Casali P, Licitra L, Alafaci E, Gennari L
Divisione di Oncologia Medica A., Istituto Nazionale Tumori, Milano.
Ann Ital Chir. 1990 Sep-Oct;61(5):509-13.
Clinical studies on adjuvant chemotherapy in colorectal cancer started 30 years ago, but some proof of its effectiveness did not come until recently. Only randomized prospective studies can provide definite evidence in this regard. Obviously, the potential value of an effective adjuvant treatment for a frequent disease such as colorectal cancer is enormous. Randomized studies had failed to provide evidence in favour of adjuvant chemotherapy in colon cancer until a recently reported study on 5-fluorouracil and levamisole. As of today, the latter regimen may be considered as the reference one for adjuvant chemotherapy in Dukes C colon cancer. In rectal cancer some studies displayed statistically significant results in favour of adjuvant chemotherapy: however, sufficient data are still unavailable to support adjuvant chemotherapy as standard treatment. On the contrary, postoperative radiotherapy is definitely effective in decreasing local relapses. Studies are underway on the combination of chemotherapy and radiotherapy in rectal cancer. In addition to systemic chemotherapy, portal infusion of cytotoxic drugs has been tested in colorectal cancer. Controlled studies are underway, but available results would not seem to support regional treatment. Recent improvement in the chemotherapy of advanced colorectal cancer has probably occurred through the pharmacologic modulation of 5-fluorouracil by leucovorin. If this will be confirmed, one will be able to resort to more effective multidrug regimens than those tested so far and an improvement in adjuvant chemotherapy may be anticipated too.
结直肠癌辅助化疗的临床研究始于30年前，但直到最近才出现其有效性的一些证据。只有随机前瞻性研究才能在这方面提供确凿证据。显然，对于结直肠癌这种常见疾病，有效的辅助治疗的潜在价值是巨大的。在最近一项关于5-氟尿嘧啶和左旋咪唑的研究报告之前，随机研究未能提供支持结肠癌辅助化疗的证据。截至目前，后一种方案可被视为 Dukes C 期结肠癌辅助化疗的参考方案。在直肠癌方面，一些研究显示辅助化疗具有统计学意义上的显著效果：然而，仍没有足够的数据支持将辅助化疗作为标准治疗方法。相反，术后放疗在减少局部复发方面肯定是有效的。目前正在进行直肠癌化疗与放疗联合应用的研究。除了全身化疗外，还在结直肠癌中试验了门静脉灌注细胞毒性药物。对照研究正在进行，但现有结果似乎不支持区域治疗。晚期结直肠癌化疗最近的进展可能是通过亚叶酸对5-氟尿嘧啶的药理调节实现的。如果这一点得到证实，那么人们将能够采用比目前试验的方案更有效的多药联合方案，辅助化疗也有望得到改善。
