Konsép oligometastasis diusulkeun ku Hellman dina 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 tumor 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 kangker colorectal 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.
Mékanisme anu mungkin sareng ciri oligotransfer
Mékanisme anu mungkin tina oligotransfer henteu ngartos sacara lengkep. Ayeuna, aya dua hipotesis ngeunaan kamekaran tumor tina tumuhna lokal dugi ka metastasis sistemik. Hipotésis 1 mangrupikeun "tekad nasib tumor primér". Hipotesis ieu yakin yén oligometastasis sareng sababaraha metastasis tiasa janten phenotypes metastatik anu béda. Dua phenotypes metastatik ieu ditangtukeun ku sababaraha populasi klon tumor anu béda, sareng poténsi metastatikna béda. ; Hipotesis 2 nyaéta "kamajuan tina oligo kana multi-metastasis". Hipotesa ieu nyebatkeun yén oligo-metastasis mangrupikeun kaayaan panengah tina panyakit. Tina oligo-metastasis kana sababaraha metastasis mangrupikeun prosés anu teras-terasan dimana parobahan genetik maénkeun Peraturan anu penting, tapi mékanisme anu jero na peryogi ditaliti deui.
Hipotesis anu béda tiasa nangtoskeun padika pangobatan anu béda pikeun tumor. Numutkeun kana Hipotésis 1, pangobatan lokal tiasa ngagaduhan beurat anu langkung ageung, sareng penyembuhan mangrupikeun tujuan anu kedah diudag. Numutkeun kana Hipotésis 2, terapi sistemik ngagaduhan beurat anu langkung ageung sareng ngiringan salamet (OS). Kauntungannana, pilihan pangobatan langkung lemah lembut sareng kirang nyerang. Ayeuna, aranjeunna condong resep hipotesa dua, tapi hipotesa hiji ogé ngagaduhan alesan na. Ningali ka panjelasan salajengna dina panilitian lanjutan. Sababaraha panaliti mendakan yén oligotransferring panginten aya hubunganana sareng ngahalangan mikroRNA.
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.
Perawatan bedah oligometastasis kanker colorectal
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.
Pikeun oligometastasis tina node limfa para-aorta (PALND) dina kanker koloréktal, upami reséksi bedah dilakukeun, OS tiasa diuntungkeun tina kirang reseksi. Mangpaat disséksi pencegahan oligometastasis di sisi pelvis kanker lambung teu jelas. Oligometastasis tulang langkung radioterapi, tapi pikeun oligometastasis kalayan gejala komprési tulang tonggong, manpaat tina pangobatan tiasa ditingali. Mangpaat operasi digabungkeun sareng radioterapi pikeun oligometastasis otak langkung atra. Upami oligometastasis ovarium sumebar ku sérum, éta saluyu sareng Hipotésis 1, sareng operasi mangrupikeun pilihan anu langkung saé pikeun pasién ieu.
Kanker kolorigol oligometastasis radiotherapy
Ayeuna, operasi mangrupikeun pilihan kahiji pikeun oligometastasis, tapi peryogi langkung seueur pamikiran, sapertos sumber oligometastasis sareng tujuan pangobatan. Fokus primér anu béda sareng oligometastasis dina bagéan anu béda tina fokus primér anu sami ogé ngagaduhan target sababaraha organ. Aranjeunna gaduh sensitipitas khusus kana perlakuan anu béda, sareng operasi sanés metoda pangobatan.
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). Sanaos data ayeuna terbatas, kalayan pamahaman anu langkung seueur ngeunaan mékanisme oligometastasis, radioterapi ogé tiasa ngagentos pangobatan.
Ablasi radiofrequency pikeun oligometastasis kanker colorectal
Pikeun sababaraha lesi leutik kalayan abrasi frékuénsi radio, naha éta metastasis ati atanapi metastasis paru, ablasi radiofrequency parantos nunjukkeun pangaruh anu saé dibandingkeun sareng pangobatan.
Gagasan sakabéh terapi oligotransfer
Pondokna, pangobatan oligometastasis kanker koloréktal kedah dievaluasi pinuh ku tim multidisiplin (MDT), sareng pasién anu status oligometastasis kedah diayak ku cara pamariksaan anu pas sareng fitur klinis. Perlakuan sistematis (sistemik) mangrupikeun dasar, sareng pangobatan lokal kedah diperhatoskeun dina dasar pangobatan sistemik anu épéktip. Dina waktos anu sasarengan, dina premis pangobatan lokal pikeun reseksi radikal (R0) atanapi NED, karusakan pangobatan lokal diminimalkeun.
