INTESTINE Vol.13 No.6(5)

特集名 大腸癌化学療法の最前線
題名 大腸癌肝転移に対する集学的治療戦略における肝切除前・切除後の化学療法について
発刊年月 2009年 11月
著者 安野 正道 東京医科歯科大学大学院医歯学総合研究科がん治療高度専門家養成プログラム
著者 杉原 健一 東京医科歯科大学大学院腫瘍外科
【 要旨 】 肝転移切除と合わせ行う化学療法には,切除不能高度肝転移を縮小させ肝切除を可能とするものと,根治切除可能例への補助化学療法がある.切除不能高度肝転移でも化学療法で数や大きさを縮小させて根治的肝切除ができれば,予後絶対不良から5年生存率35%程度までの改善が期待できる.肝転移切除後の補助化学療法の有効性については,検討の余地がある.術前補助化学療法は肝転移巣を縮小させてR0手術を増加,微小転移病巣を消滅させて肝切除後再発の抑制が期待されるが,その臨床試験の報告はまだない.
Theme Chemotherapy for colorectal cancer : An Update
Title Combination of surgery and chemotherapy in the treatment of patients with colorectal liver metastases
Author Masamichi Yasuno Cancer treatment expert program, Tokyo Medical and Dental University
Author Kenichi Sugihara Department of Surgical Oncology, Tokyo Medical and Dental University
[ Summary ] There are two types of chemotherapy for hepatic metastases from colorectal cancer in relation to multimodal treatment strategies. The first is chemotherapy for advanced liver metastases which can reduce the size and number of metastatic nodules and makes curative hepatic resection possible. The second is adjuvant chemotherapy before or after radical hepatic surgery.
Even in patients with unresectable, greatly far advanced hepatic metastases, with very poor prognose, the radical hepatic resection may be performed after the down staging of hepatic matastases with chemotherapy. Approximately a 35% 5-year survival rate may be expected. Discussions concerning the feasibility and efficacy of adjuvant chemotherapy after radical hepatic resection should continue.
It is expected that neoadjuvant chemotherapy may control recurrence after hepatic resection, by increasing the success of R0 operations because of the remarkable shrinkage of metastatic nodules produced. Adequate control of micro metastatic lesions is also possible. Unfortunately, no related studies of these combined modalities have been conducted.