基于循证医学依据的结肠癌辅助化疗

The evidence-based adjuvant chemotherapy for colon cancer

目前,氟尿嘧啶仍是结肠癌辅助化疗的基本药物,含5-FU/LV/奥沙利铂(FOLFOX或FLOX)的方案是结肠癌辅助化疗的新标准,对部分患者也可以考虑选用5-FU/LV(Mayo,Roswell Park,LV5 FU2)、卡培他滨等单药辅助化疗;目前没有证据表明辅助化疗中使用伊立替康能带来额外的获益,反而会增加化疗毒性的风险,因此,不建议在结肠癌辅助化疗中使用含伊立替康的方案。Ⅲ期结肠癌是辅助化疗的主要适应证,而"高危Ⅱ期"结肠癌也应该在患者充分知情后给予辅助化疗,高危因素包括T4肿瘤、伴有肠梗阻、穿孔、肿瘤分化差、伴有神经脉管浸润以及切除或送检淋巴结<12枚。其他的Ⅱ期结肠癌不应该常规行辅助化疗。只要身体状况允许,年龄不应该是选择辅助化疗的禁忌;结肠癌辅助化疗建议在术后8周内开始,目前的标准疗程是为期6个月。

Fluoropyrimidines are still the basic agents for adjuvant chemotherapy of colon cancer, a regimen containing 5-FU/LV/oxaliplatin （FOLFOX or FLOX） is the new standard for adjuvant settings, and FU/LV alone （Mayo, Roswell Park or LV5FU2） or single agent of capecitabine should be a choice of treatment for some particular patients; irinotecan should not be used for the adjuvant setting of colon cancer, because currently there is no evidence to show additional survival benefit with addition of irinotecan to the adjuvant treatment, but increased risk of chemotherapyrelated toxicity. Stage Ⅲ colon cancer is the main and definite indication for adjuvant chemotherapy, while adjuvant chemotherapy should not be routinely considered for stage Ⅱ colon cancer, except those with high risk factors including T4 tumor, obstruction, perforation, poor differentiation, invasion to nerve or vessels, and less than 12 examined lymph nodes. The age should not exclude the adjuvant chemotherapy if there is an adequate performance status. Adjuvant chemotherapy should be started within 8 weeks after surgery, and the current optimal duration for adjuvant chemotherapy of colon cancer should be six months.