奥沙利铂在局部进展期直肠癌术前同步放化疗中的应用进展

The Progress of Oxaliplatin Application in Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer

目前基于氟尿嘧啶及卡培他滨的术前同步放化疗是局部进展期直肠癌的标准治疗模式,但仍有较高的远处转移率,为进一步提高疗效,探索新的化疗药物越来越受到学界的重视。其中奥沙利铂因其在辅助化疗及姑息治疗中的效果卓越,受到越来越多学者的关注,并因此开展了一系列Ⅰ~Ⅲ期临床研究。绝大多数Ⅰ/Ⅱ期临床研究表明奥沙利铂具有很好的应用前景,不仅达到良好病理完全缓解（p CR）率及肿瘤降期率,且不良反应可耐受。但是,在Ⅲ期临床研究中,STAR-01、ACCORD-12、NSABP-R04、PETACC-6均为阴性结果,仅CAO/ARO/AIO-04是阳性结果 ,显示奥沙利铂组能够获得显著的总生存期（DFS）获益,故奥沙利铂能否应用于局部进展期直肠癌术前放化疗存在明显的争议。因此根据目前研究结果,在直肠癌术前新辅助放化疗中,仍然不推荐在5-Fu/卡培他滨基础上常规使用奥沙利铂。全文对奥沙利铂在局部进展期直肠癌术前同步放化疗中的应用进行了总结,希望为进一步的临床研究提供依据。

Nowadays,fluorouracil and capecitabine based-on preoperative chemoradiotherapy is the standard modality to treat locally advanced rectal cancer,but the distant metastasis rate is still high. To further improve the curative effect,the exploration of chemotherapy drugs has received increasing attention from academic circles. Among these drugs,oxaliplatin received more attention because of its excellent effects in adjunctive chemotherapy and palliative treatment. Thus a series of phase Ⅰ-Ⅲ clinical studies have been carried out. Vast majority of phase Ⅰ/Ⅱ clinical studies showed a very good application prospect of oxaliplatin,which provided not only good pathological complete response and tumor downstaging rate,but also tolerable adverse reactions. However,in phase Ⅲ clinical studies,STAR-01,ACCORD-12,NSABP R-04 and PETACC-6 were all negative results,only CAO/ARO/AIO-04 was positive result. Therefore,it is still controversial whether or not oxaliplatin can be applied in preoperative chemoradiotherapy for locally advanced rectal cancer. Nevertheless,some experiments are still continuing,it needs to wait for final results to give a further answer. Consequently the author summarized the progress of oxaliplatin application in preoperative chemoradiotherapy for locally advanced rectal cancer,expecting to provide some evidences for clinical studies. However,according to the current study results,it is still not recommended to routinely use oxaliplatin on the base of 5-Fu/capecitabine in preoperative neoadjuvantchemoradiotherapy for locally advanced rectal cancer.