Ducreux M, Boige V
Gastroenterology Unit, Department of Medicine, Institut Gustave Roussy, Villejuif, France.
Best Pract Res Clin Gastroenterol. 2002 Apr;16(2):283-98. doi: 10.1053/bega.2002.0287.
Colorectal cancer is one of the most frequent cancers in the world, especially in occidental countries. The primary curative therapy is surgical resection of the tumour. Within the last 15 years, appropriately powered prospective randomized trials have demonstrated that adjuvant post-operative chemotherapy should be the standard treatment for stage III cancers (node-positive disease). 5-Fluorouracil(5FU)/levamisole was used in the early 1990s but has now been replaced by 5FU/leucovorin. The recommended duration of treatment is 6 months. Combining levamisole with 5FU/leucovorin does not improve efficacy. In patients with stage II colon cancer it is still unclear whether adjuvant chemotherapy is effective. In an attempt to define groups of stage II cases that may benefit from adjuvant chemotherapy, considerable efforts have been made to determine molecular genetic factors (tumour-ploidy and mutations or alterations in oncogenes and tumour-suppressor genes). Regional therapy (particularly portal vein infusion) is one of the other therapeutic strategies still considered to be investigational. Current clinical trials are evaluating the role of non-fluorinated pyrimidine agents in an adjuvant setting.
结直肠癌是世界上最常见的癌症之一，在西方国家尤为如此。主要的根治性治疗方法是手术切除肿瘤。在过去15年中，有充分样本量的前瞻性随机试验表明，辅助性术后化疗应作为III期癌症（淋巴结阳性疾病）的标准治疗方法。20世纪90年代初使用的是5-氟尿嘧啶（5FU）/左旋咪唑，但现在已被5FU/亚叶酸钙取代。推荐的治疗疗程为6个月。将左旋咪唑与5FU/亚叶酸钙联合使用并不能提高疗效。对于II期结肠癌患者，辅助化疗是否有效仍不清楚。为了确定可能从辅助化疗中获益的II期病例组，人们已经做出了相当大的努力来确定分子遗传因素（肿瘤倍体以及癌基因和肿瘤抑制基因的突变或改变）。区域治疗（特别是门静脉灌注）是仍被认为处于研究阶段的其他治疗策略之一。目前的临床试验正在评估非氟化嘧啶类药物在辅助治疗中的作用。
