文档介绍：晚期大腸癌的化疗结直肠癌肝转移I期切除10-20%不可切除80-90%绝大部分肝转移灶初期不能切除手术化疗/靶向药物治疗五年生存率 30-40%5年生存率肝外转移/广泛转移II期切除10-20%目标提高结肠癌肝转移灶的切除率延长晚期结肠癌患者的生存期改善晚期结肠癌患者的生活质量1 TherapyforInitiallyResectableLiverMetastasesResultsofliversurgery RC(N>100)-yrsurvivalAdson,1984(1) 141 % 23%Hughes,1988(2) 859 - 33%Doci,1991(3) 100 5% 30%Scheele,1991(4) 219 6% 39%Rosen,1992(5) 280 4% 25%Nordlinger,1992(6) 1818 % 26%Gayowski,1994(7) 204 0% 32%Rees,1997(8) 114 1% 37%1-.,.,1984;119:647-51 5-.,.,1992;216:493-505 2-,Surgery,1988;103:278-88 6-.,-Verlag,1992;141-59 3-.,.,1991;78:797-801 7-.,Surgery,1994;116:703-11 4-.,Surgery,1991;110:13-29 8-.,.,1997;84:1136-40Peri-operativeFOLFOX4chemotherapyandsurgeryforresectablelivermetastasesfromcolorectalcancer ,,,,,,. Bechstein,,,,CRUK,ALMCAO,AGITGandFFCDALM CAOAGITGgTrialDesignandObjectivesRFOLFOX4x6cyclesSurgeryFOLFOX4x6cyclesSurgery364patientsPotentiallyresectable(1-4)livermetastasesGoal:Improveprogression-freesurvivaltodemonstratea40%increaseinmedianPFS(HR=)with80%powerand2-sidedsignificancelevel5%Progression-freesurvivalineligiblepatientsHR=;CI:-,p=%%+% At3years(years)01234560102030405060708090100ONNumberofpatientsatrisk:GUIDELINES2007“pletelyresectedlivermetastasesshouldbeoffered4to6monthsofadjuvantchemotherapy…pletedneoadjuvantchemotherapy.”2 hemotherapyforLiver-onlyMetastases