Zaanan A, Afchain P, Carrere N, Aparicio T
Service d'oncologie médicale, hôpital Saint-Antoine, Paris, France.
Gastroenterol Clin Biol. 2010 Aug-Sep;34(6-7):371-9. doi: 10.1016/j.gcb.2010.01.020. Epub 2010 May 27.
Small bowel adenocarcinoma is a rare tumor. These tumors are more often sporadic but there is some predisposing disease (Crohn disease, genetic syndrome and rarely celiac disease). Diagnosis is usually performed at an advanced stage because of non-specific nature of clinical manifestations. New methods of radiological and endoscopic exploration of small intestine should allow earlier diagnosis. Surgical resection remains the only potentially curative treatment for non-metastasic tumors. The main prognosis factor is lymph nodes involvement. The role of adjuvant chemotherapy is unclear. For metastatic tumors, 5-fluorouracil and platinum salt combination appears to be the most effective chemotherapy despite of the absence of randomized studies. A national prospective cohort study is currently evaluating the results of chemotherapy (recommended protocol: FOLFOX) as adjuvant and palliative treatment of small bowel adenocarcinoma.
小肠腺癌是一种罕见肿瘤。这些肿瘤多为散发性,但存在一些易感疾病(克罗恩病、遗传综合征,乳糜泻则较为罕见)。由于临床表现不具特异性,诊断通常在疾病晚期进行。小肠放射学和内镜检查的新方法应能实现更早诊断。手术切除仍是非转移性肿瘤唯一可能的治愈性治疗方法。主要预后因素是淋巴结受累。辅助化疗的作用尚不清楚。对于转移性肿瘤,尽管缺乏随机研究,但5-氟尿嘧啶与铂盐联合使用似乎是最有效的化疗方案。一项全国性前瞻性队列研究目前正在评估化疗(推荐方案:FOLFOX)作为小肠腺癌辅助治疗和姑息治疗的效果。