结直肠癌肺转移__培训课件.ppt

直径3CM 直径=3CM 肺射频消融治疗后OS 肺射频消融治疗后PFS 直径3CM 直径=3CM 结论： RFA被证实为一种可行且较安全的手术，具有可接受的死亡率，可提供安全地重复同一病变治疗的可能性。 RFA可以被认为是局部控制肺转移瘤的的有效治疗方法，尤其是患者不符合手术条件的，且肺内病灶不超过3厘米大小。 肺转移瘤治疗进展----内容 外科手术切除治疗 微创射频消融治疗 靶向药物联合化疗 放疗 SBRT 化疗 全身化疗 FOLFIRI FOLFOX 分子靶向药物：Bevacizumab、Cetuximab 化疗后再手术 术后辅助 介入化疗：肺转移灶栓塞化疗 放疗 肺转移瘤治疗进展----内容 外科手术切除治疗 微创射频消融治疗 靶向药物联合化疗 放疗 SBRT A total of 79 metastatic lung lesions from 50 patients who underwent curative resection for their primary colorectal cancer or salvage treatment at a recurrent site were included. 结直肠癌肺转移灶立体定向放疗的临床疗效 研究对象：50例行直肠癌原发灶根治术或转移灶解救治疗患者的79个肺部转灶 肺转移灶的放疗总结 1年及3年的局部控制率为：88.7%、70.6%； 3年OS及PFS率分别为：60.4%、24/0%； 体积≤1.5 mL肿瘤的OS明显优于体积1.5 mL肿瘤：3年-OS为68.0%比60.0%,p = 0.02;局部控制率高，有改善生存的优势； 不良反应：肺部并发症均≤ CTCAE2级； 结论：SBRT是一种可比的治疗结直肠癌肺转移性癌的方式。 总结 细胞的生物学行为是肺内转移预后的重要因素，并不决定能否切除。 CRC肺内转移最多见，肝内有转移者可同期/分期切除。 其他预后相关因素相似: 瘤体的数目、大小、LN的累及等，手术方式、靶向治疗后重新选择手术时机等均应进一步广泛深入研究。 * * 原发性：实性、非正常外观、边界不规则；转移性：可表现为囊性、囊实性，保留卵巢原形，边界光滑 The most comprehensive information on current practice is from a recent Spanish registry report of 543 patients.27?A national registry set up in Spain by Grupo Espa?ol de Cirugía Metástasis Pulmonares de Carcinoma Colo-Rectal (GECMP-CCR) collected data from 32 Spanish thoracic units on all patients with one or more histologically proven lung metastasis removed by surgery between March 2008 and February 2010. There were 65% men aged 32–88 (mean 65) years. In 55% of patients, there was a solitary metastasis. The median interval between the primary cancer resection and metastasectomy was 28?months and serum CEA was low/normal in the majority. Liver metastases were present in 29% of patients at some point before pulmonary metastasectomy. A comprehensive review of practice since the mid-1960s shows how the case mix has changed relatively little over time.23?The mean age has increased from 60 to 65?years, and the proportion of patients with a solitary metastasis has gone down from 60% to 55%. The proportion of patients who have had a prior liver met