Umqondo we-oligometastasis waphakanyiswa nguHellman ngo-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 isisu 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 umdlavuza 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.
Indlela engenzeka nezimpawu ze-oligotransfer
Indlela engenzeka ye-oligotransfer ayiqondakali ngokuphelele. Njengamanje, kunemicabango emibili mayelana nokuthuthukiswa kwezimila kusuka ekukhuleni kwasendaweni kuya ku-metastasis yohlelo. I-Hypothesis 1 "ukuzimisela kwesiphetho sesimila sokuqala". Le hypothesis ikholelwa ukuthi i-oligometastasis kanye nama-metastases amaningi angaba ngama-phenotypes ehlukile we-metastatic. Lawa ma-phenotypes amabili we-metastatic anqunywa ngabantu abahlukahlukene be-tumor clone, futhi amandla abo e-metastatic ahlukile. ; I-Hypothesis 2 ithi "inqubekela phambili isuka ku-oligo iye kuma-metastasis amaningi". Le mbono ithi i-oligo-metastasis yisimo esimaphakathi sesifo. Ukusuka ku-oligo-metastasis kuya kuma-metastases amaningi kuyinkqubo eqhubekayo lapho izinguquko zofuzo zidlala umthethonqubo obalulekile, kepha inqubo yayo ejulile idinga ukuqhubeka nokufundwa.
Ama-hypotheses ahlukile anganquma izindlela ezahlukahlukene zokwelashwa zamathumba. Ngokuya nge-Hypothesis 1, ukwelashwa kwasendaweni kungaba nesisindo esikhulu, futhi ukuphulukiswa kuyinjongo okufanele ilandelwe. Ngokuya nge-Hypothesis 2, i-systemic therapy inesisindo esikhulu futhi iphishekela ukusinda okuphelele (OS). Inzuzo, izinketho zokwelashwa zimnene kakhulu futhi azihlaseli kakhulu. Njengamanje, bathambekele ekukhetheni i-hypothesis ezimbili, kepha i-hypothesis eyodwa nayo inesizathu sayo. Ngibheke phambili kwezinye izincazelo esifundweni sokulandelela. Abanye abacwaningi bathole ukuthi i-oligotransfering ingahle ihlobane nokuvinjelwa 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.
Ukwelashwa okuhlinzekwayo kwe-oligometastasis yomdlavuza omnyama
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.
Okwe-oligometastasis ye-para-aortic lymph node (PALND) kumdlavuza obala ngokwezibalo, uma kwenziwa ukuhlinzwa kokuhlinzwa, i-OS ingazuza ekuvuseleleni okuncane. Izinzuzo zokuhlukaniswa kokuvikela kwe-oligometastasis ohlangothini lwe-pelvic lomdlavuza we-rectal azicaci. I-bone oligometastasis i-radiotherapy eyengeziwe, kepha nge-oligometastasis enezimpawu zokucindezelwa kwentambo yomgogodla, izinzuzo zokwelashwa okuhlinzekwayo zisabonakala. Inzuzo yokuhlinzwa ihlanganiswe ne-radiotherapy ye-oligometastasis yobuchopho isobala kakhulu. Uma i-ovarian oligometastasis isakazwa yi-serum, iyahambisana ne-Hypothesis 1, futhi ukuhlinzwa kuyisinqumo esingcono kulezi ziguli.
Umdlavuza we-Colorectal cancer oligometastasis radiotherapy
Njengamanje, ukuhlinzwa kuyindlela yokuqala yokukhetha i-oligometastasis, kepha ukucabanga okuningi kuyadingeka, njengomthombo we-oligometastasis nezinhloso zokwelashwa. Ukugxila okuyinhloko okuhlukile kanye ne-oligometastasis ezingxenyeni ezihlukene ze-foci efanayo eyinhloko nakho kunokukhonjwa kwezinye izitho. Banobucayi obuthile ekwelashweni okuhlukile, futhi ukuhlinzwa akuyona indlela yokwelashwa.
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). Yize imininingwane yamanje ilinganiselwe, ngokuqonda okuqhubekayo kwemishini ye-oligometastasis, i-radiotherapy nayo ingathatha indawo yokwelashwa okuhlinzwa.
Ukukhishwa kwe-Radiofrequency ye-oligometastasis yomdlavuza obala
Kwezinye izilonda ezincane ezine-ablation ye-radio frequency ablation, noma ngabe i-metastasis yesibindi noma i-metastasis yamaphaphu, i-radiofrequency ablation ikhombisile umphumela omuhle uma uqhathaniswa nokwelashwa okuhlinzwa.
Umqondo jikelele we-oligotransfer therapy
Ngamafuphi, ukwelashwa komdlavuza we-colorectal oligometastasis kudinga ukuhlolwa ngokuphelele yithimba lezinhlobonhlobo (MDT), kanti iziguli ezinesimo se-oligometastasis kufanele zihlolwe ngokuhlolwa okunembile nangezici zomtholampilo. Ukwelashwa okuhlelekile (kwesistimu) kuyisisekelo, futhi ukwelashwa kwasendaweni kufanele kubhekwe ngesisekelo sokwelashwa okusebenzayo okusebenzayo. Ngasikhathi sinye, ngaphansi kwesisekelo sokwelashwa kwasendaweni kwe-radical resection (R0) noma i-NED, ukulimala kokwelashwa kwasendaweni kuncishisiwe.
