直腸癌新輔助治療_《中國普外基礎與臨床雜志》

作者：

肖毅

中國醫學科學院北京協和醫學院北京協和醫院基本外科（北京 100730）;

關鍵詞：

直腸癌術前放化療新輔助治療

視頻：

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摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的論述近年來術前放化療即新輔助治療在中低位直腸癌綜合治療模式中的作用。
方法結合近期文獻及筆者單位的經驗，從外科治療角度，就新輔助治療的重點關注問題進行闡述。
結果新輔助治療經過20余年的發展，總劑量50 Gy的長程放療顯示出較多優勢。新輔助治療在腫瘤降期、術后局部控制率方面取得明顯優勢；但對提高保肛手術幾率目前還有不同看法；同時大量的研究結果沒有發現該治療方式能提高患者的遠期存活率；目前還沒有手段預測其治療敏感性。
結論對于進展期中低位直腸癌，新輔助治療仍是提高手術R0切除率、降低術后局部復發的有效治療方式。

引用本文： 肖毅. 直腸癌新輔助治療. 中國普外基礎與臨床雜志, 2010, 17(9): 906-909. doi: 復制

1.	Higgins GA, Humphrey EW, Dwight RW, et al. Preoperative radiation and surgery for cancer of the rectum. Veterans Administration Surgical Oncology Group Trial Ⅱ [J]. Cancer, 1986; 58(2): 352359.
2.	Gérard A, Buyse M, Nordlinger B, et al. Preoperative radiotherapy as adjuvant treatment in rectal cancer. Final results of a randomized study of the European Organization for Research and Treatment of Cancer (EORTC) [J]. Ann Surg, 1988; 208(5): 606614.
3.	Hyams DM, Mamounas EP, Petrelli N, et al. A clinical trial to evaluate the worth of preoperative multimodality therapy in patients with operable carcinoma of the rectum: a progress report of National Surgical Breast and Bowel Project Protocol R03 [J]. Dis Colon Rectum, 1997; 40(2): 131139.
4.	Medical Research Council Rectal Cancer Working Party. Randomised trial of surgery alone versus radiotherapy followed by surgery for potentially operable locally advanced rectal cance [J]. Lancet, 1996; 348(9042): 16051610.
5.	Stockholm Colorectal Cancer Study Group. Randomized study on preoperative radiotherapy in rectal carcinoma [J]. Ann Surg Oncol, 1996; 3(5): 423430.
6.	Swedish Rectal Cancer Trial. Improved survival with preoperative radiotherapy in resectable rectal cancer [J]. N Engl J Med, 1997; 336(14): 980987.
7.	Kapiteijn E, Marijnen CA, Nagtegaal ID, et al; Dutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer [J]. N Engl J Med, 2001; 345(9): 638646.
8.	Mohiuddin M, Marks G. High dose preoperative irradiation for cancer of the rectum, 19761988 [J]. Int J Radiat Oncol Biol Phys, 1991; 20(1): 3743.
9.	Janjan NA, Crane CN, Feig BW, et al. Prospective trial of preoperative concomitant boost radiotherapy with continuous infusion 5fluorouracil for locally advanced rectal cancer [J]. Int J Radiat Oncol Biol Phys, 2000; 47(3): 713718.
10.	Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer [J]. N Engl J Med, 2004; 351(17): 17311740.
11.	Bosset JF, Collette L, Calais G, et al. Chemotherapy with preoperative radiotherapy in rectal cancer [J]. N Engl J Med, 2006; 355(11): 11141123.
12.	Gérard JP, Conroy T, Bonnetain F, et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T34 rectal cancers: results of FFCD 9203 [J]. J Clin Oncol, 2006; 24(28): 46204625.
13.	吳文銘, 邱輝忠, 吳斌, 等. 臨床病理指標預測直腸癌新輔助治療療效的初步探討 [J].中華外科雜志, 2010; 48(3): 333337.
14.	Capirci C, Valentini V, Cionini L, et al. Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer: Longterm analysis of 566 ypCR patients [J]. Int J Radiat Oncol Biol Phys, 2008; 72(1): 99107.
15.	Mohiuddin M, Winter K, Mitchell E, et al. Randomized phase Ⅱ study of neoadjuvant combinedmodality chemoradiation for distal rectal cancer: Radiation Therapy Oncology Group Trial 0012 [J]. J Clin Oncol, 2006; 24(4): 650655.
16.	Ryan DP, Niedzwiecki D, Hollis D, et al. Phase Ⅰ/Ⅱ study of preoperative oxaliplatin, fluorouracil, and externalbeam radiation therapy in patients with locally advanced rectal cancer: Cancer and Leukemia Group B 89901 [J]. J Clin Oncol, 2006; 24(16): 25572562.
17.	SebagMontefiore D, Stephens RJ, Steele R, et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCICCTG C016): a multicentre, randomised trial [J]. Lancet, 2009; 373(9666): 811820.
18.	Chau I, Brown G, Cunningham D, et al. Neoadjuvant capecitabine and oxaliplatin followed by synchronous chemoradiation and total mesorectal excision in magnetic resonance imagingdefined poorrisk rectal cancer [J]. J Clin Oncol 2006; 24(4): 668674.
19.	Carlomagno C, Farella A, Bucci L, et al. Neoadjuvant treatment of rectal cancer with capecitabine and oxaliplatin in combination with radiotherapy: a phase Ⅱ study [J]. Ann Oncol, 2009; 20(5): 906912.
20.	Aschele C, Pinto C, Cordio S, et al. Preoperative fluorouracil (FU)based chemoradiation with and without weekly oxaliplatin in locally advanced rectal cancer: Pathologic response analysis of the Studio Terapia Adiuvante Retto (STAR)01 randomized phase Ⅲ trial [J]. J Clin Oncol, 2009; 27: 18s (suppl; abstr CRA4008).
21.	Gerard J, Azria D, GourgouBourgade S, et al. Randomized multicenter phase Ⅲ trial comparing two neoadjuvant chemoradiotherapy (CTRT) regimens (RT45Cap versus RT50Capox) in patients (pts) with locally advanced rectal cancer (LARC): Results of the ACCORD 12/0405 PRODIGE 2 [J]. J Clin Oncol, 2009; 27: 18s (suppl; abstr LBA4007).
22.	Crane CH, Eng C, Feig BW, et al. Phase Ⅱ trial of neoadjuvant bevacizumab, capecitabine, and radiotherapy for locally advanced rectal cancer [J]. Int J Radiat Oncol Biol Phys, 2010; 76(3): 824830.
23.	Allegra CJ, Yothers G, O’Connell MJ, et al. Initial safety report of NSABP C08: a randomized phase Ⅲ study of modified FOLFOX6 with or without bevacizumab for the adjuvant treatment of patients with stage Ⅱ or Ⅲ colon cancer [J]. J Clin Oncol, 2009; 27(2): 33853390.
24.	肖毅, 邱輝忠. 基于NCCN指南的直腸癌外科治療 [J]. 癌癥進展雜志, 2009; 7(3): 229234.
25.	Moreno García V, Cejas P, Blanco Codesido M, et al. Prognostic value of carcinoembryonic antigen level in rectal cancer treated with neoadjuvant chemoradiotherapy [J]. Int J Colorectal Dis, 2009; 24(7): 741748.
26.	GrilloRuggieri F, Mantello G, Berardi R, et al. Mucinous rectal adenocarcinoma can be associated to tumor downstaging after preoperative chemoradiotherapy [J]. Dis Colon Rectum, 2007; 50(10): 15941603.
27.	Kuremsky JG, Tepper JE, McLeod HL. Biomarkers for response to neoadjuvant chemoradiation for rectal cancer [J]. Int J Radiat Oncol Biol Phys, 2009; 74(3): 673688.
28.	HabrGama A, Perez RO, Nadalin W, et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: longterm results [J]. Ann Surg, 2004; 240(4): 711718.
29.	Hiotis SP, Weber SM, Cohen AM, et al. Assessing the predictive value of clinical complete response to neoadjuvant therapy for rectal cancer: an analysis of 488 patients [J]. J Am Coll Surg, 2002; 194(2): 131135.
30.	肖毅, 吳斌, 林國樂, 等. 直腸癌術前放化療后完全緩解病例的處理 [J]. 中國實用外科雜志, 2008; 28(5): 362364.

1. Higgins GA, Humphrey EW, Dwight RW, et al. Preoperative radiation and surgery for cancer of the rectum. Veterans Administration Surgical Oncology Group Trial Ⅱ [J]. Cancer, 1986; 58(2): 352359.
2. Gérard A, Buyse M, Nordlinger B, et al. Preoperative radiotherapy as adjuvant treatment in rectal cancer. Final results of a randomized study of the European Organization for Research and Treatment of Cancer (EORTC) [J]. Ann Surg, 1988; 208(5): 606614.
3. Hyams DM, Mamounas EP, Petrelli N, et al. A clinical trial to evaluate the worth of preoperative multimodality therapy in patients with operable carcinoma of the rectum: a progress report of National Surgical Breast and Bowel Project Protocol R03 [J]. Dis Colon Rectum, 1997; 40(2): 131139.
4. Medical Research Council Rectal Cancer Working Party. Randomised trial of surgery alone versus radiotherapy followed by surgery for potentially operable locally advanced rectal cance [J]. Lancet, 1996; 348(9042): 16051610.
5. Stockholm Colorectal Cancer Study Group. Randomized study on preoperative radiotherapy in rectal carcinoma [J]. Ann Surg Oncol, 1996; 3(5): 423430.
6. Swedish Rectal Cancer Trial. Improved survival with preoperative radiotherapy in resectable rectal cancer [J]. N Engl J Med, 1997; 336(14): 980987.
7. Kapiteijn E, Marijnen CA, Nagtegaal ID, et al; Dutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer [J]. N Engl J Med, 2001; 345(9): 638646.
8. Mohiuddin M, Marks G. High dose preoperative irradiation for cancer of the rectum, 19761988 [J]. Int J Radiat Oncol Biol Phys, 1991; 20(1): 3743.
9. Janjan NA, Crane CN, Feig BW, et al. Prospective trial of preoperative concomitant boost radiotherapy with continuous infusion 5fluorouracil for locally advanced rectal cancer [J]. Int J Radiat Oncol Biol Phys, 2000; 47(3): 713718.
10. Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer [J]. N Engl J Med, 2004; 351(17): 17311740.
11. Bosset JF, Collette L, Calais G, et al. Chemotherapy with preoperative radiotherapy in rectal cancer [J]. N Engl J Med, 2006; 355(11): 11141123.
12. Gérard JP, Conroy T, Bonnetain F, et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T34 rectal cancers: results of FFCD 9203 [J]. J Clin Oncol, 2006; 24(28): 46204625.
13. 吳文銘, 邱輝忠, 吳斌, 等. 臨床病理指標預測直腸癌新輔助治療療效的初步探討 [J].中華外科雜志, 2010; 48(3): 333337.
14. Capirci C, Valentini V, Cionini L, et al. Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer: Longterm analysis of 566 ypCR patients [J]. Int J Radiat Oncol Biol Phys, 2008; 72(1): 99107.
15. Mohiuddin M, Winter K, Mitchell E, et al. Randomized phase Ⅱ study of neoadjuvant combinedmodality chemoradiation for distal rectal cancer: Radiation Therapy Oncology Group Trial 0012 [J]. J Clin Oncol, 2006; 24(4): 650655.
16. Ryan DP, Niedzwiecki D, Hollis D, et al. Phase Ⅰ/Ⅱ study of preoperative oxaliplatin, fluorouracil, and externalbeam radiation therapy in patients with locally advanced rectal cancer: Cancer and Leukemia Group B 89901 [J]. J Clin Oncol, 2006; 24(16): 25572562.
17. SebagMontefiore D, Stephens RJ, Steele R, et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCICCTG C016): a multicentre, randomised trial [J]. Lancet, 2009; 373(9666): 811820.
18. Chau I, Brown G, Cunningham D, et al. Neoadjuvant capecitabine and oxaliplatin followed by synchronous chemoradiation and total mesorectal excision in magnetic resonance imagingdefined poorrisk rectal cancer [J]. J Clin Oncol 2006; 24(4): 668674.
19. Carlomagno C, Farella A, Bucci L, et al. Neoadjuvant treatment of rectal cancer with capecitabine and oxaliplatin in combination with radiotherapy: a phase Ⅱ study [J]. Ann Oncol, 2009; 20(5): 906912.
20. Aschele C, Pinto C, Cordio S, et al. Preoperative fluorouracil (FU)based chemoradiation with and without weekly oxaliplatin in locally advanced rectal cancer: Pathologic response analysis of the Studio Terapia Adiuvante Retto (STAR)01 randomized phase Ⅲ trial [J]. J Clin Oncol, 2009; 27: 18s (suppl; abstr CRA4008).
21. Gerard J, Azria D, GourgouBourgade S, et al. Randomized multicenter phase Ⅲ trial comparing two neoadjuvant chemoradiotherapy (CTRT) regimens (RT45Cap versus RT50Capox) in patients (pts) with locally advanced rectal cancer (LARC): Results of the ACCORD 12/0405 PRODIGE 2 [J]. J Clin Oncol, 2009; 27: 18s (suppl; abstr LBA4007).
22. Crane CH, Eng C, Feig BW, et al. Phase Ⅱ trial of neoadjuvant bevacizumab, capecitabine, and radiotherapy for locally advanced rectal cancer [J]. Int J Radiat Oncol Biol Phys, 2010; 76(3): 824830.
23. Allegra CJ, Yothers G, O’Connell MJ, et al. Initial safety report of NSABP C08: a randomized phase Ⅲ study of modified FOLFOX6 with or without bevacizumab for the adjuvant treatment of patients with stage Ⅱ or Ⅲ colon cancer [J]. J Clin Oncol, 2009; 27(2): 33853390.
24. 肖毅, 邱輝忠. 基于NCCN指南的直腸癌外科治療 [J]. 癌癥進展雜志, 2009; 7(3): 229234.
25. Moreno García V, Cejas P, Blanco Codesido M, et al. Prognostic value of carcinoembryonic antigen level in rectal cancer treated with neoadjuvant chemoradiotherapy [J]. Int J Colorectal Dis, 2009; 24(7): 741748.
26. GrilloRuggieri F, Mantello G, Berardi R, et al. Mucinous rectal adenocarcinoma can be associated to tumor downstaging after preoperative chemoradiotherapy [J]. Dis Colon Rectum, 2007; 50(10): 15941603.
27. Kuremsky JG, Tepper JE, McLeod HL. Biomarkers for response to neoadjuvant chemoradiation for rectal cancer [J]. Int J Radiat Oncol Biol Phys, 2009; 74(3): 673688.
28. HabrGama A, Perez RO, Nadalin W, et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: longterm results [J]. Ann Surg, 2004; 240(4): 711718.
29. Hiotis SP, Weber SM, Cohen AM, et al. Assessing the predictive value of clinical complete response to neoadjuvant therapy for rectal cancer: an analysis of 488 patients [J]. J Am Coll Surg, 2002; 194(2): 131135.
30. 肖毅, 吳斌, 林國樂, 等. 直腸癌術前放化療后完全緩解病例的處理 [J]. 中國實用外科雜志, 2008; 28(5): 362364.

《中國普外基礎與臨床雜志》

直腸癌新輔助治療

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

《中國普外基礎與臨床雜志》

直腸癌新輔助治療

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料