Pfungwa yeoligometastasis yakakurudzirwa naHellman muna 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 tumarara 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 kenza yakajeka 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.
Zvinogoneka mashandiro uye hunhu hweoligotransfer
Iyo inogoneka michina yeoligotransfer haina kunyatsonzwisiswa. Parizvino, pane pfungwa mbiri pamusoro pekuvandudzwa kwemamota kubva mukukura kwemuno kuenda kune systemic metastasis. Hypothesis 1 ndiko "kutsunga kwekupedzisira kwedumbu rekutanga". Iyi pfungwa inofunga kuti oligometastasis uye akawanda metastases anogona kunge akasiyana metastatic phenotypes. Aya maviri metastatic phenotypes anotemwa neakasiyana mamota clone vanhu, uye kwavo metastatic kugona kwavo kwakasiyana. ; Hypothesis 2 ndeye "kufambira mberi kubva kuoligo kuenda kune akawanda-metastasis". Iyi fungidziro inobata kuti oligo-metastasis inzvimbo yepakati yechirwere. Kubva kuoligo-metastasis kusvika kune dzakawanda metastases inzira inoenderera umo magene ekuchinja anotamba yakakosha Mutemo, asi iyo-yakadzika mashini inoda kuenderera mberi kudzidza.
Pfungwa dzakasiyana dzinogona kuona nzira dzakasiyana dzekurapa mamota. Zvinoenderana neHypothesis 1, kurapwa kwemuno kunogona kuve nehuremu hukuru, uye kupora ndicho chinangwa chinoteedzerwa. Zvinoenderana neHypothesis 2, systemic kurapa ine huremu hukuru uye inoteedzera kupona kwese (OS). Bhenefiti, sarudzo dzekurapa dzakapfava uye hadzina kukuvadza. Parizvino, ivo vanofarira kusarudza fungidziro mbiri, asi fungidziro imwe zvakare ine chikonzero chayo. Kutarisira kumberi kune dzimwe tsananguro mune yekutevera-kudzidza. Vamwe vaongorori vakaona kuti oligotransfering inogona kunge iine chekuita nekuvharirwa kwe 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.
Kuvhiya kurapwa kweoligometastasis yekenza yakajeka kenza
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.
Ye oligometastasis yepara-aortic lymph node (PALND) mukenza yakajeka, kana resection yekuvhiya ikaitwa, OS inogona kubatsirwa kubva kushoma resection. Iwo mabhenefiti ekudzivirira dissection yeoligometastasis mune yepelvic divi rekenza rectal haina kujeka. Bone oligometastasis yakawedzera radiotherapy, asi kune oligometastasis ine musana tambo kudzvinyirira zviratidzo, mabhenefiti ekurapa kwekurapa anogona achiri kuonekwa. Kubatsira kwekuvhiya kwakasanganiswa ne radiotherapy yehuropi oligometastasis kuri pachena. Kana iyo ovarian oligometastasis ikapararira neserum, inoenderana neHypothesis 1, uye kuvhiya isarudzo iri nani kune ava varwere.
Colorectal kenza oligometastasis radiotherapy
Parizvino, kuvhiyiwa ndiyo sarudzo yekutanga ye oligometastasis, asi kufunga kwakawanda kunodikanwa, senge sosi yeoligometastasis uye zvinangwa zvekurapa. Masiyano akasiyanasiyana ekutanga uye oligometastasis munzvimbo dzakasiyana dzeiyo imwechete yekutanga fosi zvakare ine kunongedzera kweimwe nhengo. Ivo vane chairo kunzwisiswa kune akasiyana marapirwo, uye kuvhiya haisiyo nzira yekurapa.
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). Kunyangwe iyo yazvino data ishoma, pamwe nekumwe kunzwisiswa kweiyo mashandiro eoligometastasis, radiotherapy inogona zvakare kutsiva kurapwa kwekuvhiya.
Radiofrequency ablation ye oligometastasis yekenza yakajeka kenza
Kune mamwe maronda madiki ane radio frequency ablation, ingave iri metastasis yechiropa kana yemapapu metastasis, radiofrequency ablation yakaratidza chinobatsira kana ichienzaniswa nekuvhiya kurapwa.
Pfungwa yose ye oligotransfer therapy
Muchidimbu, kurapwa kwecolorectal cancer cancer oligometastasis inoda kuongororwa zvizere neboka rezvemhando dzakasiyana (MDT), uye varwere vane oligometastasis chinzvimbo vanofanira kuongororwa nenzira chaiyo yekuongorora uye zvimiro zvekiriniki. Kurongeka (systemic) kurapwa ndiko hwaro, uye kurapwa kwenzvimbo kunofanirwa kutariswa pahwaro hwekurapa systemic inoshanda. Panguva imwecheteyo, pasi pechirevo chekurapwa kwemuno kweiyo radical resection (R0) kana NED, kukuvara kwekurapwa kwemuno kunoderedzwa.
