ESMO临床指南转移性结直肠癌的诊断治疗和随访2014-培训课件.pptVIP

There are two potential strategies for (neo-)adjuvant therapy in patients with resectable liver metastases: postoperative adjuvant chemotherapy with FOLFOX for 6 months or perioperative chemotherapy (3 months before and 3 months after resection of the metastases). In patients with resectable liver metastases, perioperative combination chemotherapy with the FOLFOX regimen improves the PFS by 7%-8% at 3 years, although the survival is not significantly longer [I, B]. resection of metastatic disease Resection of resectable lung metastases also offers 25%-35% 5- year survival rates in carefully selected patients.Although resection of lung metastases is less well studied, R0 resection of lung metastases can also be recommended in analogy with resection of liver metastases. Recent data even suggest that the addition of cetuximab to FOLFOX may be harmful to patients with resectable metastases [II,D]. Initially unresectable liver metastases (group 1) can become resectable after downsizing with chemotherapy (conversion to resectable disease) and, if so, resection (±ablative techniques) should be considered after multidisciplinary discussions in an expert team. resection of metastatic disease Surgery can be carried out safely after 3-4 weeks from the last cycle of chemotherapy ± cetuximab, or 6 weeks following chemotherapy plus bevacizumab. Resection of the metastases should be carried out as soon as the metastases are technically resectable, since unnecessary prolonged administration of chemotherapy may lead to increased liver toxicity and higher postoperative morbidity. The postoperative morbidity is more related to the duration of the chemotherapy than to the type of chemotherapy that is administered, although oxaliplatin and irinotecan may cause different histological changes in liver parenchyma: oxaliplatin is related to sinusoidal liver lesions and irinotecan to steatohepatitis. resection of metastatic disease In patients presenting synchronously with a prim