The treatment of liver metastases of colon cancer

By | October 24, 2011

The treatment of liver metastases of colon cancer tumor resection can cure some cases, the main factors affecting the prognosis are:
tumor> 5cm;
per disease-free survival of less than 12 months;
liver metastases> 1;
primary tumor involved lymph nodes;
CEA> 200ng/ml. Combination chemotherapy for recurrent, metastatic colon cancer effectively, 5Fu/LV is a classic and effective first-line therapy, can improve efficiency, extend the time of tumor progression CTTP) and overall survival. McArdleC et al reported 290 cases of Results colorectal liver metastases were randomized into the treatment of intravenous chemotherapy and hepatic artery infusion chemotherapy group, program 5Fu/LV, the median survival time was 13.4 months and 14.7 months for 2 years survival rate was 23% and 20%, no significant difference between the two groups.
Some physiological functions of the body has its time rhythm, some are based on 24 hours a day cycle, circadian rhythm, while others multi-day cycle. Understand the rhythm of the body function of the time period and in vivo drug effects on the process of order delivery according to their rhythm, you can obtain the best effect, but also reduced side effects. Long-term continuous infusion 5-Fu when plasma concentrations were measured, the results show the drug concentration throughout the day and dihydrodiol dehydrogenase slightly hospital CDPD) was negatively correlated with the activity of the enzyme 5-Fu is the rate-limiting enzyme clearance . Plasma concentrations of 5-Fu tend to peak in the early morning, afternoon, down into the trough. In addition, bone marrow and gastrointestinal tissues of normal DNA synthesis rate within 24 hours of rhythmic changes can affect these organizations Fu toxicity of a Sensitivity of 5. Put forward a hypothesis based on the above phenomenon, regulating 5-Fu in the 24 hours infusion rate (hour adjustment) may improve the tolerance dose of the drug and effect. And taught meningitis, hand-foot syndrome and neutropenia psychosis have significantly reduced the incidence of complications, while the infusion of anti-tumor effect of drug dose and has significantly increased sweat. These preliminary results suggest that drug infusion hour rhythm method will improve the therapeutic index of chemotherapy.
LeviF et al reported a multicenter collaborative study 186 cases of colorectal cancer patients after the transfer, adjustment programs administered by the hour, lead oxaliplatin 25mg / (m2d) at 10: OOpm administration, 4: OOpm peak, a gaze intently Prisoners H CF (leucovorin) OOmg / (m2.d) and 5-Fu600mg / (m2.d), in 10: OOpm to 10: OOam administration, 4: OOam peak at the same time with the same drug dose Comparison of continuous infusion programs, programs are 5 days, repeated every 21 days one time, hour adjustment group efficiency (50%, CR5%) higher than the continuous infusion group (29%, CR3%), and more more patients can be the treatment of colorectal cancer liver metastases (25% and 18%). Hour adjustment programs can reduce the 5-Fu induced meningitis concave-level education (76% and 14%), and oxaliplatin lead induced peripheral E-class sensory neuropathy (31% and 16%).

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