Steele G, Posner M R
Department of Surgery, New England Deaconess Hospital, Harvard Medical School, Boston, Massachusetts.
Curr Probl Cancer. 1993 Jul-Aug;17(4):223-69.
Colorectal adenocarcinoma is diagnosed in 150,000 Americans yearly, and more than 50,000 die of this disease each year. Recently, as a result of well-controlled, randomized, cooperative group trials, it has been demonstrated that adjuvant therapy of node-positive colon cancer (stage III) and node-positive or negative rectal cancer (stage II or stage III) can reduce recurrence and mortality and significantly improve overall survival. It is now the standard of care to provide adjuvant chemotherapy with 5-fluorouracil and levamisole for patients with node-positive colon cancer and provide adjuvant chemoradiotherapy with both 5-fluorouracil and high-dose radiotherapy for patients with stage II or stage III rectal cancer. It is estimated that these interventions, which are readily tolerated, will reduce the incidence of recurrence by more than 30% in both patient groups at a reasonable economic and health cost. Although the ideal method of therapy for this type of disease is not yet firmly established, it appears that adjuvant therapy for node-negative stage III colon cancer may be effective as well. Recently completed and ongoing cooperative group trials are investigating different combinations of chemotherapy and radiotherapy, including 5-fluorouracil with the biomodulator leucovorin or continuous-infusion 5-fluorouracil with radiotherapy, and comparing different durations of therapy. Other trials are investigating combined modality therapy for the neoadjuvant treatment of locally advanced rectal cancer. New findings in the genetics of colon cancer are being studied as prognostic information or markers to determine whether there are subsets of patients who might benefit from more or less therapy. Randomized placebo-controlled trials have been initiated to study the use of aspirin as a means of colon cancer prevention in high-risk populations. Taken together, the recent advances in our treatment and understanding of colorectal adenocarcinoma have resulted in a major--albeit silent--revolution in therapy and give firm promise for further progress.
每年有15万美国人被诊断出患有结肠直肠癌，每年有超过5万人死于这种疾病。最近，经过严格控制的随机合作组试验表明，对淋巴结阳性结肠癌（III期）和淋巴结阳性或阴性直肠癌（II期或III期）进行辅助治疗可降低复发率和死亡率，并显著提高总生存率。目前的标准治疗方案是，为淋巴结阳性结肠癌患者提供5-氟尿嘧啶和左旋咪唑辅助化疗，为II期或III期直肠癌患者提供5-氟尿嘧啶和高剂量放疗的辅助放化疗。据估计，这些易于耐受的干预措施将以合理的经济和健康成本使两组患者的复发率降低30%以上。尽管这种疾病的理想治疗方法尚未完全确立，但对淋巴结阴性III期结肠癌进行辅助治疗似乎也可能有效。最近完成和正在进行的合作组试验正在研究化疗和放疗的不同组合，包括5-氟尿嘧啶与生物调节剂亚叶酸联合使用或持续输注5-氟尿嘧啶与放疗联合使用，并比较不同的治疗持续时间。其他试验正在研究局部晚期直肠癌新辅助治疗的综合治疗方法。结肠癌遗传学的新发现正在作为预后信息或标志物进行研究，以确定是否有部分患者可能从更多或更少的治疗中获益。已启动随机安慰剂对照试验，以研究阿司匹林在高危人群中作为预防结肠癌手段的用途。总的来说，我们在结肠直肠癌治疗和认识方面的最新进展导致了治疗方面的一场重大——尽管悄无声息——革命，并为进一步进展带来了坚定的希望。
