Surgery and OncologySurgery and OncologyХирургия и онкология2949-5857Publishing House ABV Press9710.17650/2220-3478-2013-0-4-42-49ORIGINAL REPORTSОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯTHE ROLE OF PREOPERATIVE REGIONAL CHEMOTHERAPY FOR COLORECTAL METASTASES IN POOR PROGNOSIS PATIENTSРОЛЬ ПЕРИОПЕРАЦИОННОЙ РЕГИОНАРНОЙ ХИМИОТЕРАПИИ В ЛЕЧЕНИИ БОЛЬНЫХ КОЛОРЕКТАЛЬНЫМ РАКОМ С МЕТАСТАТИЧЕСКИМ ПОРАЖЕНИЕМ ПЕЧЕНИ В ГРУППЕ НЕБЛАГОПРИЯТНОГО ПРОГНОЗАLazarevS. A.ЛазаревС. А.
Russian Federation
serglazarev@bk.ruLazarevA. F.ЛазаревА. Ф.
Russian Federation
serglazarev@bk.ruMamontovK. G.МамонтовК. Г.
Russian Federation
serglazarev@bk.ruKotelnikovA. G.КотельниковА. Г.
Russian Federation
serglazarev@bk.ruKhaysS. L.ХайсС. Л.
Russian Federation
serglazarev@bk.ruThe Altai branch of N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, BarnaulАлтайский филиал ФГБУ «РОНЦ им. Н.Н. Блохина» РАМН, Барнаул271220132442490103201501032015Copyright ©; 2013, Lazarev S.A., Lazarev A.F., Mamontov K.G., Kotelnikov A.G., Khays S.L.Copyright ©; 2013, Лазарев С.А., Лазарев А.Ф., Мамонтов К.Г., Котельников А.Г., Хайс С.Л.2013Lazarev S.A., Lazarev A.F., Mamontov K.G., Kotelnikov A.G., Khays S.L.Лазарев С.А., Лазарев А.Ф., Мамонтов К.Г., Котельников А.Г., Хайс С.Л.https://creativecommons.org/licenses/by/4.0https://onco-surgery.info/jour/article/view/97

In this study we have analyzed 120 cases of extensive liver resection with pre- and postoperative regional chemotherapy in poor prognosis patients: 54 (45 %) of them had multiple liver metastases, 72 (60 %) – had bilobar lesions, 26 (22 %) had extrahepatic metastases. Adding bevacizumab to preoperative regional intra-arterial chemotherapy (FOLFOX) has increased objective response rate up to 65 vs 44 % in group without bevacizumab and grade III morphological response rate up to 59 vs 5 % in group without bevacizumab.Difference in overall survival in both groups was not statistically significant: 5-year survival was 16 ± 8 % and 21 ± 6 %, median survival was 35 months and 29 months in groups with or without bevacizumab, respectively.Preoperative regional intra-arterial chemotherapy has not increased the rate of bleeding and postoperative complications.

Проведен анализ результатов обширных резекций печени с периоперационной регионарной химиотерапией (ХТ) 120 больным с резектабельными метастазами колоректального рака в печень. Множественные метастазы наблюдались у 54 (45 %) больных, билобарное поражение печени у 72 (60 %), 26 (22 %) больных с внепеченочными метастазами. В качестве предоперационной ХТ одной группе лечение проводилось в режиме FOLFOX, другой в этом же режиме в сочетании с бевацизумабом. Добавление к лечению бевацизумаба сопровождалось ростом объективного эффекта до 66 % по сравнению с группой без бевацизумаба – 44 % и частоты лекарственного патоморфоза в опухоли 3-й степени 59 % по сравнению с 5 % без бевацизумаба,но не привело к достоверному повышению показателей отдаленной выживаемости: 5-летняя выживаемость 16 ± 8 %, медиана 35 мес по сравнению с 21 ± 6 % и медианой 29 мес без бевацизумаба. Дооперационная регионарная внутриартериальная ХТ не привела к увеличению интраоперационной кровопотери и частоты послеоперационных осложнений. Проведение периоперационной ХТ позволило перевести 6 (5 %) пациентов в резектабельное состояние.

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