Paolo M Cruz Jan, George C Pales Chris, Min Kim Kwang, Wan Kim Young
Division of Colorectal Surgery, Department of Surgery, Philippine General Hospital-University of the Philippines, Philippines.
J BUON. 2018 May-Jun;23(3):568-573.
The benefit of adjuvant chemotherapy has been clearly proven for patients with stage III (node-positive) and highrisk stage II colon cancer and consists to eradicating micrometastases that may be present during the time of surgical resection, reducing thereby the likelihood of disease recurrence and potentially increasing the cure rates after surgery. In this review, the appropriate timing of initiation and optimal duration of adjuvant chemotherapy are discussed. Current guidelines recommend an oxaliplatinbased regimen (FOLFOX: 5-fluorouracil with oxaliplatin or CapeOx: capecitabine with oxaliplatin) instead of 5-FU/LV (5-fluorouracil/leucovorin) for 6 months. For patients with a contraindication to oxaliplatin, a fluoropyrimidine-based regimen alone is an acceptable option. It should be initiated within 6-8 weeks from the time of surgical resection. Studies on reduced duration of fluoropyrimidine-based only regimens (bolus 5-FU/LV vs 5-FU) showed no significant difference in overall (OS) and disease free survival (DFS) benefits. However, the studies showed significantly lower toxicities for protracted venous infusion (PVI) 5-FU given for shorter duration. For oxaliplatin-based therapies, prospective trials failed to establish non-inferiority of 3 months compared to 6 months of oxaliplatin-based adjuvant therapy. The longterm data of the International Duration Evaluation of Adjuvant Chemotherapy (IDEA) collaboration for OS are not mature to date yet. Six months of oxaliplatin-based therapy still remain the standard of care. Decisions to shorten the duration of adjuvant oxaliplatin-based therapy should be dictated by drug tolerability, risk stratification of the disease, consideration of the value of decreased neurotoxicity at the cost of decreased DFS, and patient preference.
辅助化疗对Ⅲ期（淋巴结阳性）和高危Ⅱ期结肠癌患者的益处已得到明确证实，其作用在于清除手术切除时可能存在的微转移灶，从而降低疾病复发的可能性，并有可能提高术后治愈率。在本综述中，将讨论辅助化疗开始的合适时机和最佳疗程。目前的指南推荐采用基于奥沙利铂的方案（FOLFOX：5-氟尿嘧啶联合奥沙利铂或CapeOx：卡培他滨联合奥沙利铂）而非5-FU/LV（5-氟尿嘧啶/亚叶酸钙）进行6个月的治疗。对于有奥沙利铂禁忌证的患者，单独使用基于氟嘧啶的方案是可接受的选择。应在手术切除后6 - 8周内开始治疗。关于仅减少基于氟嘧啶方案疗程（推注5-FU/LV与5-FU对比）的研究表明，总体生存（OS）和无病生存（DFS）获益方面无显著差异。然而，研究显示持续时间较短的延长静脉输注（PVI）5-FU毒性显著更低。对于基于奥沙利铂的治疗，前瞻性试验未能证实3个月的基于奥沙利铂的辅助治疗不劣于6个月的治疗。国际辅助化疗疗程评估（IDEA）合作组关于OS的长期数据至今仍不成熟。6个月的基于奥沙利铂的治疗仍然是标准治疗方案。缩短基于奥沙利铂的辅助治疗疗程的决策应取决于药物耐受性、疾病风险分层、以DFS降低为代价减少神经毒性的价值考量以及患者偏好。
