Primary chemotherapy with or without colonic stent for management of irresectable stage IV colorectal cancer
Primary chemotherapy with or without colonic stent for management of irresectable stage IV colorectal cancer
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DOI：
10.1016/j.ejso.2009.10.011
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发表时间：
2010-01-01
期刊：
影响因子：
3.8
通讯作者：
Cherqui, D.
中科院分区：
文献类型：
--
作者：
Karoui, M.;Soprani, A.;Cherqui, D.
目的：不能切除的IV期结直肠癌患者的治疗是有争议的。自2000年以来，我们一直倾向于在梗阻性肿瘤的情况下进行直接化疗和支架置入术。我们的目的是报告这一策略在未选择的连续系列患者中的结果。患者和方法：从2000年到2007年，115名连续入院的IV期结直肠癌患者中有68人被认为是不能切除的。数据是前瞻性收集的。结果：68例患者中，37例接受了预期的一期化疗，19例植入支架，13例需要手术治疗，18例仅接受支持治疗。单纯化疗组12例出现局部并发症，其中肠梗阻9例，支架置入成功6例。在出现症状时需要手术的患者中，死亡率和发病率分别为31%和77%。总体而言，41名患者接受了化疗，其中6名患者降级接受根治性切除。中位生存期在整个系列和接受初次化疗的患者中分别为6.7月和15.4月(p<；0.0001)。多因素分析显示，年龄、CEA水平、初次化疗和二次根治性切除是影响生存率的独立因素。结论：对于不能切除的IV期结直肠癌患者，使用支架或不使用支架进行初次化疗是可行的。超过50%的病例，与复杂原发肿瘤二次手术率低有关。这一策略可能代表了这些患者在生存时间和质量方面的最佳姑息治疗。(C)2009爱思唯尔有限公司。保留所有权利。
Aim: Management of patients with irresectable stage IV colorectal cancer is controversial. Since 2000, we have favoured primary chemotherapy with stent insertion in case of obstructive tumor. Our aim was to report the results of this strategy in an unselected consecutive series of patients.Patients and methods: From 2000 to 2007, 68 of 115 consecutive patients admitted with stage IV colorectal cancer were considered irresectable. Data were collected prospectively. Feasibility and outcomes were analysed in an intention to treat basis.Results: Of 68 patients, 37 received the intended primary chemotherapy, with stent insertion in 19, 13 required surgery as initial management and 18 patients received supportive care only. Twelve patients in the primary chemotherapy group developed local complication, including bowel obstruction in 9, successfully managed by stent in 6 of them. In patients requiring surgery at presentation, mortality and morbidity were 31% and 77%, respectively. Overall, 41 patients received chemotherapy, of whom, 6 were downstaged to undergo curative resection. Median survival was 6.7 and 15.4 months for the whole series and patients treated by primary chemotherapy, respectively (p < 0.0001). On multivariate analysis, age, CEA level, primary chemotherapy and secondary curative resection were independently associated with survival. primary chemotherapy with or without stent is feasible inConclusion: In unselected patients with irresectable stage IV colorectal cancer. more than 50% of cases and is associated with a low rate of secondary surgery for complicated primary tumor. This strategy may represent the best palliation in these patients for both duration and quality of survival. (C) 2009 Elsevier Ltd. All rights reserved.