Transarterial chemoembolization (TACE) for colorectal liver metastases-current status and critical review

被引:56
|
作者
Massmann, Alexander [1 ]
Rodt, Thomas [2 ]
Marquardt, Steffen [2 ]
Seidel, Roland [1 ]
Thomas, Katrina [3 ]
Wacker, Frank [2 ]
Richter, Goetz M. [3 ]
Kauczor, Hans U. [4 ]
Buecker, Arno [1 ]
Pereira, Philippe L. [5 ]
Sommer, Christof M. [3 ,4 ]
机构
[1] Univ Saarland, Med Ctr, Clin Diagnost & Intervent Radiol, D-66421 Homburg Saar, Germany
[2] Hannover Med Sch, Dept Diagnost & Intervent Radiol, D-30625 Hannover, Germany
[3] Klinikum Stuttgart, Clin Diagnost & Intervent Radiol, D-70174 Stuttgart, Germany
[4] Univ Heidelberg Hosp, Clin Diagnost & Intervent Radiol, D-69120 Heidelberg, Germany
[5] SLK Kliniken Heilbronn GmbH, Clin Radiol, Minimally Invas Therapies & Nucl Med, D-74078 Heilbronn, Germany
关键词
Transarterial chemoembolization (TACE); Embolization; Hepatic artery infusion (HAI); Colorectal liver metastases; Surgical resection; HEPATIC ARTERIAL INFUSION; DRUG-ELUTING BEADS; PHASE-II TRIAL; DEGRADABLE STARCH MICROSPHERES; FLUOROURACIL PLUS LEUCOVORIN; QUALITY-OF-LIFE; FACTOR GM-CSF; SYSTEMIC CHEMOTHERAPY; FOLINIC ACID; INTRAARTERIAL CHEMOTHERAPY;
D O I
10.1007/s00423-015-1308-9
中图分类号
R61 [外科手术学];
学科分类号
摘要
Transarterial liver-directed therapies are currently not recommended as a standard treatment for colorectal liver metastases. Transarterial chemoembolization (TACE), however, is increasingly used for patients with liver-dominant colorectal metastases after failure of surgery or systemic chemotherapy. The limited available data potentially reveals TACE as a valuable option for pre- and post-operative downsizing, minimizing time-to-surgery, and prolongation of overall survival after surgery in patients with colorectal liver only metastases. In this overview, the current status of TACE for the treatment of liver-dominant colorectal liver metastases is presented. Critical comments on its rationale, technical success, complications, toxicity, and side effects as well as oncologic outcomes are discussed. The role of TACE as a valuable adjunct to surgery is addressed regarding pre- and post-operative downsizing, conversion to resectability as well as improvement of the recurrence rate after potentially curative liver resection. Additionally, the concept of TACE for liver-dominant metastatic disease with a focus on new embolization technologies is outlined. There is encouraging data with regard to technical success, safety, and oncologic efficacy of TACE for colorectal liver metastases. The majority of studies are non-randomized single-center series mostly after failure of systemic therapies in the 2nd line and beyond. Emerging techniques including embolization with calibrated microspheres, with or without additional cytotoxic drugs, degradable starch microspheres, and technical innovations, e.g., cone-beam computed tomography (CT) allow a new highly standardized TACE procedure. The real efficacy of TACE for colorectal liver metastases in a neoadjuvant, adjuvant, and palliative setting has now to be evaluated in prospective randomized controlled trials.
引用
收藏
页码:641 / 659
页数:19
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