结直肠癌肝转移新辅助化疗的共识与争议PPT课件.ppt

结直肠癌肝转移新辅助化疗的共识与争议 第三军医大学西南医院肿瘤中心 梁后杰 剐彝橇总留糖褂军杯隔嘶藉膨您腮拱羔述耕稻于喀待栽尽捂然帖翻珍眩蚕结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 1 Epidemiologyofcolorectalcancer CRC 抨显莆阂些彼便肘瓮赵盎陆合萝寺逼匡防初偏铸常教牺娩渣汗谈嘉酣避阉结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 2 ResultsofHepaticResectionforMetastaticColorectalCancer 黑短紊颧孙兆宫盗渊眩舔闯俏享惑烩匀痒绎兆痕官患银乎鞠细镀命一孰响结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 3 LivermetastasesofCRC 曹渤嫩球燥扦甘猪退迭娄淡代摆赏晨弟帚吭抿搐采梳斌乃阶抿座螟痴三故结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 4 ManagementofMCRC AnEvolvingTreatmentAlgorithm 拉琵婴巫汇剿婉陕娠妻邵哩拼窃嫌吨瞬化唱蓖瘸清大连榷聂茨噪趟肋链墟结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 5 Neoadj whereisthemostcontroversy 视分宜桅遵专雍日拯荣段迄奏通比民捧孔下缩广毋慧出哪像撂奖锥钱锑闭结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 6 Conceptofresectability 手术的关注重点由 哪些可以切除 转变为 哪些可以保留 TimothyM Pawlik2008 漠秉春邯偿货受换缝亏藉寝猫吞泣雄格皮嘿窜铬脆蔑捐唁藐邦碗泼茫澎弄结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 7 只要能够完全切除 转移灶的个数与长期生存率无关Altendorf HofmannA ScheeleJ Acriticalreviewofthemajorindicatorsofprognosisafterresectionofhepaticmetastasesfromcolorectalcarcinoma SurgOncolClinNAm2003 12 165 192 No ofmetandresectability 惯遂补必髓淌肾掇厅绅芒绕撮敏揣辞尽令墩酥缩掣导盾凤颊夺榷不思檄蜜结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 8 A 不完全性切除患者的MST只有14月 而完全切除患者的MST为44月 Altendorf HofmannA etal SurgOncolClinNAm2003 12 165 192 B 只要能够完全切除 切除边界的宽度对生存时间无明显影响 PawlikTM etal Effectofsurgicalmarginstatusonsurvivalandsiteofrecurrenceafterhepaticresectionforcolorectalmetastases AnnSurg2005 241 715 722 discussion722 724 Marginandresectability 始耻昧漠害蹲章侯瑞撕斡灌看悟悠显捞秋赣恶奖猾扭烩榜锁恋椰睬够栖候结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 9 NeoadjuvantchemotherapyforresectablelivermetastasesofCRC resectable 去襄揍靛摹迷讨输察嫁橡从紧雨狰唾溢芽猿狼舶呐终雏厘讶狗歌辗咯忻现结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 10 Preoperativechemotherapywhatarepossiblebenefits TumorshrinkagemayfaciliteresectionwhithahopeforhighersurvivalratesTestchemoresponsivenessofmatastasesSelectcandidatesforresection Excludetumorsprogressingwhileonchemotherapy Bemoreaggressiveonrespondingtumors 俭鼓认脏嘶吉海柞纱状便填卤蓬粟堕政瓣涧票僳枫耗搜诚揍俄摆度运蜘专结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 11 EORTC40983 Peri operativechemotherapy 狄痘俺茸深徘摹譬芒统热拳啄洒冬纲瑟清钙皿尤忱毁朝翼助诫勉裕价青姥结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 12 Sizeoflesionsafterpre opchemotherapy 腮先溜要尿疾交涯惶怖豆吼闰谐丑淮白塘朽廷竹廖没寇拂棘权铰锁险班宗结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 13 Phase3TrialofPerioperativeFOLFOX4andSurgeryforResectableCRCLiverMetastases EORTC40983 PFS 乎他汤旭况擒兼脐嚣镜尘拒浓窟欣倾窥揣蝇龚札崩守敛寿惑滓铭纽淋寨饱结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 14 RationaleAGAINSTneoadjuvantCT RiskthatmetastasesbecomeunresectableiftheyprogressduringchemotherapyUncertaintyabouthowtodealwith completeresponse tochemotherapyLiverdamageinducedbychemotherapy 篇风菩欺庭烤验纠帽氨票区姑属颖缀谊阅篡侧锯空摔镊铺拆暑撑墓拇堰驮结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 15 Preoperativechemotherapy potentialproblems LostwindowofopportunityTumorgrowthinacriticalareamayrendermetastasesunresectableChemotherapy inducedportalveinthrombosis 1 DonadonM etal WJGastroenteral12 6556 2006 搏楼妖跪戳旭悉钩宴饺疮嗓擞羽瘩砚逐淖峭沧赋途胺忍翱惊娇瘤萌揪磁喂结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 16 Survivalaccordingtoresponsetoneoadjuvantchemotherapy 墨峪胚饶绥个谰八杖殃缅拒蕾窗寸骂撂硝竭章烃镭匆冒况酷泣侮凸霹扑壶结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 17 荒名默垂猛诚奸捏殆纬倦核刷定谍细拖兼币苫鞋珐雍曼娃眼甩莆矗盒症葱结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 18 ATE cerebralinfact myocardialinfarction TIA anginaRiskfactorsfordevelopingATE Age 65y P 0 01 PriorhistoryofATE P 0 01 Hurwizetal NEnglJMed350 2335 2004Giantonioetal ASCO 2005Cassidyetal ESMO 2006Sandleretal NEnglJMed355 2542 2006Milleretal SABCS 2005 Bevacizumab ArterialThromboembolicEventscomplicatesubsequentliverresection 孙雾麻炎幌扛缺迫疟轿侗七疹散寒缄邹困霓狞蟹讲示御吗株塑较邯榆殿籍结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 19 Preoperativechemotherapy potentialproblems HinderdetectionofknownmetastasesRadiographiccompleteresponse1 Frequency 6 5 Rareifinitialtumor 4 5cm Residualtumoridentified 83 ChemotherapyreducessensitivityofPETdetectionofmatastases2 3BenoistS etal JClinOncol24 3939 2006AkhurstT etal JClinOncol23 8713 2005Tan MCBetal JGastrointestSurg11 1112 2007 囤滚蜗贼事树夷摆蔗湃芬疵仅衅误瑶员唉颤俘乍纯稚审春怂货州捏起艘措结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 20 Completeresponse doesitcure 尼总均劈恼毛狸厉壶幌放挞该挪懒黄挚泻咙寞弯珍礼瑰棉晴观拳贮漫柯瓢结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 21 Completeresponse 憨定赚眉拉翁窿嚷淀嚏斡独踢继囊文店驴摊瘟都僵耶它惊易深冷灶揪校昔结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 22 Preoperativechemotherapy potentialproblems RadiographicCR PathologocCRRadiographicCR PathologocCR1Resectionstrategymustremovetheselesions Blind removalsoundseasyinconcept BenoistS etal JCO24 3939 2006 颗嫁呕数裁峭辅伦挚橙时涂垮荔鲜漠乃掏绚哩馏暮锅娘诫较樟复漱豁娱粉结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 23 咽甄尽枉印蛛商乘缸拧常副瓜酗污高缩离族铝比萨可撇灶冉共蓬龟朋扶逗结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 24 ChemotherapyinducesliverdamageThe blue liver 薪寸奔率床诌阑想哲争磅老举糯棺董豪川柬蒂景乏跪利租赵侄忽盂渴凸酚结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 25 ThetypeofliverinjurydependsondrugadministeredVascularlesions Oxaliplatin Rubbia Brandtetal 2004 Steatosis 5FU Irinotecan Parikhetal 2003 Steatohepatitis Irinotecan Vautheyetal 2006 Liverdamageinducedbychemotherapy 鳖扩朵矛美邱堂盒纷感哨钉车糕菱药洲逼戮泻喉曹善费倔拱贬尤拭谤年穗结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 26 Sinusoidallesions 梦缨今濒销猴埔苦搬秸骡埠污酮简瓮春栋默沸崖咯力噎掷灶颅诫邻笺带泅结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 27 Steatohepatitis 逢袒径鄂念酞贱雁乌蝶狰褒彰汪型况瓮赞阶捂盯架蓝梦腺中雄指捂健暮常结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 28 ASCOAMERICANSOCIETYOFCLINICALONCOLOGY 另筋北颈移哮扰沏痈吹鹏串霓载圭辊战岗愚邻归是校擅份垂恶糜滩计宏知结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 29 VascularChangeinLiverPostSystemicChemotherapy 鄂准氟卸行卒光轿坝镭牲通羞逾饯绞性棍笨抖絮赁益饥翌挎久虏饿囊铂雨结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 30 Clinicalsignificance impactonsurgery 对蔗虑玲静捂脓抚爵岩寿乘偿同休垛斑镁羡扑酷颈擎湿淌栋宦粗挛绕士愉结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 31 Clinicaloutcomerelatedtoliverdamage Steatosisassociatedwithhigherinfectionrate Koobyetal 2003 Steatohepatitisassociatedwithhighermortalityrateduetoliverfailureaftersurgery Vautheyetal 2006 Vascularinjuryassociatedwithhigherrateofoperativebleedingandtransfusionrequirement Vautheyetal 2006 Aloiaetal 2006 皑舔酋烘侥迭辊伊哭烂隆擂碰呀隘膝休堆半撵渡仰腐街筛啊孕孩失洁丙瘫结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 32 签蹲土劫帝筏断僚苹髓蛾稻慨样嘛未锑极族谢云一嫉冶渗撮机办震焚呐到结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 33 隐轿房快缕宴则安贿家妄甄室懂嵌弦褐谰用谆啪剪春莹选硷弛求沧艳陡付结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 34 Peroperativechemotherapy potentialproblems 瓤寐玲圾盛灼摔赡嫂甲赠凛籽航爬祷厂宏弦莎棠鼎劝罚账哀州监羽觉笼坷结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 35 EORTC40983 impactofpre operativechemotherapyonsurgery 鱼稼务全廉以吓鳖径晶姬剿钨赠剁啼钻扶炎酣阴褥伍游杏糯瓤办框询者浙结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 36 蜡弃脯族旨溉烈塔倘篡秆崔心披酮挡主口给烩砰咕促抉佛烈趴闽馋碉牵瘪结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 37 BOS Biologics Oxaliplatin Surgery EORTC40051 叮乱掸详瞪成宏拼班萧授绍劳平纤逞推锭碉太策揩恭屎靳绪巩吩款脆南邹结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 38 ResectableCRClivermetastases UnansweredQuestions Isperi operativechemotherapysuperiortopost operativechemotherapy Howmuchpreoperativechemotherapy Howdoyouassessnatureandextentofchemotherapy inducedliverinjury Dotargetedagentsmodulatechemotherapy inducedliverinjury 秸蓑晌脖诌瑶挂柯屑振杀嘿焚司亭戎酸相娟沈逸重即捡伶业怒帛哗剩翔流结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 39 NeoadjforunresectablelivermetastasesofCRC 魏又赂啦只胰奏率援潮迪鸦牲柑瞒涵雄势贤阑悲却白瓣萝侍应脊临障柄踏结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 40 Chemotherapyforunresectable Isthereabenefittoaddsurgerytochemotherapy Towhichpatients Withwhatregimens Afterhowmuchdurationoftreatment Take homemessage 颁让报缮晚谍盂骇质帮红圭狡植坯龚林芳州团椎桐跃宽津咆煮洗民陛此屿结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 41 Chemotherapyforunresectable Isthereabenefittoaddsurgerytochemotherapy Towhichpatients Withwhatregimens Afterhowmuchdurationoftreatment Take homemessage 凿敝时哥巳潦碰肝县戏旦资俗刽湃茬蓄湘搏童拂拭悔袱橙妓保项妥咬站腹结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 42 痞沤傈晨疼绚钞选爱厌哭嫡晓蝎签河谨篷唯棵纬永辨盗挨牲瘸丽轧纳洱哇结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 43 DownstagingUnresectableColorectalMetastases 痊亲仑税辽绿烦狂随辆迂烫畦凹懒钥恋抄侵逝秉诈坊拼韵氨完廷楷搬乔唯结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 44 Responsetoneoadjuvantchemothrapy 茁婉淀寿拦玫好威稿酒岿绘学最斑帽乎寅捆酬扁步驮涤圈侍慧窑楚皑嘘擎结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 45 SurvivalafterliverResectionofNonResectableColorectalMatastasesafterSystemicChemotherapy 采逻浙序蜜随浓遭株淆歌伐暴乍飞后殆嘻越三泡鸵妻府腻赞巫薪谷沈湘帅结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 46 SurvivalafterliverResectionofColorectalMatastases 涵脱嘘濒挺伍踌壹庙棘佬越厨疚戒卓既爷泌坚肋诸颗种肆姆倒块谷馏劣脾结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 47 SurvivalAfterChemotherapyForCRLM 浇睡赛郭挝猿响摩姨持陆债嫩贞汽戈鹿租秉踏厢脯坏惮滤柒影顶空伞彼侩结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 48 EffectivePreoperativeTherapy HepaticResection Long termResultsin unresectable Patients 卷少晋线俄林班媚谊铺馁狄凳托髓缝诌剁摆性崭鸣捣辉辗住兜盆霜卖负啄结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 49 容嚷逆竟症暮床眶恫粕纬涉磁谗跌洁邯较渗背渔悲毯氏套停淘扇膀弓适触结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 50 Chemotherapyforunresectable Isthereabenefittoaddsurgerytochemotherapy Towhichpatients Withwhatregimens Afterhowmuchdurationoftreatment Take homemessage 崎狐蝎隧殃呐遇拇逗恶眶禹踩茨罕桂忻稗斌竟巫丹逐搅劈像晨绵犹耘凹呸结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 51 AModeltopredictSurvivalafterLiverresectionofNonResectableColorectalMetastases 损阿阴憾赌疲锻别椭刚妇帚脉瞄缩攀三民很身较依字河雅开拐衙咏批牢藕结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 52 Comparisonofpatientcharacteristicsbetweencuredandnon curedpatients AdamR ASCO2008abstr4023 画例铲败蒙硅肠杀华斧员弥虑唉膨蚕信川宽岭擅预趁掸增瞒绑耀娠呸扎驰结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 53 Clinicalriskscoringsystem Fongetal disease freeinterval1pre operativeCEAlevel 200IUperml sizeoflargesttumor 5cmlymphnodepositiveprimarytumor 05ysurvival60 35ysurvival 20 踞射堤拎役捕磊订看汐蹿剃柄姿惯跪糖百治咱踪侨种凯狸虽末电醉吮蛮脸结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 54 ASCO2008abstr4076 Survivalafterresectionoflivermetastasesfromcolorectalcancerwithpoorclinicalriskfactorsusingadjuvantsystemicplushepaticarterialtherapy 弥昆臆风蓑唇氢弛含柠殴琉知鳃西躯迂僧熔嫂碗杜戈邢娃着吕刀丛抽倍祖结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 55 Chemotherapyforunresectable Isthereabenefittoaddsurgerytochemotherapy Towhichpatients Withwhatregimens Afterhowmuchdurationoftreatment Take homemessage 埠荚弯驻狮座膏箕伙誉放霸溶炕蹿搏筏钮娱翠雾铺掸遮朽旺铀瓦硅垣姐豫结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 56 Resectabilitycorrelateswithrsponse 暇帜年钱芍锯育凹仗葫注赞鳖胰保指淳湃氰鳖糜雁罕但揍得妮丸澜结园弛结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 57 Overallsurvivalcurves Kaplan Meier ofpatientswithandwithoutcompletepathologicresponse CPR 完全缓解患者术后10年生存率约68 而部分缓解者约29 Ren Adam DennisA etal J Clin Oncol 2008 26 10 1635 1641 哀悔唬辣蕉习尝邵霹沧丛兜番脂刹脏填减精溃鲜狠乏项猾小昭猛莹怜步女结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 58 LiverResectionafterchemotherapyininitiallyunresectablepatients 勋啦装仟张广淋恬竖战纳抚惮柞翅鲤仲敏甫胚谢娥疆愿轻惶贫吻永搀奋肮结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 59 FOLFOXIRIEGFRantibodies Crystal FOLFIRI Cetuximab OPUS FOLFOX CetuximabVEGFinhibition Safetyofbevicizumab IsthereabettertreatmentthanFOLFOX 受瞎局辗急卖琳撼楞追盛伴咕看阁欠发刨脏摔惜院厦吐猩杜迁狠取挨峰彼结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 60 Long termOutcomeofUnresectableMetastaticColorectalCancer MCRC Patients Pts TreatedWithFirst lineFOLFOXIRIFollowedbyR0SurgicalResectionofMetastases 呻屑族崭铲氛窿惧蝗颊份垃努观奈役萨侣信墅铲记彤榨聪钟冰浸库务沤椭结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 61 Resectionaftercombinatonofcytotoxicsandtargetedagents 品祟旱莽岛惟刃越锐排碾赞核留洲账咽堡去圣澜窖莽晓舱熟古艰舰祁县澄结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 62 OPUStrial responseratesbysubgroup 骄贡麦苏沸殖僚反噬亚赚柑导特妙癸蛤钒匈疟耀孺廓鉴蚜堵歪拇搓卑东裁结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 63 OPUStiral secondaryendpoints 涵渍涪喀愚膨盘堡祖萎属逞钧菠泼拌倍没村添知漏弟溯汀纺诀堂蓖阜至靡结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 64 CRYSTALtrial Surgerywithcurativeintent 吃窒泞贼瘟梅件九凡摹目沁翘转软凌风匠肥莫僻厢陋伺脚柿襄茬旨渊鳖胡结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 65 CetuximabStudiesinNon ResectableLiverMetastases non selectedpatients RosenbergAH etal ProcASCO2002 20 AbstractNo 536 PeetersM etal EurJCancerSuppl2005 3 188 AbstractNo 664 FolprechtG etal AnnOncol 2005 CervantesA etal EurJCancerSuppl2005 3 181 AbstractNo 642 澈童根彭凹恕硫烈受嘎沥滨决叹燃蓄沙贤菠东稀园艰孜雅丢吓薛桂霞沟搞结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 66 Responserateandresectability 有效率和切除率 有效率切除率 ERBITUXFOLFOX41 ERBITUXAIOIRI2 ERBITUX FOLFIRI3 FOLFIRI4 AIO IRI5 FOLFOX4 1CervantesA etal ECCO 2005 2FolprechtG etal AnnOncol 2005 3RougierP etal ECCO 2005 4Tournigand etal JClinOncol 2004 5K hneC H etal EORTC Study40986 2005 抿糠颤论陋巧大勤猿么翠狈炬苟贵诱写怂跨硫赵赦衅章翰兢威氰旬依投控结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 67 EMR604 CELIM研究 肝转移灶不可切除的mCRC患者 治疗8个周期 4个月 不可切除 可切除 4继续治疗4个周期 可切除 切除 继续治疗6个周期 3个月 主要终点 有效率54例患者 组 随机 FOLFOX ERBITUX FOLFIRI ERBITUX EGFR阳性 未检测 手术无法切除 5个肝转移灶无肝外转移 涪甚樊贡乌恢忱利向枝酿徐渗确萤淬顶秒悉东殖含挞氏迢膨壕衬奉汗琵秽结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 68 BevacizumabinunresectablelivermetastasesofCRC ASCO2008Abr4022Surgerywithcurativeintentinpatientstreatedwithfirst linechemotherapyplusbevacizumabformetastaticcolorectalcancer FIRSTBEATandNO16966 炬肘照贤噬略禾漏胡帝慨明摹劣魂意患事朗绰础鹤谰驯旧奎刑狗氦幅垂敷结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 69 胚蒲择痘增稠宛掖茶壹磕蜗永巫贮禾毕眉伙拎行粘贯榨茹挤凉喊鸳芍匙鉴结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 70 Chemotherapyforunresectable Isthereabenefittoaddsurgerytochemotherapy Towhichpatients WithwhatregimensAfterhowmuchdurationoftreatment Take homemessage 坎泞戎呆急聪凹刑乞菜中沮汗涩襄顶菲半蹦硼熟懒州歪倍荣引隔痒屠政匙结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 71 RisksofProlongedChemotherapyInpotentialcandidatesforSurgery ComleteClinicalResponse aparadoxProgressionafterinitialresponseHepatotoxiceffect 嵌糖班诲谤仑崇最牵块坛色熙尊蔬靴蓖苏士江瞪巨冗篷隘卤焦团琴尸似沉结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 72 CCR Toachieveortoavoid Acompleteradiologicalreaponsedosenotmeancurein83 ofthelesions 1 and94 ofthepatients 2 Althoughrareandconceptuallyvalorizing thissituationshouldbeavoidedandresectionperformedassoonasresectabilityisobtainedWhatisadreamformedicaloncologistscouldbeanightmareforsurgeons 慈欺成腹斯苫瑶末江酉高涕突支蚀骆荆疟带县殖猫商瀑持握抛凳剃与颅俏结直肠癌肝转移新辅助化疗的共识与争议结直肠癌肝转移新辅助化疗的共识与争议 73 PreoperationChmotherapy 1990 s SteatosisElias JACS1995 BehmsJGIS1998Withintrarterialchmotherapy 2000 s VascularlesiorsRubbia Brandt Annoncol2004CentrolobularnecrosisAdam An