The Role of Conventional TACE (cTACE) and DEBIRI-TACE in Colorectal Cancer Liver Metastases.
The Role of Conventional TACE (cTACE) and DEBIRI-TACE in Colorectal Cancer Liver Metastases.
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DOI：
10.3390/cancers14061503
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发表时间：
2022-03-15
期刊：
影响因子：
5.2
通讯作者：
Lahrsow M
中科院分区：
文献类型：
--
作者：
Vogl TJ;Lahrsow M
结直肠癌肝转移具有巨大的临床影响和患病率。由于结肠直肠癌是最常见的癌症之一，因此在日常实践中经常遇到此类患者。尽管如此，手术和全身化疗构成了一线治疗，这取决于临床环境。然而，如果患者存在不可切除的仅肝脏转移或肝脏优势转移和/或对全身化疗无反应，则介入放射科医生可以提供基于血管方法的局部治疗，以实现局部肿瘤控制或降低肿瘤负荷。这些疗法通常称为经动脉化疗栓塞（TACE）。这种治疗也可以与全身或其他局部治疗相结合。根据当地实践和专业知识，TACE可以与化疗剂和栓塞剂或药物洗脱珠的组合一起提供，这些药物洗脱珠栓塞转移瘤及其供血血管供应，并随着时间的推移释放化疗剂。在下面的综述中，我们比较了这些不同的方法在局部治疗结直肠癌肝转移的代表性研究结果。结直肠癌（CRC）是世界范围内最常见的肿瘤实体之一，也是癌症相关死亡的常见原因。因此，结直肠癌肝转移（CRLM）构成了严重的生命限制因素。CRLM的治疗是一个主要的挑战，手术切除以及全身化疗仍然是一线治疗选择。多年来，当常规治疗失败或发生转移复发时，介入放射科医生提供的几种局部、血管和基于图像的治疗已经出现。这些选择包括常规/传统的经动脉化疗栓塞（cTACE），通过局部注射化疗剂和栓塞剂的组合。类似的治疗是最近的伊立替康负载药物洗脱珠TACE（DEBIRI-TACE），使用相同的方法给药。许多研究表明，这些不同类型的化疗栓塞可以安全地应用于不同的临床环境。此外，这种治疗也可以与其他局部或全身治疗相结合。不幸的是，由于在CRLM中研究TACE的患者人群不一致，批评者指出，仍然缺乏支持积极患者结局的确切证据。在以下文章中，我们回顾了常规和DEBIRI-TACE的研究。虽然高度依赖于临床环境、既往治疗和一般研究人群，但cTACE和DEBIRI-TACE显示出相当的结果。我们提出了最具代表性的研究不同的化疗栓塞程序和比较的结果。虽然这两种方法都有令人信服的证据，但仍有必要进一步研究以确定哪些患者从这些治疗中获益最多。总之，我们确定TACE是不同临床环境中CRLM的可行选择。然而，希望采用多学科方法为患者提供尽可能好的护理。
Liver metastases of colorectal cancer have an enormous clinical impact and prevalence. As colorectal cancer is one of the most common cancers, such patients are routinely encountered in day-to-day practice. Still, surgery and systemic chemotherapy constitute the first-line therapies depending on clinical setting. However, if patients present with non-resectable liver-only or liver-dominant metastases and/or do not respond to systemic chemotherapy, local therapies based on a vascular approach can be offered by interventional radiologists to achieve local tumor control or to downstage tumor burden. These therapies are generally called transarterial chemoembolization (TACE). Such treatments can also be combined with systemic or other local therapies. Depending on local practice and expertise, TACE can be offered with a combination of chemotherapeutic agents and embolizing agents or drug-eluting beads which embolize the metastases and its feeding vascular supply and release a chemotherapeutic agent over time. In the following review we compare these different approaches in the local therapy of liver metastases of colorectal cancer by presenting representative study results. Colorectal cancer (CRC) is one of the most common tumor entities worldwide and a common cause of cancer-associated death. Colorectal cancer liver metastases (CRLM) thereby constitute a severe life-limiting factor. The therapy of CRLM presents a major challenge and surgical resection as well as systemic chemotherapy remain the first-line treatment options. Over the years several locoregional, vascular- and image-based treatments offered by interventional radiologists have emerged when conventional therapies fail, or metastases recurrence occurs. Among such options is the conventional/traditional transarterial chemoembolization (cTACE) by local injection of a combination of chemotherapeutic- and embolic-agents. A similar treatment is the more recent irinotecan-loaded drug-eluting beads TACE (DEBIRI-TACE), which are administered using the same approach. Numerous studies have shown that these different types of chemoembolization can be applied in different clinical settings safely. Furthermore, such treatments can also be combined with other local or systemic therapies. Unfortunately, due to the incoherent patient populations of studies investigating TACE in CRLM, critics state that the definite evidence supporting positive patient outcomes is still lacking. In the following article we review studies on conventional and DEBIRI-TACE. Although highly dependent on the clinical setting, prior therapies and generally the study population, cTACE and DEBIRI-TACE show comparable results. We present the most representative studies on the different chemoembolization procedures and compare the results. Although there is compelling evidence for both approaches, further studies are necessary to determine which patients profit most from these therapies. In conclusion, we determine TACE to be a viable option in CRLM in different clinical settings. Nevertheless, a multidisciplinary approach is desired to offer patients the best possible care.
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