直肠癌新辅助化疗的研究进展

doi:10.16139/j.1007-9610.2022.04.020

摘要/Abstract

摘要：

直肠癌是全球重要的公共健康问题,带来巨大的经济负担。美国综合癌症网指南推荐新辅助放、化疗以及全直肠系膜切除术、术后辅助化疗为局部晚期直肠癌病人的标准治疗模式。新辅助化疗是一种尚未广泛应用的治疗选择,理论上能避免放疗相关毒副反应,提高病人生存率。本文回顾直肠癌新辅助化疗的发展、理论基础、治疗方案及其疗程、依从性、不良反应以及疗效评估,探讨未来优化方向。

关键词: 直肠癌, 新辅助治疗, 化疗, 放疗

Abstract:

Rectal cancer is an important global public health problem and a huge economic burden. The clinical guideline was recommended by the National Comprehensive Cancer Network in America that neoadjuvant chemoradiothe-rapy, total mesorectal excision, postoperative adjuvant chemotherapy is the standard treatment for the patients with locally advanced rectal cancer. Neoadjuvant chemotherapy is an emerging option that has not yet been widely applied in the treatment of rectal cancer. In theory, this strategy is supposed to avoid the toxin of radiotherapy and increase patient survival. Neoadjuvant chemotherapy in rectal cancer was reviewed in this article including the development, basic theory, treatment strategy and course, compliance, adverse reactions and efficacy assessment, the direction of future optimization was explored.

Key words: Rectal cancer, Neoadjuvant therapy, Chemotherapy, Radiotherapy

中图分类号:

R735.37

郭杨, 郭天安, 徐烨. 直肠癌新辅助化疗的研究进展[J]. 外科理论与实践, 2022, 27(04): 370-374.

GUO Yang, GUO Tian′an, XU Ye. Recent advance in neoadjuvant chemotherapy for rectal cancer[J]. Journal of Surgery Concepts & Practice, 2022, 27(04): 370-374.

图/表 1

表1

单臂直肠癌新辅助化疗试验

参考文献	发表年份	入选标准	总例数	治疗方案	新辅助化疗依从性	不良反应	病理完全缓解率	R0切除率	局部复发率	远处转移率	生存率
GEMCAD 0801^[15-16]	2014, 2017	cT₃期,肿瘤位于中间1/3	46	1. XELOX+贝伐单抗(4周期,最后1周期无贝伐单抗) 2. 手术	不详	3、4级不良39.0%,2例死于新辅助化疗期	20.0%	100%	2.0%	不详	1年无病生存率75.0%
Schrag等^[17]	2014	距肛门边缘5~12 cm, cT₃N^-/ cT₃N⁺期,cT₄期者排除	32	1. mFOLFOX6(6周期)+贝伐单抗(1-4周期) 2. 肿瘤无反应/进展者进行放疗,有反应者立即进行TME	93.8%	2例死亡	25.0%	100%	0	12.5%	4年无病生存率84.0%, 4年总体生存率91.6%
Hasegawa等^[18]	2017	cT₃N₀M₀期或T_1~3 N₁M₀期,肿瘤远端边缘位于腹膜返折线或其下方	60	1. KRAS野生型:mFOLFOX6+贝伐单抗/西妥昔单抗(6周期),KRAS突变型:mFOLFOX6(6周期) 2. TME	88.0%	不详	16.7%	98.3%	不详	不详	不详
FACT^[19]	2017	Ⅱ/Ⅲ期;T₃期或T₄期	52	1. mFOLFOX6 (4周期,若结束后肿瘤无进展,则再进行 2周期) 2. TME	96.2%(完成4周期), 84.5%(完成6周期)	不详	11.9%	92.9%	不详	不详	不详
FORTUNE^[20]	2019	Ⅱ期(T_3~4N₀期)或Ⅲ期(T_1~4 N_1~2期),距肛<12 cm	106	1. mFOLFOXIRI (4~6周期) 2. 任何证据表明原发肿瘤进展、新辅助化疗后直肠系膜筋膜阳性或ycT_4a/b阳性的高危因素都是放疗的指征 3. TME手术	100%	无死亡病人	20.4%	98.8%	不详	不详	不详
Toritani等^[21]	2020	临床Ⅲ期,KRAS野生型,距肛门边缘5~12 cm	50	1.mFOLFOX6 +帕尼单抗(6周期) 2. 新辅助化疗后6周内进行手术	96.0%	3级不良24.0%,无4级事件或死亡病人	8.00%	100%	2.0%	26.0%	3年无复发生存率 79.0%,3年总体生存率 93.7%
Cienfuegos等^[22]	2020	cT_2~3期和(或)N⁺期,距肛14~15 cm内	27	1. 奥沙利铂+卡培他滨/5-FU(4~7周期) 2. 手术	100%	无4级不良或死亡病人	14.8%	100%	0	11.0%	5年无病生存率84.7%, 5年总体生存率85.0%

表1

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