Klinik für Strahlentherapie und Onkologie, Universität Frankfurt, Frankfurt am Main, Germany.
Strahlenther Onkol. 2010 Dec;186(12):658-64. doi: 10.1007/s00066-010-2194-2. Epub 2010 Nov 30.
in the era of preoperative chemoradiotherapy (CRT) and total mesorectal excision (TME), the development of distant metastases is the predominant mode of failure in rectal cancer patients today. Integrating more effective systemic therapy into combined modality programs is the challenge. The question that needs to be addressed is how and when to apply systemic treatment with adequate dose and intensity.
this review article focuses on phase II-III trials designed to improve 5-fluorouracil (5-FU)-based combined modality treatment for rectal cancer patients through the inclusion of concurrent, adjuvant or, most recently, induction combination chemotherapy. Computerized bibliographic searches of PubMed were supplemented with hand searches of reference lists and abstracts of ASCO/ASTRO/ESTRO meetings.
after preoperative CRT and surgical resection, approximately one third of patients do not receive adjuvant chemotherapy, mainly due to surgical complications, patients' refusal, or investigator's discretion. In order to be able to apply chemotherapy with sufficient dose and intensity, an innovative approach is to deliver systemic therapy prior to preoperative CRT rather than adjuvant chemotherapy. Emerging evidence from several phase II trials and, recently, randomized phase II trials indicate that induction chemotherapy is feasible, does not compromise CRT or surgical resection, and enables the delivery of chemotherapy in adequate dose and intensity. Although this approach did not increase local efficacy in recent trials (e.g., pathological complete response rates, tumor regression, R0 resection rates, local control), it may help to improve control of distant disease.
whether this improvement in applicability and dose density of chemotherapy will ultimately translate into improved disease-free survival will have to be tested in a larger phase III trial.
在术前放化疗（CRT）和全直肠系膜切除术（TME）时代，远处转移的发展是当今直肠癌患者失败的主要模式。将更有效的系统治疗纳入联合治疗方案是一项挑战。需要解决的问题是如何以及何时以适当的剂量和强度应用全身治疗。
本文回顾了旨在通过包括同期、辅助或最近的诱导联合化疗来提高基于氟尿嘧啶（5-FU）的联合治疗方案治疗直肠癌患者疗效的 II-III 期临床试验。通过计算机检索 PubMed 数据库，并辅以 ASCO/ASTRO/ESTRO 会议的参考文献和摘要的手工检索。
在术前 CRT 和手术切除后，约三分之一的患者未接受辅助化疗，主要原因是手术并发症、患者拒绝或研究者的判断。为了能够以足够的剂量和强度应用化疗，可以采用在术前 CRT 之前而不是辅助化疗之前给予全身治疗的创新方法。来自几项 II 期试验的新证据，最近还有随机 II 期试验表明，诱导化疗是可行的，不会影响 CRT 或手术切除，并能够以足够的剂量和强度给予化疗。尽管这种方法在最近的试验中并没有提高局部疗效（例如，病理完全缓解率、肿瘤退缩、R0 切除率、局部控制率），但它可能有助于改善远处疾病的控制。
这种化疗适用性和剂量密度的提高是否最终会转化为无病生存率的提高，将需要在更大规模的 III 期试验中进行检验。
