An gabatar da manufar oligometastasis ne daga Hellman a 1995. He pointed out that the lesion refers to some intermediate states between the localized growth of the tumor and systemic metastasis. Oligometastasis is organ-specific, but still does not have the ability to metastasize. It is at an early stage of tumo metastasis. The number and location of metastases Is limited. For these oligometastases, local treatment can be used to achieve disease control. Hellman believes that the state of oligometastasis may be related to tumor type, “seed cell” dissemination ability, stage and restriction ability of metastasis target organs.
There is no unified definition of the concept of oligometastasis. At present, oligometastasis is considered to be an intermediate state. Under this state, active and effective local treatment can achieve the purpose of disease control. The European Society of Medical Oncology (ESMO) 2016 consensus guidelines for the management of patients with metastatic maganin ciwon daji defined oligometastatic disease (OMD) as a disease state with ≤2 metastatic sites and ≤5 total metastases. There are three main types of oligometastasis in metastatic colorectal cancer (mCRC): simultaneous oligometastasis coexisting with the primary foci, metachronous oligometastasis that occurs after the primary foci are controlled, and induction after systemic system therapy Widow transfer. These three types of treatment may be different, and more clinical research and data are needed to explain.
Matsaloli da ka iya yiwuwa da halayen oligotransfer
Ba a fahimci hanyar da za a iya amfani da oligotransfer ba sosai. A halin yanzu, akwai maganganu guda biyu game da ci gaba da ciwace-ciwace daga ci gaban gida zuwa tsarin metastasis. Tsinkaya ta 1 ita ce “ƙaddara game da ƙaddarar asalin tumo”. Wannan tsinkayen yayi imanin cewa oligometastasis da kuma metastases da yawa na iya zama nau'ikan halittun metastatic daban-daban. Wadannan nau'ikan halittu guda biyu wadanda aka tsara su ta mutane masu tarin yawa, kuma karfinsu ya banbanta. ; Magana 2 shine "cigaba daga oligo zuwa multi-metastasis". Wannan tunanin yana ɗaukar cewa oligo-metastasis shine matsakaiciyar yanayin cutar. Daga oligo-metastasis zuwa metastases da yawa hanya ce mai ci gaba wanda canje-canjen halittu ke taka muhimmiyar ƙa'ida, amma tsarin zurfinsa yana buƙatar ƙarin nazari.
Maganganu daban-daban na iya ƙayyade hanyoyin magani daban-daban don ciwace-ciwacen daji. Dangane da Hasashe na 1, magani na gida na iya samun nauyi mai yawa, kuma warkarwa shine makasudin da za a bi. Dangane da Hasashe na 2, gyaran tsari yana da nauyi mafi girma kuma yana biyan rayuwa gabaɗaya (OS). Amfana, zaɓuɓɓukan magani sun fi sauƙi da rashin cin zali. A halin yanzu, sun fi son zato biyu, amma zato daya ma yana da dalilinshi. Ana sa ran ƙarin bayani a cikin binciken da ke biye. Wasu masu bincike sun gano cewa oligotransferring na iya zama yana da alaƙa da toshewar microRNA.
The ESMO consensus guidelines recommend that the treatment endpoint of oligometastasis is a tumor-free state (NED); the principles of treatment include systemic treatment and local treatment (including surgery), and the core of treatment is the best perioperative treatment plan. The guideline emphasizes the importance of “locally destructive treatment” (LAT) in the treatment of oligometastasis. The local non-surgical treatments used include ablation, transhepatic artery treatment, and radiation therapy.
Yin magani na tiyata na oligometastasis na ciwon sankarar sankarau
Surgical treatment is the most commonly considered treatment method for oligometastasis of colorectal cancer (Table 1). Regardless of liver oligometastasis and lung oligometastasis, surgical treatment can produce significant OS benefits. Poor prognostic factors after hepatic oligometastasis include positive lymph nodes, elevated carcinoembryonic antigen (CEA) levels, tumor diameters greater than 10 cm, and positive margins. Factors related to the prognosis of lung oligometastasis include: CEA ≥5 ng / ml, tumor free interval (DFI) <36 months, number of lesions> 1, etc.
Don oligometastasis na para-aortic lymph node (PALND) a cikin ciwon daji na launi, idan an yi aikin tiyata, ana iya amfani da OS daga ƙananan raguwa. Fa'idojin rarraba rigakafin oligometastasis a cikin ɓangaren ƙugu na kansar dubura ba su da tabbas. Kashi na oligometastasis ya fi aikin radiotherapy, amma don oligometastasis tare da alamun alamun matsewar jijiya, ana iya ganin fa'idojin jiyya. Fa'idar tiyata haɗe tare da radiotherapy don ƙwaƙwalwar oligometastasis ta fi bayyana. Idan kwai oligometastasis ya yadu daga kwaya, ya yi daidai da Tsammani 1, kuma tiyata shine mafi kyawun zaɓi ga waɗannan marasa lafiya.
Cutar sankarar oligometastasis radiotherapy
A halin yanzu, tiyata ita ce zaɓi na farko don oligometastasis, amma ana buƙatar ƙarin tunani, kamar tushen oligometastasis da makasudin magani. Bambance-bambance na farko da oligometastasis a sassa daban-daban na mahimman manufofin kuma suna da niyyar wasu gabobin. Suna da ƙwarewa ta musamman ga magunguna daban-daban, kuma tiyata ba hanyar magani bace.
With the update of technology, we also have other treatments, such as radiotherapy, radiofrequency ablation, etc. For some oligometastasis, we need to consider giving patients minimal damage. Stereotactic radiotherapy (SBRT) can bring certain survival benefits for liver metastases and lung metastases. High-throughput SBRT has unique advantages over perioperative and postoperative complications over surgical treatment. Therefore, radiotherapy is also a good treatment option for oligometastasis (Table 2). Kodayake bayanan yanzu suna iyakance, tare da ƙarin fahimtar tsarin oligometastasis, aikin rediyo na iya maye gurbin maganin tiyata.
Rushewar radiyo don oligometastasis na cututtukan cikin gida
Ga wasu ƙananan raunuka tare da cirewar mitar rediyo, shin maganin hanta ne ko ƙwayar ƙwayar huhu, haɓakar rediyo yana nuna sakamako mai amfani idan aka kwatanta da maganin tiyata.
Babban ra'ayi game da maganin oligotransfer
A takaice dai, ana bukatar a tantance cikakken maganin cutar oligometastasis ta mahaifa ta hanyar multidisciplinary team (MDT), kuma yakamata a duba marasa lafiya da yanayin oligometastasis ta hanyar cikakken bincike da sifofin asibiti. Tsarin tsari (tsari) shine tushe, kuma yakamata ayi la`akari da maganin cikin gida bisa ingantaccen tsarin tsari. A lokaci guda, a ƙarƙashin jigon jiyya na cikin gida don sakewa mai tsattsauran ra'ayi (R0) ko NED, an rage lalacewar maganin cikin gida.
