Gill Sharlene, Meyerhardt Jeffrey A, Arun Monica, Veenstra Christine M
1 BC Cancer, Vancouver, British Columbia, Canada.
2 Dana-Farber Cancer Institute, Boston, MA.
Am Soc Clin Oncol Educ Book. 2019 Jan;39:226-235. doi: 10.1200/EDBK_237443. Epub 2019 May 17.
Adjuvant fluoropyrimidine-based chemotherapy has been the standard of care for resected stage III colon cancer since the 1990s; the evolution from 12 to 6 months of fluoropyrimidine therapy and the addition of oxaliplatin to fluoropyrimidine therapy have led to the current accepted standard. However, controversies remain. What is the benefit of adjuvant chemotherapy in stage II disease, and in whom? What is the optimal duration of adjuvant chemotherapy? How should patients with early-stage colon cancer be followed after surgery and adjuvant treatment? Recent evidence has emerged to help inform these important questions, including the International Duration Evaluation of Adjuvant therapy (IDEA) collaboration, which is the largest, prospective study in colon cancer with 12,834 patients. This review discusses current and future risk stratification strategies in stage II disease: the optimal duration of adjuvant oxaliplatin-containing chemotherapy in stage II and III disease according to the IDEA study, and the recent evidence and updated recommendations for surveillance of early-stage colon cancer after resection.
自20世纪90年代以来，基于氟嘧啶的辅助化疗一直是III期结肠癌切除术后的标准治疗方法；氟嘧啶治疗时间从12个月缩短至6个月以及在氟嘧啶治疗中加入奥沙利铂，促成了目前公认的标准。然而，争议仍然存在。辅助化疗对II期疾病有何益处，哪些患者能从中获益？辅助化疗的最佳疗程是多久？早期结肠癌患者术后及辅助治疗后应如何随访？近期出现的证据有助于解答这些重要问题，包括国际辅助治疗疗程评估（IDEA）协作组的研究，该研究是针对12834例患者开展的规模最大的结肠癌前瞻性研究。本综述讨论了II期疾病当前和未来的风险分层策略：根据IDEA研究，II期和III期疾病含奥沙利铂辅助化疗的最佳疗程，以及近期关于早期结肠癌切除术后监测的证据和更新建议。
