4

结肠癌治疗选择概述

表6. 0-III期结肠癌标准治疗方案
表6. 0-III期结肠癌标准治疗方案
分期(TNM分期)​ 标准治疗方案
0期结肠癌 手术​
I期结肠癌 手术​
II期结肠癌 手术​
III期结肠癌 手术​
辅助化疗​

表7. IV期与复发性结肠癌的治疗方案
表7. IV期与复发性结肠癌的治疗方案
分期(TNM分期) 治疗方案
肝转移治疗 手术​
新辅助化疗​
局部消融​
辅助化疗​
动脉内化疗​
 IV期与复发性结肠癌治疗 手术​
化疗与靶向治疗​
二线化疗

主要外科治疗

局限性结肠癌的标准治疗一直以来都是开腹手术切除原发病灶与区域淋巴结。

两项研究评估了腹腔镜[1][2][3][4]在结肠癌治疗中的价值。

证据(腹腔镜手术):

对于精心选择的可切除结肠癌肝转移和肺转移患者,手术治愈率可达25%至40%。外科技术的发展和术前影像学的进步帮助医生可以更准确地选择手术病人。

辅助化疗

对于II期结肠癌患者,辅助化疗的潜在价值尚存争议。汇总分析和荟萃分析显示,在采取以氟尿嘧啶(5-FU)为基础的化疗组与观察组的比较中,化疗组患者OS提高2%-4%[8][9][10]。(更多信息请见本节: II期结肠癌的治疗。)

2000年以前,对于III期结肠癌患者,5-FU是唯一有效的细胞毒性辅助化疗药物。2000年之后,卡培他滨逐渐成为5-FU和亚叶酸的等效替代药物。同时,相比5-FU联合亚叶酸方案,5-FU、亚叶酸联合奥沙利铂方案改善了患者的OS。(更多信息请见本节: III期结肠癌的治疗。)

辅助放疗

化疗联合放疗对治疗直肠癌(腹膜反折以下)有非常重要的意义,而辅助放疗在结肠癌( 腹膜反折以上)治疗中的作用尚未确定。治疗模式分析和单中心回顾性研究指出,放疗对于某些高风险结肠癌患者(例如T4肿瘤、肿瘤位于非移动部位、局部穿孔、梗阻和术后残余病灶)有一定作用[11][12][13][14][15][16]

证据(辅助放疗):

对于根治术后的结肠癌患者,目前标准治疗方案并不包括辅助放疗,尽管辅助放疗可能对病灶残留的患者有效。

参考文献

1. Bokey EL, Moore JW, Chapuis PH, et al.: Morbidity and mortality following laparoscopic-assisted right hemicolectomy for cancer. Dis Colon Rectum 39 (10 Suppl): S24-8, 1996.[PUBMED Abstract]

2. Franklin ME Jr, Rosenthal D, Abrego-Medina D, et al.: Prospective comparison of open vs. laparoscopic colon surgery for carcinoma. Five-year results. Dis Colon Rectum 39 (10 Suppl): S35-46, 1996.[PUBMED Abstract]

3. Fleshman JW, Nelson H, Peters WR, et al.: Early results of laparoscopic surgery for colorectal cancer. Retrospective analysis of 372 patients treated by Clinical Outcomes of Surgical Therapy (COST) Study Group. Dis Colon Rectum 39 (10 Suppl): S53-8, 1996.[PUBMED Abstract]

4. Schwenk W, Böhm B, Müller JM: Postoperative pain and fatigue after laparoscopic or conventional colorectal resections. A prospective randomized trial. Surg Endosc 12 (9): 1131-6, 1998.[PUBMED Abstract]

5. Clinical Outcomes of Surgical Therapy Study Group.: A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350 (20): 2050-9, 2004. [PUBMED Abstract]

6. Weeks JC, Nelson H, Gelber S, et al.: Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 287 (3): 321-8, 2002.[PUBMED Abstract]

7. Lacy AM, García-Valdecasas JC, Delgado S, et al.: Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359 (9325): 2224-9, 2002. [PUBMED Abstract]

8. Efficacy of adjuvant fluorouracil and folinic acid in B2 colon cancer. International Multicentre Pooled Analysis of B2 Colon Cancer Trials (IMPACT B2) Investigators. J Clin Oncol 17 (5): 1356-63, 1999. [PUBMED Abstract]

9. Gill S, Loprinzi CL, Sargent DJ, et al.: Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much? J Clin Oncol 22 (10): 1797-806, 2004.[PUBMED Abstract]

10. Mamounas E, Wieand S, Wolmark N, et al.: Comparative efficacy of adjuvant chemotherapy in patients with Dukes' B versus Dukes' C colon cancer: results from four National Surgical Adjuvant Breast and Bowel Project adjuvant studies (C-01, C-02, C-03, and C-04) J Clin Oncol 17 (5): 1349-55, 1999.[PUBMED Abstract]

11. Willett C, Tepper JE, Cohen A, et al.: Local failure following curative resection of colonic adenocarcinoma. Int J Radiat Oncol Biol Phys 10 (5): 645-51, 1984.[PUBMED Abstract]

12. Willett C, Tepper JE, Cohen A, et al.: Obstructive and perforative colonic carcinoma: patterns of failure. J Clin Oncol 3 (3): 379-84, 1985. [PUBMED Abstract]

13. Gunderson LL, Sosin H, Levitt S: Extrapelvic colon--areas of failure in a reoperation series: implications for adjuvant therapy. Int J Radiat Oncol Biol Phys 11 (4): 731-41, 1985.[PUBMED Abstract]

14. Willett CG, Fung CY, Kaufman DS, et al.: Postoperative radiation therapy for high-risk colon carcinoma. J Clin Oncol 11 (6): 1112-7, 1993. [PUBMED Abstract]

15. Willett CG, Goldberg S, Shellito PC, et al.: Does postoperative irradiation play a role in the adjuvant therapy of stage T4 colon cancer? Cancer J Sci Am 5 (4): 242-7, 1999 Jul-Aug.[PUBMED Abstract]

16. Schild SE, Gunderson LL, Haddock MG, et al.: The treatment of locally advanced colon cancer. Int J Radiat Oncol Biol Phys 37 (1): 51-8, 1997. [PUBMED Abstract]

17. Martenson JA Jr, Willett CG, Sargent DJ, et al.: Phase III study of adjuvant chemotherapy and radiation therapy compared with chemotherapy alone in the surgical adjuvant treatment of colon cancer: results of intergroup protocol 0130. J Clin Oncol 22 (16): 3277-83, 2004.[PUBMED Abstract]

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