Meyers B M, Cosby R, Quereshy F, Jonker D
Juravinski Cancer Centre, Department of Oncology, McMaster University, Hamilton, ON.
Program in Evidence-Based Care, Department of Oncology, McMaster University, Juravinski Campus, Hamilton, ON.
Curr Oncol. 2016 Dec;23(6):418-424. doi: 10.3747/co.23.3330. Epub 2016 Dec 21.
Updated practice guidelines on adjuvant chemotherapy for completely resected colon cancer are lacking. In 2008, Cancer Care Ontario's Program in Evidence-Based Care developed a guideline on adjuvant therapy for stages ii and iii colon cancer. With newer regimens being assessed in this patient population and older agents being either abandoned because of non-effectiveness or replaced by agents that are more efficacious, a full update of the original guideline was undertaken.
Literature searches (January 1987 to August 2015) of medline, embase, and the Cochrane Library were conducted; in addition, abstracts from the American Society of Clinical Oncology, the European Society for Medical Oncology, and the European Cancer Congress were reviewed (the latter for January 2007 to August 2015). A practice guideline was drafted that was then scrutinized by internal and external reviewers whose comments were incorporated into the final guideline.
Twenty-six unique reports of eighteen randomized controlled trials and thirteen unique reports of twelve meta-analyses or pooled analyses were included in the evidence base. The 5 recommendations developed included 3 for stage ii colon cancer and 2 for stage iii colon cancer.
Patients with completely resected stage iii colon cancer should be offered adjuvant 5-fluorouracil (5fu)-based chemotherapy with or without oxaliplatin (based on definitive data for improvements in survival and disease-free survival). Patients with resected stage ii colon cancer without "high-risk" features should not receive adjuvant chemotherapy. For patients with "high-risk" features, 5fu-based chemotherapy with or without oxaliplatin should be offered, although no clinical trials have been conducted to conclusively demonstrate the same benefits seen in stage iii colon cancer.
目前缺乏关于完全切除的结肠癌辅助化疗的最新实践指南。2008年，安大略癌症护理循证护理项目制定了一份关于II期和III期结肠癌辅助治疗的指南。鉴于该患者群体中正在评估更新的治疗方案，且一些较老的药物因无效而被摒弃或被更有效的药物所取代，因此对原指南进行了全面更新。
检索了1987年1月至2015年8月期间的医学期刊数据库（Medline）、荷兰医学文摘数据库（Embase）和考科蓝图书馆；此外，还查阅了美国临床肿瘤学会、欧洲医学肿瘤学会和欧洲癌症大会的摘要（后者涵盖2007年1月至2015年8月）。起草了一份实践指南，随后由内部和外部评审员进行审查，他们的意见被纳入最终指南。
证据库纳入了18项随机对照试验的26份独立报告以及12项荟萃分析或汇总分析的13份独立报告。制定的5项建议包括3项针对II期结肠癌，2项针对III期结肠癌。
对于完全切除的III期结肠癌患者，应提供含或不含奥沙利铂的基于5-氟尿嘧啶（5-FU）的辅助化疗（基于生存和无病生存改善的确切数据）。无“高危”特征的切除II期结肠癌患者不应接受辅助化疗。对于有“高危”特征的患者，应提供含或不含奥沙利铂的基于5-FU的化疗，尽管尚未进行临床试验以确凿证明其与III期结肠癌具有相同的获益。
