Colorectal liver metastases — to treat or not to treat?
Colorectal liver metastases — to treat or not to treat?
复制标题
结直肠肝转移——治疗还是不治疗？
作者：
I. Taylor
最近，肝转移瘤的治疗引起了人们极大的兴趣。原因有两方面。首先，改进的术前评估使得能够更仔细地选择患者，因此从切除手术中获得了更好的结果，其次，更好地了解肝脏肿瘤的血液供应导致设计用于切断血管或选择性地向肿瘤提供高浓度细胞毒性药物的技术。不幸的是，总的来说，这些较新的技术是以极大的热情引进的，但评估不够。这导致了病人和医生的困惑和沮丧。那些不幸发生结直肠肝转移的患者，无论是孤立的还是多发的，在绝大多数情况下都是无法治愈的，并且必须非常小心，如果副作用的显著痛苦掩盖了任何可能的缓解，则不要进行最好的姑息治疗。然而，最近主要来自美国的重要报告使我们有必要重新思考对这一共同问题的态度。这篇评论的目的是作为一个关键的评估方法，可用于治疗肝转移，特别注意那些所产生的大肠癌。
There has been a remarkable resurgence of interest recently in the treatment of liver metastases. The reasons for this are twofold. Firstly, improved pre-operative assessment has enabled more careful patient selection and hence better results have been achieved from resectional surgery, and secondly, better understanding of the blood supply to liver tumours has resulted in techniques designed either to devascularize or to deliver high concentrations of cytotoxic drugs selectively to the tumour. Unfortunately in the main, these newer techniques have been introduced with tremendous enthusiasm but insufficient assessment. This has resulted in confusion and frustration for both patients and doctors alike. Those patients unfortunate enough to develop colorectal liver metastases, either solitary or multiple, are, in the vast majority of cases incurable and one must be most careful not to institute treatment which may be at best palliative, if significant distress from side-effects overshadows any possible palliation’. Nevertheless, important recent reports chiefly from the USA have necessitated a re-thinking of attitudes towards this common problem. This review is intended as a critical assessment of the methods available to treat liver metastases, paying particular attention to those arising from cancer of the large bowel.