Glimelius Bengt, Cavalli-Björkman Nina
Department of Radiology, Oncology and Radiation Science, University of Uppsala, Uppsala, Sweden.
Scand J Gastroenterol. 2012 Mar;47(3):296-314. doi: 10.3109/00365521.2012.640828. Epub 2012 Jan 16.
Metastatic colorectal cancer has a poor prognosis, and the majority of patients are left with palliative measures. The development seen using medical treatments are reviewed.
A systematic approach to the literature-based evidence of effects from palliative chemotherapy and targeted drugs was aimed at.
The continuous improvements during the past 20-25 years have been documented in several large conclusive trials. At the end of the 1980s, the evidence that chemotherapy should be used at all was very limited, whereas presently most patients can be offered three lines of chemotherapy with or without a targeted drug based upon good scientific evidence. Median survival in trials has gradually improved from about 6 months to above 24 months in the most recent trials. Survival in the populations has, however, not improved to the same extent. Several important issues remain to be solved, such as the best sequence of treatments, what regimens to use in various situations, when to start and when to stop if a response is seen, whether cure may be possible in a small subset of patients, and socioeconomic issues. Integration of surgery and other local methods have further improved outcome for some individuals, but must be fine-tuned.
Progress has been rapid in advanced colorectal cancer. This is likely a result of well-designed trials in collaboration between academy and industry, showing a great interest in the disease. A multi-professional approach and future collaborations may hopefully introduce new treatment concepts, further improving outcome.
转移性结直肠癌预后较差，大多数患者只能采取姑息治疗措施。本文对采用药物治疗所取得的进展进行综述。
旨在对基于文献的姑息性化疗和靶向药物疗效证据进行系统研究。
过去20 - 25年期间的持续进展已在多项大型确定性试验中得到证实。在20世纪80年代末，化疗是否应被使用的证据非常有限，而目前，基于充分的科学证据，大多数患者可以接受三线化疗，可联合或不联合靶向药物。试验中的中位生存期已从约6个月逐渐提高到最近试验中的24个月以上。然而，总体人群的生存期并未得到同等程度的改善。仍有几个重要问题有待解决，例如最佳治疗顺序、在各种情况下使用何种方案、出现反应时何时开始和停止治疗、一小部分患者是否有可能治愈以及社会经济问题。手术和其他局部治疗方法的结合进一步改善了部分患者的预后，但必须进行微调。
晚期结直肠癌进展迅速。这可能是学术机构与产业界合作开展精心设计试验的结果，表明对该疾病的高度关注。多专业方法和未来合作有望引入新的治疗理念，进一步改善预后。
