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Chimiothérapie intra-artérielle hépatique, chimioembolisation et radioembolisation : un apport important pour le traitement des métastases hépatiques des cancers colorectaux

Intra-arterial hepatic chemotherapy, chemoembolisation and radioembolisation: a significant contribution in the treatment of colorectal cancer liver metastases

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Oncologie

Résumé

Les traitements locaux des métastases hépatiques (MH) des adénocarcinomes colorectaux (CCR) prennent une place de plus en plus importante dans les stratégies thérapeutiques des patients ayant des MH non résécables limitées ou prédominantes au foie. La chimiothérapie intraartérielle hépatique (CIAH) a démontré très tôt son efficacité. Sa combinaison avec des polychimiothérapies systémiques a permis de doubler les taux de réponse et d’augmenter les taux de résection secondaires et la survie des patients. L’efficacité des chimioembolisations (CE) et des radioembolisations (RE) a surtout été établie à partir d’études de phase II ou de phase III les ayant évaluées à des stades très avancés, où la survie sans progression et la survie globale étaient augmentées. La place de ces traitements à des stades plus précoces est en cours d’évaluation, et devrait permettre d’optimiser la prise en charge des patients avec MH. Ces traitements locaux doivent être aujourd’hui utilisés en combinaison avec des traitements systémiques efficaces et/ou des résections, et le choix des meilleures stratégies et protocoles doit être fait en RCP spécialisées.

Abstract

Local treatment of liver metastases (LM) of colorectal adenocarcinomas (CRC) has an emerging role in strategies of treatment for patients with limited or predominant unresectable LM. Hepatic intra-arterial chemotherapy (HIAC) demonstrated efficacy. Its combination with systemic chemotherapy allowed to double the response rate, and increased the rate of secondary resection and survival of patients. The effectiveness of chemoembolization (CE) and radio-embolization (RE) was primarily established from Phase II or Phase III evaluation of patients in very advanced stages, and progression-free survival and overall survival were increased. The role of these treatments at earlier stages is being evaluated and is expected to optimize the care of patients with LM. These local treatments must now be used in combination with effective systemic therapies, and/or resection, and the choice of the best strategies and protocols must be done in specialized team with collaboration of expert radiologist, nuclear medicine and oncologist.

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Authors and Affiliations

  1. Service HGE et oncologie digestive, CHU Georges-Pompidou (HEGP), Assistance publique-Hôpitaux de Paris, université Paris-V-René-Descartes, 20, rue Leblanc, F-75015, Paris, France

    S. Pernot, J. N. Vaillant, C. Lepère, J. Taieb & P. Rougier

  2. Service radiologie interventionnelle, CHU Georges-Pompidou (HEGP), Assistance publique-Hôpitaux de Paris, université Paris-V-René-Descartes, 20, rue Leblanc, F-75015, Paris, France

    O. Pellerin & M. Sapoval

  3. Département de médecine nucléaire, CHU Georges-Pompidou (HEGP), Assistance publique-Hôpitaux de Paris, université Paris-V-René-Descartes, 20, rue Leblanc, F-75015, Paris, France

    N. Ghazzar

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  1. S. Pernot
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Pernot, S., Pellerin, O., Ghazzar, N. et al. Chimiothérapie intra-artérielle hépatique, chimioembolisation et radioembolisation : un apport important pour le traitement des métastases hépatiques des cancers colorectaux. Oncologie 16, 571–578 (2014). https://doi.org/10.1007/s10269-014-2468-x

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  • DOI: https://doi.org/10.1007/s10269-014-2468-x

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