Recent advance in neoadjuvant chemotherapy for rectal cancer

doi:10.16139/j.1007-9610.2022.04.020

Abstract

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

CLC Number:

R735.37

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.

Figures/Tables 1

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%

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