorectal cancer include oxaliplatin-based and irinotecan-based combination and the introduction of biological agents such as bevacizumab and cetuximab. Systemic therapies need to be used in patients with high risk stage II and stage III colorectal cancer and in patients with metastatic disease. Evidence for liver resection and ablation, pulmonary metastasectomy and/or radio-frequency ablation, and cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy for metastasis to sites of the liver, lung, and peritoneum respectively are well established. The biggest challenge is to select the right patients for metastasectomy and to pursue metastatic disease as a chronic disease to ensure appropriate personalized therapy, pursue second-line therapies or repeat surgeries, and minimize toxicities of therapies.