Purpose. The usual first- and second-line treatments for inoperable liver metastases from colorectal cancer (CRC) involve systemic chemotherapy, often with molecular targeted therapy. Chemoembolization, using microspheres loaded with irinotecan, has also been available as a treatment option for many years, used mainly in later lines of treatment when, due to increasing resistance, other chemotherapy regimens may have been exhausted. However, when there are contraindications to molecular therapies, the use of chemoembolization as first or second lines of treatment, in combination with FOLFIRI chemotherapy, may provide greater efficacy due to reduced irinotecan resistance. Objective. The aim of the study was to evaluate the efficacy and safety of transarterial chemoembolization (DEB-TACE) procedures for the treatment of metastatic liver lesions from CRC, using irinotecan-loaded microspheres as first-line treatment together with FOLFIRI chemotherapy. Patients and methods. The analysis included 20 patients (12 females; 8 males) with unresectable liver metastases in the course of CRC with KRAS, NRAS and BRAF mutations, who underwent 73 chemoembolization procedures with microspheres loaded with 100 mg of irinotecan, in combination with interspersed FOLFIRI chemotherapy. Response to treatment was assessed through computed tomography according to the Modified Response Evaluation Criteria in Solid Tumors (mRECIST). Progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan–Meier method. Assessment of adverse events utilized the Cancer Therapy Evaluation Program’s Common Terminology Criteria for Adverse Events (CTCAE; version 5.0). Results. Partial remission (PR) was observed in 11 (55%) patients while 5 (25%) patients showed stable disease (SD). Progression (PD) was observed in 4 (20%) patients. Median PFS was 9.1 months (95% CI: 7.2–10.1 months) and median OS was 20.7 months (95% CI: 18.2–23.3 months). The most common adverse events (AEs) resulting in treatment delay were hematological disorders, notably neutropenia (CTCAE grades 1–3). No deaths or AEs above grade 3 occurred during TACE. Continued FOLFIRI chemotherapy after TACE treatments resulted in grade 4 neutropenia in two patients, grade 3 in four patients and grade 2 thrombocytopenia in two patients. Conclusion. Combining FOLFIRI chemotherapy with chemoembolization procedures for liver metastatic lesions from colorectal cancer may provide a valuable treatment option for patients not qualified for monoclonal antibody therapy.
目的。结直肠癌（CRC）不可手术肝转移的常规一线和二线治疗通常采用全身化疗，常联合分子靶向治疗。载有伊立替康的微球化疗栓塞术作为治疗选择已应用多年，主要用于后续治疗阶段，此时由于耐药性增加，其他化疗方案可能已用尽。然而，当存在分子治疗禁忌症时，将化疗栓塞术与FOLFIRI化疗联合作为一线或二线治疗，可能因降低伊立替康耐药性而提供更佳疗效。研究目的。本研究旨在评估使用载伊立替康微球经动脉化疗栓塞术（DEB-TACE）联合FOLFIRI化疗作为一线治疗，处理结直肠癌肝转移病灶的疗效与安全性。患者与方法。分析纳入20例（女性12例，男性8例）伴有KRAS、NRAS及BRAF基因突变的不可切除结直肠癌肝转移患者，共接受73次载有100mg伊立替康微球的化疗栓塞治疗，并联合间歇性FOLFIRI化疗。治疗反应通过计算机断层扫描依据实体瘤改良疗效评价标准（mRECIST）进行评估。采用Kaplan-Meier法计算无进展生存期（PFS）和总生存期（OS）。不良事件评估采用癌症治疗评估项目的常见不良事件评价标准（CTCAE 5.0版）。结果。11例（55%）患者达到部分缓解（PR），5例（25%）患者疾病稳定（SD），4例（20%）患者出现疾病进展（PD）。中位PFS为9.1个月（95% CI：7.2-10.1个月），中位OS为20.7个月（95% CI：18.2-23.3个月）。导致治疗延迟的最常见不良事件为血液学异常，特别是中性粒细胞减少症（CTCAE 1-3级）。TACE治疗期间未发生死亡或3级以上不良事件。TACE术后继续FOLFIRI化疗导致2例患者出现4级中性粒细胞减少、4例患者出现3级中性粒细胞减少及2例患者出现2级血小板减少。结论。对于不符合单克隆抗体治疗条件的患者，FOLFIRI化疗联合化疗栓塞术治疗结直肠癌肝转移病灶可能提供有价值的治疗选择。
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