Fikradda oligometastasis waxaa soo jeediyay Hellman 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 buro 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 kansarka mindhicirka 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.
Farsamaynta suurtagalka ah iyo sifooyinka oligotransfer
Farsamaynta suurtogalka ah ee oligotransferfer si buuxda looma fahmin. Waqtigan xaadirka ah, waxaa jira laba mala-awaal oo ku saabsan horumarka burooyinka laga soo bilaabo koritaanka maxalliga ah ilaa nidaamka metastasis. Mala-awaal 1 waa "go'aaminta qaddarka burada aasaasiga ah". Qiyaastaani waxay aaminsan tahay in oligometastasis iyo metastases badan ay noqon karaan noocyo kala duwan oo metastatic ah. Labadan nooc ee metastatic phenotypes waxaa go'aamiya dadweynaha burooyinka kala duwan, iyo awooddooda metastatic way kala duwan yihiin. ; Malo awaalka 2 waa "horumarka laga soo bilaabo oligo ilaa multi-metastasis". Qiyaastaani waxay qabtaa in oligo-metastasis ay tahay xaalad dhexe oo cudurka ah. Laga soo bilaabo oligo-metastasis ilaa metastases fara badan waa geedi socod isdaba joog ah oo isbeddelada hidaha ay ka ciyaaraan Xeerar muhiim ah, laakiin farsamadeeda qoto dheer waxay u baahan tahay daraasad dheeraad ah.
Malo awaal kala duwan ayaa go'aamin kara habab daaweyn kala duwan oo ku saabsan burooyinka. Sida laga soo xigtay mala-awaal 1, daaweynta maxalliga ah waxay yeelan kartaa culeys aad u weyn, bogsiintuna waa ujeeddada la doonayo in la eryo Marka loo eego Hypothesis 2, daaweynta nidaamsan waxay leedahay culeys aad u weyn waxayna raadineysaa guud ahaan badbaadada (OS). Faa'iidada, xulashooyinka daaweyntu waa kuwo jilicsan oo aan waxtar lahayn. Waqtigaan la joogo, waxay doorbidaan mala-awaal laba, laakiin mala-awaal midka mid ah isna wuxuu leeyahay sababtiisa. Waxaan rajeyneynaa sharaxaad dheeraad ah ee daraasadda dabagalka ah. Baarayaasha qaar waxay ogaadeen in oligotransferring laga yaabo inuu xiriir la leeyahay xannibaadda 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.
Daaweynta qalliinka ee oligometastasis ee kansarka mindhicirka
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.
Xanuunka oligometastasis ee qanjirada 'para-aortic lymph node' (PALND) ee kansarka mindhicirka, haddii qalliin la jaro, OS waxaa looga faa'iideysan karaa jarid yar. Faa'iidooyinka ka-hortagga kala-bixinta oligometastasis ee dhinaca miskaha ee kansarka malawadka ma cadda. Lafaha oligometastasis waa shucaac badan, laakiin oligometastasis oo leh astaamaha isku-xoqidda laf-dhabarka, faa'iidooyinka daaweynta qalliinka wali waa la arki karaa. Faa'iidada qalliinka oo lagu daro shucaaca shucaaca maskaxda oligometastasis ayaa aad u muuqda. Haddii ugxanta oligometastasis ku faafo serum, waxay la jaanqaadaysaa Hypothesis 1, qalliinkuna waa xulasho ka wanaagsan bukaannadan.
Daweynta shucaaca oligometastasis
Waqtigan xaadirka ah, qalliinka ayaa ah doorashada koowaad ee oligometastasis, laakiin feker dheeri ah ayaa sidoo kale loo baahan yahay, sida ilaha oligometastasis iyo yoolalka daaweynta. Ujeeddooyinka aasaasiga ah iyo oligometastasis ee qaybaha kala duwan ee isla ujeeddooyinka aasaasiga ah ayaa sidoo kale leh bartilmaameedka xubnaha qaarkood. Waxay xasaasiyad gaar ah u leeyihiin daaweyn kala duwan, qalliinkuna maaha hab daaweyn.
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). In kasta oo xogta hadda jirta ay xaddidan tahay, iyadoo faham dheeri ah laga helayo habka oligometastasis, haddana shucaaca ayaa sidoo kale beddeli kara daaweynta qalliinka.
Soocelinta shucaaca shucaaca ee oligometastasis ee kansarka mindhicirka
Dhaawacyada qaarkood ee leh ka-goynta raadiyaha, haddii ay tahay metastasis-ka beerka ama metastasis sambabka, ka-soo-noqoshada shucaaca ayaa muujiyay saameyn faa'iido leh marka la barbar dhigo daaweynta qalliinka.
Fikradda guud ee daaweynta oligotransferfer
Marka la soo koobo, daaweynta kansarka mindhicirka oligometastasis wuxuu u baahan yahay inuu si buuxda u qiimeeyo koox isku dhafan (MDT), bukaanada qaba xaalad oligometastasis waa in lagu baaro iyadoo la adeegsanayo baaritaan sax ah iyo astaamaha caafimaad. Daaweynta nidaamsan (nidaamsan) waa aasaaska, iyo daaweynta degaanka waa in loo tixgeliyaa iyadoo lagu saleynayo daaweynta nidaamsan ee wax ku oolka ah. Isla mar ahaantaana, iyada oo loo eegayo daaweynta maxalliga ah ee loogu talagalay ficil-celinta xagjirka ah (R0) ama NED, dhaawaca daaweynta deegaanka ayaa la yareeyaa.
