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Новые возможности в лечении рака прямой кишки
Новые возможности в лечении рака прямой кишки
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Аннотация
В статье рассматриваются вопросы оптимизации лечебной стратегии в отношении местнораспространенного рака прямой кишки. В результате проведенных ранее многочисленных исследований тримодальный подход, состоящий из предоперационной химиолучевой терапии с 5-фторурацилом, последующей операции и адъювантной химиотерапии (также с 5-фторурацилом), стал стандартом лечения этой формы заболевания. Представленные на ASCO 2011 данные крупных рандомизированных исследований по сравнению капецитабина и 5-фторурацила в периоперационной химиолучевой терапии рака прямой кишки убедительно доказали, что применение капецитабина ассоциируется с улучшением клинических исходов. Таким образом, капецитабин может эффективно и безопасно заменить 5-фторурацил в программах химиолучевой терапии. Дополнительное использование оксалиплатина требует дальнейшего изучения и в настоящее время рутинно не рекомендовано.
Ключевые слова: рак прямой кишки, химиолучевая терапия, капецитабин (Кселода), оксалиплатин.
Key words: locally advanced rectal cancer, chemoradiotherapy, capecitabine, oxaliplatin.
Ключевые слова: рак прямой кишки, химиолучевая терапия, капецитабин (Кселода), оксалиплатин.
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Key words: locally advanced rectal cancer, chemoradiotherapy, capecitabine, oxaliplatin.
Полный текст
Список литературы
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25. Kalofonos HP, Pentheroudakis G, Rigatos S et al. A randomased phase III trial of adjuvant radio-chemotherapy comparing irinotecan (CPT-11), 5-FU and leucovorin to 5-FU and leucovorin in patients with rectal cancer. Ann Oncol 2006; 17 (Suppl. 9). Abstr. 3320 (P. 116).
26. Roh MS. The impact of capecitabine and oxaliplatin in the preoperative multimodality treatment in patients with carcinoma of the rectum: NSABP R-04. J Clin Oncol 2011; V29 (I 18S, Part I): P221S (abstr. 3503).
27. Roedel C. Preoperative chemoradiotherapy and postoperative chemotherapy with 5-fluorouracil and oxaliplatin versus 5-fluorouracil alone in locally advanced rectal cancer: First results of the German CAO/ARO/AIO-04 randomized phase III trial. Proc ASCO 2011. J Clin Oncol 2011; V29 (I 18S, Part I I): P780S (abstr. LBA 3505).
28. Hofheinz R. Capecitabine (Cape) versus 5-fluorouracil (5-FU)-based (neo)adjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC): Long-term results of randomized, phase III trial. J Clin Oncol 2011; V29 (I 18S, Part I): P222S (abstr. 3504).
29. Bonnetain F. An analysis of preoperative chemoradiotherapy with 5-FU/leucovorin for T3-4 rectal cancer on survival in a pooled analysis of EORTC 22921 and FFCD 9203 trial: Surrogacy in question? J Clin Oncol 2011; V 29 (I 18S, Part I): P22S (abstr. 3506).
30. Venook AP. Postoperative adjuvant chemotherapy (CTX) use in patients (Pts) with stage II–III rectal cancer treated with neoadjuvant chemoradiotherapy: A National Comprehensive Cancer Network (NCCN) analysis. J Clin Oncol 2011; V 29 (I 18S, Part I): P224S (abstr. 3515).
2. Center MM, Jemal A, Ward E. International trends in colorectal cancer incidence rates. Cancer Epidem Biomark Prev 2009; 18 (6): 1688–94.
3. Барсуков Ю.А., Кныш В.И. Современные возможности лечения колоректального рака. Соврем. онкология. 2006; 8 (2): 7–16.
4. Tepper JE, O’Conell MJ, Petroni GR et al. Adjuvant postoperative fluorouracil-modulated chemotherapy combined with pelvic radiation therapy for rectal cancer: Initial results of Intergroup 0114. J Clin Oncol 1997; 15: 2030–9.
5. Smalley SR, Benedetti JK, Williamson SK et al. Phase III trial of fluorouracil-based chemotherapy regimens plus radiotherapy in postoperative adjuvant rectal cancer: GI INT 0144. J Clin Oncol 2006; 24 (22): 3542–7.
6. O'Connell MJ, Martenson JA, Wieand HS et al. Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. N Engl J Med 1994; 331 (8): 502–7.
7. O’Dwyer PJ, Eckhardt SG, Haller DG et al. Recommendation of Gastrointestinal Scientific Leadership Council of the Coalition of Cancer Cooperative Groups. J Clin Oncol 2007; 25: 2313–21.
8. Sauer R, Becker H, Hohenberger W et al. Preoperative chemo/radiotherapy as compared with post-operative chemo/radiotherapy for locally advanced rectal cancer. N Engl J Med 2004; 351: 1731–40.
9. Janjan NA, Khoo VS, Abbruzzese J et al. Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the MD Anderson Cancer Center experience. Int J Radiat Oncol Biol Phys 1999; 44 (5): 1027–38.
10. Crane CH, Skibber JM, Birnbaum EH et al. The addition of continuous infusion 5-FU to preoperative radiation therapy increases tumor response, leading to increased sphincter preservation in locally advanced rectal cancer. Int J Radiat Oncol Biol Phys 2003; 57 (1): 84–9.
11. Grann A, Minsky BD, Cohen AM et al. Preliminary results of preoperative 5-fluorouracil, low-dose leucovorin, and concurrent radiation therapy for clinically resectable T3-rectal cancer. Dis Colon Rectum 1997; 40 (5): 515–22.
12. Rich TA, Skibber JM, Ajani JA et al. Preoperative infusional chemoradiation therapy for stage T3-rectal cancer. Int J Radiat Oncol Biol Phys 1995; 32 (4): 1025–9.
13. Chari RS, Tyler DS, Anscher MS et al. Preoperative radiation and chemotherapy in the treatment of adenocarcinoma of the rectum. Ann Surg 1995; 221 (6): 778–87.
14. Bosset JF, Magnin V, Maingon P et al. Preoperative radiochemotherapy in rectal cancer: long-term results of a phase II trial. Int J Radiat Oncol Biol Phys 2000; 46 (2): 323–7.
15. Hiotis SP, Weber SM, Cohen AM et al. Assessing the predictive value of clinical complete response to neoadjuvant therapy for rectal cancer: an analysis of 488 patients. J Am Coll Surg 2002; 194 (2): 131–6.
16. Sauer R. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after median follow-up of 11 years. J Clin Oncol 2011; V29 (I 18S, Part I): p225S (abstr. 3516).
17. Arnold D, Schmoll H.-J. (Neo-) adjuvant treatment in colorectal cancer. Ann Oncol 2005; 15 (Suppl. 2): 133–40.
18 Cervantes A, Chirivella I, Rodriguez-Braun E et al. A multimodality approach to localized rectal cancer. Ann of Oncol 2006; 18 (Suppl. 10): 129–34.
19. Wiggers T. Multidisciplinary treatment of locally advanced rectal cancer. Eur J Cancer 2007; V5 (Suppl. 5): 375–6.
20. Cassidy J, Twelves C, Nowacki M et al. Improved safety of capecitabine versus bolus 5-fluorouracil/leucovorin adjuvant therapy for colon cancer (the X-ACT phase III study). Gastrointestinal Cancer Sympos 2004. Abstr. 219.
21. Twelves C, Scheithauer W, McKendrick J et al. 5-year overall survival update from X-ACT trial of capecitabine vs 5-FU/LV as adjuvant therapy for stage III colon cancer. Eur J Cancer 2007; 5 (5): 384 (Po 6587).
22. Andre T, Boni C, Mounedji-Boudiaf et al. Oxaliplatin, fluorouracil and leucovorinas adjuvant treatment for colon cancer. N Engl J Med 2004; 350: 2343–51.
23. De Gramont A, Boni C, Navarro M et al. Oxaliplatin/5-FU/LV in adjuvant colon cancer: Updated efficacy results on the MOSAIC trial, including survival, with a median follow-up of six years. ASCO 2007; 25 (Suppl. 18). Abstr. 4007.
24. Glynne-Jones R, Sebag-Montefiore D, Maugahn TS et al. A phase I dose escalation study of continuous oral capecitabine with oxaliplatin and pelvic radiation (XELOX-RT) in patients with locally advanced rectal cancer. Ann Oncol 2006; 17: 50–6.
25. Kalofonos HP, Pentheroudakis G, Rigatos S et al. A randomased phase III trial of adjuvant radio-chemotherapy comparing irinotecan (CPT-11), 5-FU and leucovorin to 5-FU and leucovorin in patients with rectal cancer. Ann Oncol 2006; 17 (Suppl. 9). Abstr. 3320 (P. 116).
26. Roh MS. The impact of capecitabine and oxaliplatin in the preoperative multimodality treatment in patients with carcinoma of the rectum: NSABP R-04. J Clin Oncol 2011; V29 (I 18S, Part I): P221S (abstr. 3503).
27. Roedel C. Preoperative chemoradiotherapy and postoperative chemotherapy with 5-fluorouracil and oxaliplatin versus 5-fluorouracil alone in locally advanced rectal cancer: First results of the German CAO/ARO/AIO-04 randomized phase III trial. Proc ASCO 2011. J Clin Oncol 2011; V29 (I 18S, Part I I): P780S (abstr. LBA 3505).
28. Hofheinz R. Capecitabine (Cape) versus 5-fluorouracil (5-FU)-based (neo)adjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC): Long-term results of randomized, phase III trial. J Clin Oncol 2011; V29 (I 18S, Part I): P222S (abstr. 3504).
29. Bonnetain F. An analysis of preoperative chemoradiotherapy with 5-FU/leucovorin for T3-4 rectal cancer on survival in a pooled analysis of EORTC 22921 and FFCD 9203 trial: Surrogacy in question? J Clin Oncol 2011; V 29 (I 18S, Part I): P22S (abstr. 3506).
30. Venook AP. Postoperative adjuvant chemotherapy (CTX) use in patients (Pts) with stage II–III rectal cancer treated with neoadjuvant chemoradiotherapy: A National Comprehensive Cancer Network (NCCN) analysis. J Clin Oncol 2011; V 29 (I 18S, Part I): P224S (abstr. 3515).
Авторы
Е.В.Артамонова
РОНЦ им. Н.Н.Блохина РАМН, Москва
N.N.Blohin Cancer Research Center
РОНЦ им. Н.Н.Блохина РАМН, Москва
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N.N.Blohin Cancer Research Center
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