Arnold Dirk, Stein Alexander
Hubertus Wald Tumour Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Germany.
Onkologie. 2012;35 Suppl 1:42-8. doi: 10.1159/000334821. Epub 2012 Jan 20.
In the last 15 years, significant progress in the management of colorectal cancer (CRC) has been achieved with several new agents licensed extending median overall survival for stage IV disease to about 2 years. Treatment of CRC is stage-specific, multidisciplinary, and based on patient and tumor characteristics. Although especially early stages (0-III, according to Union for International Cancer Control) are treated with curative intent, patients with limited stage IV disease (liver and/or lung or localized peritoneal metastases) might still be curable in a multimodality approach including surgery, perioperative chemotherapy and/or radiotherapy. Despite the broad variety of prognostic factors, treatment decisions and selection of drugs are mainly based on clinicopathologic variables for early stage CRC, extent of disease, potential resectability, patients' eligibility to receive aggressive treatments including chemotherapy, surgery, and very few molecular markers such as KRAS mutational status for advanced disease. However, a tailored approach for the treatment of CRC taking into account all mentioned factors is currently recommended by national and international guidelines and will be discussed in this review.
在过去15年里,结直肠癌(CRC)管理方面取得了重大进展,几种新获批药物将IV期疾病的中位总生存期延长至约2年。CRC的治疗是针对特定阶段的、多学科的,并基于患者和肿瘤特征。尽管特别是早期阶段(根据国际癌症控制联盟为0-III期)以治愈为目的进行治疗,但有限的IV期疾病(肝和/或肺或局限性腹膜转移)患者通过包括手术、围手术期化疗和/或放疗在内的多模式方法仍可能治愈。尽管有各种各样的预后因素,但早期CRC的治疗决策和药物选择主要基于临床病理变量、疾病范围、潜在可切除性、患者接受包括化疗、手术在内的积极治疗的资格,以及晚期疾病很少的分子标志物,如KRAS突变状态。然而,目前国家和国际指南推荐采用一种考虑所有上述因素的CRC治疗定制方法,本文将对此进行讨论。