Van Cutsem E, Peeters M, Verslype C, Filez L, Haustermans K, Janssens J
Department of Internal Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
Hepatogastroenterology. 1999 Mar-Apr;46(26):709-16.
Colorectal cancer is one of the most frequent malignancies and one of the greatest causes of cancer death in the Western world. The prognosis is determined by the stage at diagnosis. Patients with metastatic colon cancer have a bad prognosis. Chemotherapeutic treatment with 5-Fluorouracil (5-FU) and folinic acid is actually considered as the standard treatment in patients with metastatic disease. Although the survival benefit is relatively small, many patients can benefit from this treatment in terms of tumor regression or symptom improvement. Several new drugs are actually in development and create hope for improved tumor or symptom control and longer survival. Thymidylate synthase inhibitors (raltitrexed), topoisomerase I inhibitors (irinotecan), the oral 5-FU prodrugs (capecitabine, UFT), ethynyluracil, and oxaliplatin are promising new drugs. The challenge will be to determine the best combination of these new drugs and the exact sequence in which these drugs will be used. Adjuvant post-operative chemotherapy in colon cancer is one of the most important advances in oncology that has been introduced into the clinic during the last years. For rectal cancer, an adjuvant treatment should consist of a combined chemo-radiotherapy. The search for better prognostic factors for recurrence should help to focus on a better adjuvant treatment for patients with the highest risk for recurrence.
结直肠癌是西方世界最常见的恶性肿瘤之一，也是癌症死亡的主要原因之一。预后取决于诊断时的分期。转移性结肠癌患者预后不良。5-氟尿嘧啶（5-FU）和亚叶酸的化疗实际上被认为是转移性疾病患者的标准治疗方法。尽管生存获益相对较小，但许多患者可从该治疗中在肿瘤消退或症状改善方面获益。目前有几种新药正在研发中，为改善肿瘤控制或症状控制以及延长生存期带来了希望。胸苷酸合成酶抑制剂（雷替曲塞）、拓扑异构酶I抑制剂（伊立替康）、口服5-FU前体药物（卡培他滨、优福定）、乙炔尿嘧啶和奥沙利铂都是有前景的新药。挑战在于确定这些新药的最佳组合以及使用这些药物的确切顺序。结肠癌术后辅助化疗是近年来肿瘤学领域引入临床的最重要进展之一。对于直肠癌，辅助治疗应包括化疗联合放疗。寻找更好的复发预后因素应有助于针对复发风险最高的患者进行更好的辅助治疗。
