| Theme |
How to Manage Distant Metastases from Gastrointestinal Cancer? |
| Title |
Treatment Strategy for Patients with Hematogenous Metastases from Gastric and Colorectal Cancers |
| Author |
Hideki Ueno |
Department of Surgery 1, National Defense Medical College |
| Author |
Takashi Ichikura |
Department of Surgery 1, National Defense Medical College |
| Author |
Yojiro Hashiguchi |
Department of Surgery 1, National Defense Medical College |
| Author |
Hidetaka Mochizuki |
Department of Surgery 1, National Defense Medical College |
| [ Summary ] |
A therapeutic strategy, including regional and systemic treatments, for patients with hematogenous metastases from gastric and colorectal cancers was discussed, based on the results from resent reports. The indications for regional therapies, such as surgical resection, hepatic arterial infusion chemotherapy (HAl), and ablation therapy differs between gastric cancer and colorectal cancer, due to the differences in their biological attitudes.
The survival benefits from surgical treatment (5-year survival rate after hepatic resection : 25-40% ; 5-year survival rate after pulmonary resection : 24-48%) have been generally accepted for patients with metastatic tumors from colorectal cancer. With regard to metastatic liver tumors from gastric cancer, the significance of regional treatments remains controversial. However, some favorable prognostic results are reported regarding surgical treatment for patients having single metastatic liver tumors without extrahepatic disease. In the case of well-maintained HAl for patients with gastric liver metastases, a FAM (5-FU + ADM + MMC) regimen yields response rates of 56-72 %, which is better than that for systemic chemotherapy (S-1 or S-1 plus CDDP). It is generally accepted that there is no surgical indication for patients with lung metastasis from gastric cancer. |