McMullen Kevin P, Blackstock A William
Department of Radiation Oncology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA.
Clin Colorectal Cancer. 2002 May;2(1):24-30. doi: 10.3816/CCC.2002.n.008.
Surgery remains the mainstay of treatment for colorectal cancer. Although the role of radiation therapy in colon cancer is unclear, its role in the management of locally advanced rectal cancer has been extensively studied in clinical trials. The use of postoperative chemoradiotherapy has been shown to improve local control and disease-free survival in patients with locally advanced disease over surgery alone; however, an overall survival advantage remains unproven. Clinical trials evaluating preoperative radiotherapy have demonstrated an improved local control as well as a survival advantage. Randomized studies comparing preoperative versus postoperative combined-modality approaches have failed in the United States, mainly due to the perceived advantages of preoperative treatment: improved patient tolerance, tumor downstaging, and fewer treatment-related complications. While 5-fluorouracil-based chemotherapy remains the standard systemic agent used along with radiation, other novel agents and strategies have recently been developed and are under investigation. In this review, we discuss the use of novel anticancer agents in combination with radiation therapy for the treatment of locally advanced rectal cancer.
手术仍然是结直肠癌治疗的主要手段。虽然放射治疗在结肠癌中的作用尚不清楚，但它在局部晚期直肠癌治疗中的作用已在临床试验中得到广泛研究。术后放化疗已被证明，与单纯手术相比，可改善局部晚期疾病患者的局部控制和无病生存率；然而，总体生存优势尚未得到证实。评估术前放疗的临床试验已证明局部控制得到改善，以及生存优势。在美国，比较术前与术后综合治疗方法的随机研究失败了，主要是因为术前治疗具有一些优势：患者耐受性提高、肿瘤降期以及治疗相关并发症减少。虽然基于5-氟尿嘧啶的化疗仍然是与放疗联合使用的标准全身用药，但最近已开发出其他新型药物和策略并正在进行研究。在这篇综述中，我们讨论了新型抗癌药物与放射治疗联合用于治疗局部晚期直肠癌的情况。
