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논문KCI 등재

간 전이를 동반한 대장암 치료의 최신지견

Recent advances in the treatment of patients with colorectal liver metastases

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대한내과학회 (The Korean Association Of Internal Medicine)|2010.08|대한내과학회지 (The Korean Journal of Medicine)|제79권 제2호|pp. 125-132

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키워드

대장암; 간 전이; 선행항암화학요법; 간 절제술; 표적치료제Colorectal cancer; Liver metastases; Neoadjuvant; Liver resection; Targeted agents
주제분류내과학

초록

간 전이를 동반한 대장암 환자에서 일부는 간 절제로 완치를 시도할 수 있으며 20~30%에서 재발 없이 장기생존을 기대할 수 있으나 대부분의 환자가 수술이 불가능하거나 수술 후 재발된다. 최근 표적치료제를 포함한 항암화학요법의발전과 수술 방법의 향상으로 완치를 시도하려는 노력이 지속되고 있으며 현재까지의 연구결과를 종합해 본다면 우선 절제 가능한 대장암 간 전이의 경우에도 수술 전후의 항암화학요법이 추천되며 초기에는 절제가 어려운 간 전이의 경우에도 반응률이 높은 항암화학요법을 시도하여 종양의 크기 감소가 뚜렷하다면 수술적 절제를 고려해야 할 것이다. 하지만 수술 전 항암제 투여 기간 등은 수술 후 합병증이나 간 손상 등과의 연관성에 대해 고려해야 하겠고, 처음 항암 제치료를 결정할 때 특히 cetuximab의 사용을 계획한다면 KRAS 돌연변이와 같은 종양의 생물학적 예측인자에 대한고려가 있어야 한다. 간 전이를 포함한 종양의 완전 절제 후 에도 재발율을 줄이기 위한 수술 후 보조항암화학요법을 고려해야 할 것이다. 앞으로도 표적치료제를 포함한 보다 효율적이고 이상적인 항암화학요법과 수술 방법에 대한 지속적인 연구가 필요하며 실제 임상에서 간 전이를 동반한 대장암 환자의 치료를 결정할 때 무엇보다 중요한 것은 여러 전문의의 다학제적 협력일 것이다.

Abstract

Colorectal cancer (CRC) is 2nd to 3rd common cancer and the annual incidence of CRC is increasing in Korea. The liver is the most frequent metastatic site of colorectal cancer and approximately one forth of patients presents with liver metastasis at initial diagnosis. Without treatment, patients with colorectal liver metastasis (CRLM) have a poor prognosis; however, long-term survival benefits and even cure have been reported in a portion of patients undergoing surgical resection of liver metastasis. In addition, advances in chemotherapeutic agents, imaging, and surgical techniques can increase the number of patients who are eligible for curative resection. In the past 10 years, combination chemotherapy with 5-fluorouracil (5-U)/leucovorin (LV) and oxaliplatin or irinotecan was becoming the standard chemotherapy of treatment for metastatic CRC including CRLM. Furthermore, the combined use of targeted agents, such as cetuximab and bevacizumab, plus standard chemotherapeutics revealed more improvements in response rates and survival. Even in patients with resectable CRLM, perioperative chemotherapy with surgical resection could improve in progression free survival. However, the curable portion of patients with CRLM was still less than 20~30%, more detail management based on multidisciplinary team approaches should be needed.

참고문헌 (43)

  1. Korean Central Cancer Registry, "Annual Report of Cancer Registry in 2006, 2007, 2010", ~
  2. Nordlinger B, "Does chemotherapy prior to liver resection increase the potential for cure in patients with metastatic colorectal cancer? A report from the European Colorectal Metastases Treatment Group", Eur J Cancer, 43, pp.2037~2045 (2007)
  3. Van Cutsem E, "Towards a pan-European consensus on the treatment of patients with colorectal liver metastases", Eur J Cancer, 42, pp.2212~2221 (2006)
  4. Figueras J, "Surgical resection of colorectal liver metastases in patients with expanded indications: a single-center experience with 501 patients", Dis Colon Rectum, 50, pp.478~488 (2007)
  5. Adam R, "Five-year survival following hepatic resection after neoadjuvant therapy for nonresectable colorectal", Ann Surg Oncol, 8, pp.347~353 (2001)
  6. de Liguori Carino N, "Liver resection for colorectal liver metastases in older patients", Crit Rev Oncol Hematol, 67, pp.273~278 (2008)
  7. Simmonds PC, "Palliative chemotherapy for advanced colorectal cancer: systematic review and meta-analysis", BMJ, 321, pp.531~535 (2000)
  8. Folprecht G, "Neoadjuvant treatment of unresectable colorectal liver metastases: correlation between tumour response and resection rates", Ann Oncol, 16, pp.1311~1319 (2005)
  9. Bismuth H, "Resection of nonresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy", Ann Surg, 224, pp.509~520 (1996)
  10. Giacchetti S, "Long-term survival of patients with unresectable colorectal cancer liver metastases following infusional chemotherapy with 5-fluorouracil, leucovorin, oxaliplatin and surgery", Ann Oncol, 10, pp.663~669 (1999)
  11. Adam R, "Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: A model to predict long-term survival", Ann Surg, 240, pp.644~657 (2004)
  12. Baize N, "Long-term survival of patients downstaged by oxaliplatin and 5-fluorouracil combination followed by rescue surgery for unresectable colorectal liver metastases", Gastroenterol Clin Biol, 30, pp.1349~1353 (2006)
  13. Alberts SR, "Oxaliplatin, fluorouracil, and leucovorin for patients with unresectable liver-only metastases from colorectal cancer: A North Central Cancer Treatment Group phase II study", J Clin Oncol, 23, pp.9243~9249 (2005)
  14. Pozzo C, "Neoadjuvant treatment of unresectable liver disease with irinotecan and 5-fluorouracil plus folinic acid in colorectal cancer patients", Ann Oncol, 15, pp.933~939 (2004)
  15. Souglakos J, "FOLFOXIRI (folinic acid, 5-fluorouracil, oxaliplatin and irinotecan) vs. FOLFIRI (folinic acid, 5-fluorouracil and irinotecan) as first-line treatment in metastatic colorectal can cer (MCC): A multicentre randomised phase III trial from the Hellenic Oncology Research Group (HORG)", Br J Cancer, 94, pp.798~805 (2006)
  16. Falcone A, "Phase III trial of infusional fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) compared with infusional fluorouracil, leucovorin, and irinotecan (FOLFIRI) as first-line treatment for metastatic colorectal cancer: The Gruppo Oncologico Nord Ovest", J Clin Oncol, 25, pp.1670~1676 (2007)
  17. Cervantes A, "Cetuximab plus oxaliplatin", 5-fluorouracil (5-FU), Eur J Cancer, pp.2005, (Suppl 3)[DOI]
  18. Folprecht G, "Cetuximab and irinotecan", 5-fluorouracil, Ann Oncol, pp.2006, 17[DOI]
  19. Kopetz S, "Preliminary results from a phase II study of infusional 5-FU, leucovorin and irinotecan (FOLFIRI) plus bevacizumab as first-line treatment for metastatic colorectal cancer (mCRC)", J Clin Oncol, 24(Abstr 3579) (2006)
  20. Bokemeyer C, "Cetuximab plus 5-FU", FA, Eur J Cancer, pp.2007, (Suppl 5)[DOI]
  21. Van Cutsem E, "CRYSTAL, a randomized phase III trial of cetuximab plus FOLFIRI vs. FOLFIRI in first-line metastatic colorectal cancer (mCRC)", Eur J Cancer, (Suppl 5), pp.4~ (2007)
  22. Van Cutsem E, "KRAS status and efficacy in the first-line treatment of patients with metastatic colorectal cancer (mCRC) treated with FOLFIRI with or without cetuximab: the CRYSTAL experience", J Clin Oncol, 26(Abstr 2) (2008)
  23. Bokemeyer C, "KRAS status and efficacy of first-line treatment of patients with metastatic colorectal cancer (mCRC) with FOLFOX with or without cetuximab: the OPUS experience", J Clin Oncol, 26(Abstr 4000) (2008)
  24. Folprecht G, "Randomized multicenter study of cetuximab plus FOLFOX or cetuximab plus FOLFIRI in neoadjuvant treatment of non-resectable colorectal liver metastases (CLM)", Ann Oncol, 19(Abstr 510PD), pp.viii168~ (2008)
  25. Cassidy J, "Surgery with curative intent in patients (pts) treated with first-line chemotherapy (CT)+bevacizumab (BEV) for metastatic colorectal cancer (mCRC): First BEAT and NO16966", J Clin Oncol, 26(Abstr 4022) (2008)
  26. Nordlinger B, "Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial", Lancet, 371, pp.1007~1016 (2008)
  27. Gruenberger B, "Importance of response to neoadjuvant chemotherapy in potentially curable colorectal cancer liver metastases", BMC Cancer, 8, pp.120~ (2008)
  28. Abdalla EK, "Colorectal metastases: resect or ablate?", Ann Surg Oncol, 13, pp.602~603 (2006)
  29. André T, "Multicenter International Study of Oxaliplatin", 5-Fluorouracil, N Engl J Med, pp.2004, 350[DOI]
  30. André T, "Adjuvant treatment of colon cancer MOSAIC study's main results", Bull Cancer, 93(Suppl 1), pp.S5~S9 (2006)
  31. Portier G, "Multicenter randomized trial of adjuvant fluorouracil and folinic acid compared with surgery alone after resection of colorectal liver metastases: FFCD ACHBTH AURC 9002 trial", J Clin Oncol, 24, pp.4976~4982 (2006)
  32. Mitry E, "Adjuvant chemotherapy after potentially curative resection of metastases from colorectal cancer: a pooled analysis of two randomized trials", J Clin Oncol, 26, pp.4906~4911 (2008)
  33. Mitry E, "Adjuvant chemotherapy after potentially curative resection of metastases from colorectal cancer: a pooled analysis of two randomized trials", J Clin Oncol, 26, pp.4906~4911 (2008)
  34. Parks R, "Adjuvant chemotherapy improves survival after resection of hepatic colorectal metastases: analysis of data from two continents", J Am Coll Surg, 204, pp.753~763 (2007)
  35. Kornprat P, "Outcome after hepatectomy for multiple (four or more) colorectal metastases in the era of effective chemotherapy", Ann Surg Oncol, 14, pp.1151~1160 (2007)
  36. Ychou M, "A randomized phase III study comparing adjuvont 5-fluorouracil", folinic acid with FOLFIRI in patients following complete resection of liver metastases from colorectal cancer, 2009, pp.20, 1964~1970
  37. Vauthey JN, "Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases", J Clin Oncol, 24, pp.2065~2072 (2006)
  38. Aloia T, "Liver histology and surgical outcomes after preoperative chemotherapy with fluorouracil plus oxaliplatin in colorectal cancer liver metastases", J Clin Oncol, 24, pp.4983~4990 (2006)
  39. Karoui M, "Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases", Ann Surg, 243, pp.1~7 (2006)
  40. Gruenberger B, "Bevacizumab, capecitabine, and oxaliplatin as neoadjuvant therapy for patients with potentially curable metastatic colorectal cancer", J Clin Oncol, 26, pp.1830~1835 (2008)
  41. Nordlinger B, "Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients", Cancer, 77, pp.1254~1262 (1996), Association Francaise de Chirurgie.
  42. Nordlinger B, "European Colorectal Metastases Treatment Group; Sixth International Colorectal Liver Metastases Workshop. Combination of surgery and chemotherapy and the role of targeted agents in the treatment of patients with colorectal liver metastases: recommendations from an expert panel", Ann Oncol, 20, pp.985~992 (2009)
  43. Adam R, "Hepatic resection after rescue cetuximab treatment for colorectal liver metastases previously refractory to conventional systemic therapy", J Clin Oncol, 25, pp.4593~4602 (2007)

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