Comment on 'repetitive transarterial chemoembolization (TACE) of liver metastases from gastric cancer: Local control and survival results': Will there be clinical implications in the future?

摘要

We read with great interest the article entitled "Repetitive transarterial chemoembolization (TACE) of liver metastases from gastric cancer: Local control and survival result" published in your journal [1]. The authors reported attractive results, achieved by transarterial chemoembolization (TACE) management of patients affected by liver metastases from gastric cancer (GC). Although their survival data derived from a retrospective analysis, we think interesting to stress their potential clinical relevance; therefore we would like to make a general discussion and finally address some issues regarding their data. Despite a declining incidence in many developed countries GC remains a frequent, highly lethal neoplasm. In 2012 in the United States [2] an estimated 21,320 patients will be diagnosed, with an estimated 10,540 disease related deaths. Approximately 35% of patients present at diagnosis with metastatic GC and another 70% of patients who underwent radical surgery for the primary tumor will have recurrence or develop distant metastases, with a median survival rarely approaching 1 year, despite palliative chemotherapy [3,4]. Thus we agree with the authors that the search of novel treatment strategies to manage GC should be warranted. On the other hand, we think important to remark that metastatic liver involvement, which occurs in up to 50% of GC patients, often represents only part of a generalized spread of the primary tumor [3]. Direct liver invasion by malignant cells is usually restricted to segments II or III and isolated metastases are unusual, accounting for only 0.5% of cases in the Linhares's series [5].