8

III期结肠癌的治疗

III期结肠癌表示已有淋巴结受累。相关研究显示,受累淋巴结数量影响预后;1-3枚淋巴结受累患者的生存期优于4枚或更多淋巴结受累的患者。

III期结肠癌的标准治疗选择

III期结肠癌的标准治疗选择包括:

手术

III期结肠癌的手术治疗为广泛外科切除联合肠吻合术。

证据(腹腔镜手术):

两组3年复发率和3年总生存率均相似。(更多信息请参见:治疗方案概述章节中的主要外科治疗 。)

该项研究的生活质量部分另行发表,结果显示LAC术后有很小的短期生活质量获益[6]。[证据等级:1iiC ]

辅助化疗

本章节将介绍下列化疗联合用药方案:

FOLFOX4方案(奥沙利铂、亚叶酸联合氟尿嘧啶[5-FU]):第1天行奥沙利铂(85mg/m2)输液,时间2小时。第1天与第2天行亚叶酸(200mg/m2)输液,时间各2小时。输液后静脉推注负荷剂量5-FU(400mg/m2),随后第1天和第2天泵入5-FU(600mg/m2),时间各22小时。每两周重复上述化疗方案。

左旋咪唑方案(5-FU联合左旋咪唑):第1-5天静脉推注5-FU(每天450mg/ m2),此后每周给药一次。28天后加用左旋咪唑(50mg)口服每天3次,每2周3天。

梅奥诊所或美国北部癌症治疗中心协作组织(NCCTG)方案(5FU联合低剂量左旋咪唑):静脉推注5-FU(450mg/ m2)与亚叶酸(20mg/ m2),每天1次,每28天给药5天。

Roswell-Park方案或美国乳腺与肠道外科辅助治疗研究组(NSABP)方案(5-FU联合高剂量左旋咪唑):静脉推注5-FU(500mg/ m2)与亚叶酸(500mg/ m2),每周1次,每8周连续给药6周。

在2000年前,5-FU是唯一对III期结肠癌患者有效的细胞毒性化疗药物。许多早期随机临床试验显示含5-FU的辅助化疗并不改善患者生存[6][7][8][9]。这些临床研究仅使用5-FU或5-FU-司莫司汀(甲基环己亚硝脲,即甲基-CCNU)作为化疗药物。

证据(单独使用5-FU或5-FU-司莫司汀):

卡培他滨

卡培他滨是一种口服氟嘧啶药物,在体内经过3步酶转化反应产生5-FU,最后一步发生在肿瘤细胞中。对于转移性结肠癌患者,两项临床研究显示了卡培他滨和5-FU-亚叶酸的等效性[22][23]

III期结肠癌患者接受卡培他滨辅助化疗的效果等同于静脉推注5-FU和亚叶酸。

证据(卡培他滨):

奥沙利铂

奥沙利铂联用5-FU-亚叶酸方案对转移性结直肠癌患者有显著疗效。

证据(奥沙利铂):

FOLFOX方案现已成为新一代III期结肠癌临床试验的标准参考方案[26]

处于临床评估阶段的治疗方案

相比各种术后辅助化疗方案,应鼓励符合条件的患者参加设计良好的临床研究[27]

目前开展的临床试验

现招募 III期结肠癌​患者的美国临床试验请参见美国NCI癌症临床试验列表,可根据部位、药物、干预或其他标准进行筛选。

NCI网站也提供关于临床试验的基本信息。

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. 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]

6. Panettiere FJ, Goodman PJ, Costanzi JJ, et al.: Adjuvant therapy in large bowel adenocarcinoma: long-term results of a Southwest Oncology Group Study. J Clin Oncol 6 (6): 947-54, 1988.[PUBMED Abstract]

7. Adjuvant therapy of colon cancer--results of a prospectively randomized trial. Gastrointestinal Tumor Study Group. N Engl J Med 310 (12): 737-43, 1984.[PUBMED Abstract]

8. Higgins GA Jr, Amadeo JH, McElhinney J, et al.: Efficacy of prolonged intermittent therapy with combined 5-fluorouracil and methyl-CCNU following resection for carcinoma of the large bowel. A Veterans Administration Surgical Oncology Group report. Cancer 53 (1): 1-8, 1984.[PUBMED Abstract]

9. Buyse M, Zeleniuch-Jacquotte A, Chalmers TC: Adjuvant therapy of colorectal cancer. Why we still don't know. JAMA 259 (24): 3571-8, 1988. [PUBMED Abstract]

10. Laurie JA, Moertel CG, Fleming TR, et al.: Surgical adjuvant therapy of large-bowel carcinoma: an evaluation of levamisole and the combination of levamisole and fluorouracil. The North Central Cancer Treatment Group and the Mayo Clinic. J Clin Oncol 7 (10): 1447-56, 1989.[PUBMED Abstract]

11. Moertel CG, Fleming TR, Macdonald JS, et al.: Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. N Engl J Med 322 (6): 352-8, 1990.[PUBMED Abstract]

12. Wolmark N, Rockette H, Fisher B, et al.: The benefit of leucovorin-modulated fluorouracil as postoperative adjuvant therapy for primary colon cancer: results from National Surgical Adjuvant Breast and Bowel Project protocol C-03. J Clin Oncol 11 (10): 1879-87, 1993. [PUBMED Abstract]

13. Efficacy of adjuvant fluorouracil and folinic acid in colon cancer. International Multicentre Pooled Analysis of Colon Cancer Trials (IMPACT) investigators. Lancet 345 (8955): 939-44, 1995.[PUBMED Abstract]

14. O'Connell M, Mailliard J, Macdonald J, et al.: An intergroup trial of intensive course 5FU and low dose leucovorin as surgical adjuvant therapy for high risk colon cancer. [Abstract] Proceedings of the American Society of Clinical Oncology 12: A-552, 190, 1993.

15. Haller DG, Catalano PJ, Macdonald JS, et al.: Phase III study of fluorouracil, leucovorin, and levamisole in high-risk stage II and III colon cancer: final report of Intergroup 0089. J Clin Oncol 23 (34): 8671-8, 2005.[PUBMED Abstract]

16. Wolmark N, Bryant J, Smith R, et al.: Adjuvant 5-fluorouracil and leucovorin with or without interferon alfa-2a in colon carcinoma: National Surgical Adjuvant Breast and Bowel Project protocol C-05. J Natl Cancer Inst 90 (23): 1810-6, 1998.[PUBMED Abstract]

17. Wolmark N, Rockette H, Mamounas E, et al.: Clinical trial to assess the relative efficacy of fluorouracil and leucovorin, fluorouracil and levamisole, and fluorouracil, leucovorin, and levamisole in patients with Dukes' B and C carcinoma of the colon: results from National Surgical Adjuvant Breast and Bowel Project C-04. J Clin Oncol 17 (11): 3553-9, 1999.[PUBMED Abstract]

18. Okuno SH, Woodhouse CL, Loprinzi CL, et al.: Phase III placebo-controlled clinical trial evaluation of glutamine for decreasing mucositis in patients receiving 5FU (fluorouracil)-base chemotherapy. [Abstract] Proceedings of the American Society of Clinical Oncology 17: A-256, 1998.

19. Andre T, Colin P, Louvet C, et al.: Semimonthly versus monthly regimen of fluorouracil and leucovorin administered for 24 or 36 weeks as adjuvant therapy in stage II and III colon cancer: results of a randomized trial. J Clin Oncol 21 (15): 2896-903, 2003.[PUBMED Abstract]

20. Comparison of flourouracil with additional levamisole, higher-dose folinic acid, or both, as adjuvant chemotherapy for colorectal cancer: a randomised trial. QUASAR Collaborative Group. Lancet 355 (9215): 1588-96, 2000. [PUBMED Abstract]

21. Sargent DJ, Goldberg RM, Jacobson SD, et al.: A pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients. N Engl J Med 345 (15): 1091-7, 2001.[PUBMED Abstract]

22. Van Cutsem E, Twelves C, Cassidy J, et al.: Oral capecitabine compared with intravenous fluorouracil plus leucovorin in patients with metastatic colorectal cancer: results of a large phase III study. J Clin Oncol 19 (21): 4097-106, 2001.[PUBMED Abstract]

23. Hoff PM, Ansari R, Batist G, et al.: Comparison of oral capecitabine versus intravenous fluorouracil plus leucovorin as first-line treatment in 605 patients with metastatic colorectal cancer: results of a randomized phase III study. J Clin Oncol 19 (8): 2282-92, 2001. [PUBMED Abstract]

24. Twelves C, Wong A, Nowacki MP, et al.: Capecitabine as adjuvant treatment for stage III colon cancer. N Engl J Med 352 (26): 2696-704, 2005.[PUBMED Abstract]

25. André T, Boni C, Mounedji-Boudiaf L, et al.: Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med 350 (23): 2343-51, 2004. [PUBMED Abstract]

26. André T, Boni C, Navarro M, et al.: Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial. J Clin Oncol 27 (19): 3109-16, 2009.[PUBMED Abstract]

27. Rougier P, Nordlinger B: Large scale trial for adjuvant treatment in high risk resected colorectal cancers. Rationale to test the combination of loco-regional and systemic chemotherapy and to compare l-leucovorin + 5-FU to levamisole + 5-FU. Ann Oncol 4 (Suppl 2): 21-8, 1993. [PUBMED Abstract]

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