Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany.
Curr Opin Oncol. 2012 Jul;24(4):441-7. doi: 10.1097/CCO.0b013e328352ea02.
To discuss the recent developments of multimodal treatment for patients with local advanced rectal cancer, including incorporation of new chemotherapeutic and targeted agents, and the optimal sequence and timing of treatment components.
Five randomized trials have been completed to determine whether the addition of oxaliplatin to preoperative, fluorouracil-based chemoradiotherapy (CRT) offers an advantage compared to single-agent fluorouracil CRT. Early results from the ACCORD 12, STAR-01, and NSAPB R-04 trials did not confirm a significant improvement of early efficacy endpoints with the addition of oxaliplatin, whereas the German CAO/ARO/AIO-04 did. Most of the phase II trials incorporating cetuximab into CRT reported disappointingly low rates of pathologic complete response (pCR); the combination of CRT with VEGF inhibition showed encouraging pCR rates; however, it was associated with increased surgical complications. Novel clinical trials address the role of induction chemotherapy, of delayed, minimal or omitted surgery following CRT, or the omission of radiotherapy for selected patients.
At this time, the use of oxaliplatin or targeted agents as component of multimodality treatment for rectal cancer outside of a clinical trial is not recommended. The inclusion of different treatment options, according to tumor stage, location, imaging features, and response, will render the multimodal treatment approach of rectal cancer more risk-adapted.
讨论局部晚期直肠癌多模式治疗的最新进展，包括新的化疗和靶向药物的应用，以及治疗成分的最佳顺序和时机。
已经完成了五项随机试验，以确定奥沙利铂联合术前氟尿嘧啶为基础的放化疗（CRT）是否优于单药氟尿嘧啶 CRT。ACCORD 12、STAR-01 和 NSAPB R-04 试验的早期结果并未证实奥沙利铂的加入能显著改善早期疗效终点，而德国 CAO/ARO/AIO-04 试验则证实了这一点。大多数将西妥昔单抗纳入 CRT 的 II 期试验报告称，病理完全缓解（pCR）率令人失望地低；CRT 联合 VEGF 抑制显示出令人鼓舞的 pCR 率；然而，它与手术并发症的增加有关。新的临床试验探讨了诱导化疗、CRT 后延迟、最小或省略手术，或为选定患者省略放疗的作用。
目前，不建议在临床试验之外将奥沙利铂或靶向药物作为直肠癌多模式治疗的一部分。根据肿瘤分期、位置、影像学特征和反应纳入不同的治疗选择，将使直肠癌的多模式治疗方法更加适应风险。
