结直肠癌肝转移新辅助化疗的共识与争议.ppt

结直肠癌肝转移新辅助化疗的共识与争议 梁后杰 Epidemiology of colorectal cancer(CRC) Results of Hepatic Resection for Metastatic Colorectal Cancer Liver metastases of CRC Management of MCRC:An Evolving Treatment Algorithm Neoadj:where is the most controversy Concept of resectability No.of met and resectability Margin and resectability Neoadjuvant chemotherapy for resectable liver metastases of CRC resectable Preoperative chemotherapywhat are possible benefits? Tumor shrinkage may facilite resection whith a hope for higher survival rates Test chemoresponsiveness of matastases Select candidates for resection -Exclude tumors progressing while on chemotherapy -Be more aggressive on responding tumors EORTC 40983:Peri-operative chemotherapy Size of lesions after pre-op chemotherapy Phase 3 Trial of Perioperative FOLFOX4 and Surgery for Resectable CRC Liver Metastases (EORTC 40983):PFS Rationale AGAINST neoadjuvant CT Preoperative chemotherapy:potential problems Survival according to response to neoadjuvant chemotherapy Bevacizumab:Arterial Thromboembolic Events complicate subsequent liver resection Preoperative chemotherapy:potential problems “Complete response”:does it cure? Complete response Preoperative chemotherapy:potential problems Chemotherapy induces liver damage The “blue” liver Liver damage induced by chemotherapy Sinusoidal lesions Steatohepatitis ASCO AMERICAN SOCIETY OF CLINICAL ONCOLOGY Vascular Change in Liver Post Systemic Chemotherapy Clinical significance:impact on surgery Clinical outcome related to liver damage Steatosis associated with higher infection rate (Kooby et al, 2003) Steatohepatitis associated with higher mortality rate due to liver failure after surgery (Vauthey et al. 2006) Vascular injury associated with higher rate of operative bleeding and transfusion requirement (Vauthey et al. 2006. Aloia et al. 2006 ) Peroperative chemotherapy:potential problems EORTC 40983:impact of pre-operative chemotherapy on sur