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[结直肠癌的辅助治疗和围手术期新辅助治疗]

[Adjuvant and perioperative neoadjuvant therapy for colorectal cancer].

作者信息

Liu F Q, Cai S J

机构信息

Department of Colorectal Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.

出版信息

Zhonghua Wei Chang Wai Ke Za Zhi. 2019 Apr 25;22(4):315-320. doi: 10.3760/cma.j.issn.1671-0274.2019.04.002.

Abstract

Colorectal cancer is one of the most common malignant tumors in the world, threatening human health. The treatment strategy of stage II and stage III colorectal cancer has changed from surgery alone to multidisciplinary mode emphasizing perioperative treatment. The indication of adjuvant chemotherapy for stage II colon cancer is still defined by high-risk factors, but only microsatellite status and gene mutation can help predict efficacy of chemotherapy. Combined chemotherapy is the main adjuvant therapy for stage III colon cancer. The recommended course of adjuvant chemotherapy is 6 months. Based on the results of the IDEA study, the three-month CapeOX regimen (oxaliplatin and capecitabine) is recommended for the treatment of patients with T1-3 and N1 tumors. Neoadjuvant chemotherapy for locally advanced colon cancer is still in the exploratory stage of clinical trials. The difference between the treatment of rectal cancer and colon cancer lies in the application of radiotherapy. Chemoradiotherapy combined with TME (total mesorectal excision) surgery and adjuvant chemotherapy has become the standard treatment for locally advanced rectal cancer. Nowadays, the research hotspots in neoadjuvant therapy of rectal cancer include neoadjuvant chemotherapy and total neoadjuvant therapy (TNT). This article will review the progress of perioperative treatment for colorectal cancer.

摘要

结直肠癌是世界上最常见的恶性肿瘤之一,威胁着人类健康。II期和III期结直肠癌的治疗策略已从单纯手术转变为强调围手术期治疗的多学科模式。II期结肠癌辅助化疗的指征仍由高危因素定义,但只有微卫星状态和基因突变有助于预测化疗疗效。联合化疗是III期结肠癌的主要辅助治疗方法。辅助化疗的推荐疗程为6个月。基于IDEA研究的结果,对于T1-3和N1肿瘤患者,推荐采用为期三个月的CapeOX方案(奥沙利铂和卡培他滨)进行治疗。局部晚期结肠癌的新辅助化疗仍处于临床试验的探索阶段。直肠癌和结肠癌治疗的区别在于放疗的应用。放化疗联合全直肠系膜切除术(TME)和辅助化疗已成为局部晚期直肠癌的标准治疗方法。如今,直肠癌新辅助治疗的研究热点包括新辅助化疗和全新辅助治疗(TNT)。本文将综述结直肠癌围手术期治疗的进展。

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