直肠癌的新辅助治疗

doi:10.11904/j.issn.1002-3070.2016.05.014

摘要/Abstract

摘要： 近年来,直肠癌发病率逐年上升,随着新辅助治疗的提出与应用,直肠癌的疗效得到提升,引起国内外学者的关注。新辅助治疗包括术前放疗、术前化疗和术前同步放化疗。其中术前放疗方式可分为短程放疗和常规放疗,通过比较T降期率、保肛率、完全缓解率等指标,对两种方式的临床效果进行了评价。尽管单纯术前化疗的经验还不够丰富,但其仍在降低肿瘤分期等方面具有优势。目前,临床应用最多的为术前同步放化疗,且国内外学者均认为该方式在治疗直肠癌时具有明显优势,同时,三维放疗技术可使靶区分布更为均匀,对病灶治疗更为精准。但直肠癌的新辅助治疗在国内却尚未广泛应用于临床,对其临床效果的确定仍需进一步的理论支持,本文就直肠癌的新辅助治疗做一综述。

关键词: 直肠癌, 新辅助治疗, 三维放疗技术

Abstract: The incidence of rectal cancer has been increasing in recent years.It leads to more attention of scholars at home and abroad,which the efficacy of rectal cancer has been improved by using neoadjuvant therapy all over the world.It is included preoperative radiotherapy,preoperative chemotherapy and preoperative chemoradiotherapy.Preoperative radiotherapy,which can be divided into short radiotherapy and conventional radiotherapy,are evaluated by comparison of T drop rate,sphincter preservation rate,complete remission rate and other indicators of clinical effect.Although the experience of pure preoperative chemotherapy is not rich enough,it still has an advantage in lowering the tumour stage and other aspects.Currently,preoperative chemoradiotherapy is a good choice for rectal cancer,because it could make an obvious advantage in the treatment,at the same time,three-dimensional radiotherapy can make target more evenly distributed and focus treatment more precise.However,neoadjuvant therapy has insufficient support in clinical in our country.So it needs to get more information for clinical effectiveness of applying preoperative chemoradiotherapy.This study is to summarize the new adjuvant treatment of rectal cancer.

Key words: Rectal cancer, Neoadjuvant therapy, Three-dimensional radiotherapy

中图分类号:

R730.55

杨梅健, 宝莹娜综述, 赵建国审校. 直肠癌的新辅助治疗[J]. 实用肿瘤学杂志, 2016, 30(5): 453-457.

YANG Meijian, BAO Yingna, ZHAO Jianguo. Advances in neoadjuvant therapy of rectal cancer[J]. PRACTICAL ONCOLOGY JOURNAL, 2016, 30(5): 453-457.

参考文献

1 Rutter CM,Johnson EA,Feuer EJ,et al.Seculat trends in colon and rectal cancer relative survival[J].Natl Cancer Inst,2013,105(23):1806-1813.
2 van Giin W,Marijinen CA,Naqteqaal ID,et al.Preoperative radiotherapy combined with total mesorectal excision for respectable rectal cancer:12-year follow-up of the multicentre,randomised controlled TME trial[J].Lancet Oncol,2011,12(6):575-582.
3 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.
4 Latkauskas T,Pauzas H,Gineikiene I,et al.Initial results of a randomized controlled trial comparing clinical and pathological downstaging of rectal cancer after preoperative short-course radiotherapy or long-term chemoradiotherapy,both with delayed surgery[J].Colorectal Disease,2012,14(3):294-298.
5 Eitta MA,EI-Wahidi GF,Fouda MA,et al.Preoperative radiotherapy in resectable rectal cancer:a prospective randomized study of two different approaches[J].Jegypt Nati Canc Inst,2010,22(3):155-164.
6 Francois Y,Nemoz CJ,Baulieux J,et al.Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer:the Lyon R90-01 randomized trial[J].Clin Oncol,1999,17(8):2396-2396.
7 Marincaae AM,Prunoiu VM,Br?tucu E,et al.Clinical and paraclinical criteria of patient selection for the non-operative treatment in completely responsive rectal cancer(after neoadjuvant radiochemotherapy)[J].Chirurgia,2015,110(4):351-355.
8 Crane CH,Skibber JM,Feig BW,et al.Response to preoperative chemoradiation increases the use of sphincter-preserving surgery in patients with locally advanced low rectal carcinoma[J].Cancer,2003,97(2):517-524.
9 Sanghera P,Wong DW,Mcconkey CC,et al.Chemoradiotherapy for rectal cancer:an updated analysis of factors affecting pathological reponse[J].Clin Oncol,2008,20(2):176-183.
10 Camma C,Giunta M,Fiorica F,et al.Preoperative radiotherapy for resectable rectal cancer:a meta-analysis[J].JAMA,2000,284(8):23-30.
11 Klenova A,Parvanova V,Georqiev R,et al.Preoperative radiotherapy in rectal cancer:treatment results of three different dose regimens[J].Buon,2006,11(2):161-166.
12 Mohiuddin M,Winter K,Mitchel E,et al.Randomized phase Ⅱ study of neoadjuvant combined modality chemoradiation for distal rectal cancer:radiation therapy oncology group trial 0012 [J].Clin Oncol,2006,24(4):650-655.
13 庞晓冰,温尊北,于进,等.术前三维适形放疗并卡培他滨治疗局部晚期直肠癌的临床研究[J].中国伤残医学,2014,22(2):7-8.
14 Brooks CJ,Lee YK,Aitken K,et al.Organ-sparing intensity-modulated radiotherapy for anal cancer using the ACTII schedule:a comparison of conventional and intensity-modulated radiotherapy plans[J].Clinical Oncology,2013,25(3):155-161.
15 Ishii Y,Hasegawa H,Endo T,et al.Medium-term results of neoadjuvant systemic chemotherapy using irinotecan,5-fluorouracil,and leucovorin in patients with locally advanced rectal cancer[J].Eur J Surg Oncol,2010,36(11):1061-1065.
16 Tveit KM,Bruheim K,Glimelius B,et al.Late patient-reported toxicity after preoperative radiotherapy or chemoradiotherapy in nonresectable rectal cancer:results from a randomized Phase Ⅲ study[J].Int J Randiat Oncol Biol Phys,2011,81(4):1017-1024.
17 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.
18 Ceelen W,Fierens K,Van-Nieuwenhove Y,et al.Preoperative chemoradiation versus radiation alone for stage Ⅱ and Ⅲ resectable rectal cancer:a systematic review and meta-analysis[J].Int J Cancer,2009,124(12):2966-2972.
19 董新华,张谢夫,杨振,等.术前同步放化疗联合TME治疗Ⅱ/Ⅲ期直肠癌的临床疗效[J].世界华人消化杂志,2013,21(29):3163-3167.
20 刘艳梅,应申鹏,于进,等.术前联合希罗达同步放化疗治疗中低位直肠癌近期疗效观察[J].温州医学院学报,2013,43(10):647-677.
21 Bosset JF,Calais G,Mineur L,et al.Fluorouracil-based adjuvant chemotherapy after preoperative chemoradiotherapy in rectal cancer:long-term results of the EORTC 22921 randomised study[J].Lancet Oncol 2014,15(2):184-190.
22 朱卫国,尤振兵,韩济华,等.术前三维适形放射治疗并希罗达治疗局部晚期直肠癌的疗效[J].实用医学杂志,2009,25(6):967-969.
23 钱璐,陈程.新辅助化疗在中晚期低位直肠癌直肠系膜切除术中的应用[J].河北医学,2011,17(1):95-97.
24 Shin SJ,Kim NK,Keum KC,et al.Phase Ⅱ study of preoperative chemoradiotherapy(CRT)with irinotecan plus S-1 in locally advanced rectal cancer[J].Radiother Oncol,2010,95(3):303-307.
25 Sadahiro S,Suzuki T,Tanaka A,et al.PhaseⅠ/Ⅱ study of preperative concurrent chemoradiotherapy with S-1 for locally advanced,resectablae rectal adenocarcinoma[J].Oncology,2011,81(5/6):306-311.
26 Tevis SE,Kohlnhofer BM,Stringfield S,et al.Postoperative complications in patients with rectal cancer are associated with delays in chemotherapy that lead to worse disease-free and overall survival[J].Colon Rectum,2013,56(12):1339-1348.
27 王明.替吉奥联合三维适形调强技术术前同步放化疗治疗直肠癌的临床观察[D].石家庄:河北医科大学,2015.
28 贾彦召,余杰,饶石磊.宫颈癌三维适形放疗与二维放疗计划的比较分析[J].中国实用医药,2015,26(5):61-62.
29 叶序卷,高远红,陈利,等.直肠癌术前五野静态调强和容积弧形调强放疗剂量学的比较研究[J].临床肿瘤学杂志,2012,17(8):717-720.
30 刘跃平,赵红莉,戴建荣,等.直肠癌手术后三野适形放射治疗和三射野调强放射治疗的剂量学比较[J].中国肿瘤临床与康复,2013,20(6):545-548.
31 任烨.术前同步放化疗是直肠癌标准治疗模式[J].实用肿瘤杂志,2013,28(1):20-23.

[1]	梁帅兵, 于震, 唐丹, 赵泽亮. 低位结扎肠系膜下动脉在非Ⅰ型乙状结肠系膜腹腔镜Dixon术中的临床意义[J]. 实用肿瘤学杂志, 2019, 33(2): 155-159.
[2]	方琳, 刘超, 张纯慧, 张艳桥. 转移性结直肠癌维持治疗的研究现状与治疗策略[J]. 实用肿瘤学杂志, 2019, 33(2): 173-178.
[3]	佟广海, 田洋, 吴华星. 脂质组学在结直肠癌研究中的应用[J]. 实用肿瘤学杂志, 2019, 33(2): 179-192.
[4]	刘恒辰, 张新宇. Toll样受体信号通路作为结直肠癌潜在治疗靶点的研究进展[J]. 实用肿瘤学杂志, 2019, 33(2): 188-192.
[5]	肖洪伟, 陈升, 王艳良, 苏学良. 距肛缘≤8 cm的T₁期直肠癌患者经肛门局部切除术的预后及影响因素分析[J]. 实用肿瘤学杂志, 2018, 32(6): 545-549.
[6]	王鹏, 周海涛, 梁建伟, 周志祥. 肠系膜纤维瘤病误诊为早期直肠癌根治术后复发1例报道及文献复习[J]. 实用肿瘤学杂志, 2018, 32(5): 442-444.
[7]	刘宏涛, 张彤彤综述, 刘雁军审校. 肥胖与结直肠癌发病机制的研究进展[J]. 实用肿瘤学杂志, 2018, 32(5): 464-467.
[8]	王志, 刘忠卫, 曾雪芸, 隋明洁, 廖静怡, 李月欢, 黄卫东, 刘国祥. 基于EQ-5D-5L的结直肠癌癌前病变患者健康相关生命质量研究[J]. 实用肿瘤学杂志, 2018, 32(4): 320-326.
[9]	陈祥, 周剑良, 王彬冰, 李浦, 单国平. 直肠癌术后固定剂量率容积调强放射治疗的初步研究[J]. 实用肿瘤学杂志, 2018, 32(4): 327-332.
[10]	崔雪阳, 邢承忠. 液体活检在结直肠癌领域的研究及应用现状[J]. 实用肿瘤学杂志, 2018, 32(4): 367-370.
[11]	李文琪, 耿敬姝. RAS/RAF突变与MSI状态在结直肠癌治疗中的研究进展[J]. 实用肿瘤学杂志, 2018, 32(4): 371-376.
[12]	张姗姗, 吴华星审校. 代谢组学在结直肠癌诊断中的应用[J]. 实用肿瘤学杂志, 2017, 31(6): 573-576.
[13]	孙丽娜, 赵晓迪综述, 卢瑗瑗, 王新审校. LncRNA与胃肠道肿瘤化疗耐药的研究进展[J]. 实用肿瘤学杂志, 2017, 31(5): 448-453.
[14]	王东亮,戚宁,牟冠男,张月桂. 结直肠癌肿瘤微环境中调节性T细胞CD39、CD73亚群及二者双阳性亚群的临床意义[J]. 实用肿瘤学杂志, 2017, 31(4): 329-334.
[15]	郝小军，王传卓，赵相轩，辛鹤，刘兆玉. miR-34a对结肠癌细胞SW480增殖、迁移和侵袭能力的影响及机制探讨[J]. 实用肿瘤学杂志, 2017, 31(3): 193-198.