Oya Masatoshi, Sameshima Shinichi, Tagaya Nobumi, Takeshita Emiko, Koketsu Shinichiro, Sugamata Yoshitake, Yoshiba Hidemaro, Ueno Masashi, Fujimoto Yoshiya, Suenaga Mitsukuni
First Dept. of Surgery, Koshigaya Hospital, Dokkyo University School of Medicine, Koshigaya, Saitama, Japan.
Gan To Kagaku Ryoho. 2011 Aug;38(8):1252-5.
Recent advances in chemotherapy and chemoradiation therapy for colorectal cancer have made neoadjuvant treatment an eligible therapeutic option for selected cases of marginally resectable colorectal cancer. However, marginally resectable colorectal cancer is not well defined. The authors suggest that a primary lesion is marginally resectable if extended resection such as pelvic exenteration and pancreaticoduedenectomy are not completely curative. Even if the lesion itself is resectable, it is marginally resectable if it has unfavorable prognostic factors such as numerous metastases to the regional lymph nodes. Rectal cancer invading beyond mesorectal fascia, or having bilateral or multiple lateral lymph node metastasis, may also be marginally resectable. All locally recurrent lesions may be marginally resectable because the prognosis after surgical resection is poor. Multiple liver metastases, liver metastasis for which resection requires vascular reconstruction, and technically resectable liver metastasis with unfavorable prognostic factors, are also thought to be marginally resectable. Neoadjuvant chemotherapy regimens including oxaliplatin and irinotecan combined with bevacizumab, cetuximab and panitumumab may be effective for hastening the curability of such marginally resectable tumors. For primary advanced rectal cancer and locally recurrent rectal cancer, neoadjuvant radiation combined with chemotherapy using oxaliplatin and irinotecan are being explored. A number of clinical trials are currently ongoing, and are expected to clarify the effectiveness of neoajuvant treatment for marginally resectable colorectal cancer.
结直肠癌化疗和放化疗的最新进展使新辅助治疗成为部分边缘可切除结直肠癌病例的合适治疗选择。然而，边缘可切除的结直肠癌尚无明确的定义。作者认为，如果扩大切除（如盆腔脏器切除术和胰十二指肠切除术）不能达到根治效果，则原发性病变属于边缘可切除。即使病变本身可切除，但如果存在预后不良因素，如区域淋巴结大量转移，也属于边缘可切除。侵犯超过直肠系膜筋膜的直肠癌，或伴有双侧或多发侧方淋巴结转移的直肠癌，也可能属于边缘可切除。所有局部复发病变可能都属于边缘可切除，因为手术切除后的预后较差。多发肝转移、切除需要血管重建的肝转移，以及具有预后不良因素但技术上可切除的肝转移，也被认为属于边缘可切除。包括奥沙利铂和伊立替康联合贝伐单抗、西妥昔单抗和帕尼单抗的新辅助化疗方案，可能对提高这类边缘可切除肿瘤的可治愈性有效。对于原发性晚期直肠癌和局部复发性直肠癌，正在探索新辅助放疗联合使用奥沙利铂和伊立替康的化疗。目前有多项临床试验正在进行，有望阐明新辅助治疗对边缘可切除结直肠癌的有效性。
