References

tumors

Malignant tumours

2224-50572587-6813

Rosoncoweb

10.18027/2224-5057-2014-3-132-136

tumors-80

Research Article

ОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ

ORIGINAL REPORTS

СПОРНЫЕ ВОПРОСЫ АДЪЮВАНТНОЙ ХИМИОТЕРАПИИ РАКА ПРЯМОЙ КИШКИ ВТОРОЙ СТАДИИ

CONTROVERSIAL ISSUES OF ADJUVANT CHEMOTHERAPY OF STAGE II COLORECTAL CANCER

Федянин

М. Ю.

Fedyanin

M. Yu.

Контактная информация: Федянин Михаил Юрьевич (Fedyanin Mikhail), кандидат медицинских наук, врач-онколог отделения клинической фармакологии и химиотерапии ФГБНУ «Российский онкологический центр имени Н. Н. Блохина», +7 (905) 704–33–18, fedianinmu@mail.ru.

fedianinmu@mail.ru

Российский онкологический научный центр им. Н. Н. БлохинаRussian Federation

2014

21052015

03132136

2015

Федянин М.Ю.

Fedyanin M.Y.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.malignanttumors.org/jour/article/view/80

При II и III стадии рака прямой кишки (cT3/сТ 4 или cN+) в большинстве случаях стандартным подходом в лечебной тактике является сочетание хирургического и предоперационного химиолучевого лечения. Такой подход позволяет значимо снизить частоту рецидивов болезни, а в некоторых исследованиях приводит к улучшению общей выживаемости. Однако в течение последующих 10 лет от 30% при IIa до 70% больных при IIIc стадии погибают от прогрессирования болезни. При этом прогрессирование заболевания у большинства реализуется через отдаленное метастазирование, что диктует необходимость совершенствования системной терапии. Основным методом профилактики отдаленного метастазирования при ранних стадиях болезни является адъювантная химиотерапия. Однако к настоящему времени данные об эффективности послеоперационного лечения при раке прямой кишки после предоперационной химиолучевой терапии остаются противоречивыми. Настоящий обзор литературы посвящен анализу результатов исследований, посвященных оценке эффективности адъювантной химиотерапии у больных раком прямой кишки после проведенного предоперационного лечения при II стадии болезни.

At stage II and III colon cancer (cT3/PT 4 or cN +), in most cases, the standard approach in the treatment strategy is a combination of surgery and preoperative chemoradiotherapy. This approach allows to reduce significantly the frequency of relapses and, according some studies, it leads to improvement in overall survival. However 10 years after surgery from 30% patients with stage IIc to 70% patients with stage IIIc die from disease progression. This progression of the disease in the majority cases manifests with distant metastasis, which dictates the need of improving of systemic therapy. Adjuvant chemotherapy is the main method of preventing distant metastasis at the early stages of the disease. However, for today the data on the effectiveness of post-operative treatment of rectal cancer after preoperative chemoradiotherapy remains controversial. This literature review is devoted to the analysis of the results of studies evaluating the effectiveness of adjuvant chemotherapy in patients with rectal cancer after preoperative treatment for stage II disease.

рак прямой кишкиадъювантная химиотерапия

rectal canceradjuvant chemotherapy

References1

van Gijn W, Marijnen CA, Nagtegaal ID, et.al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol. 2011 Jun;12 (6):575–82.

Fokas E, Liersch T, Fietkau R, et al. Tumor regression grading after preoperative chemoradiotherapy for locally advanced rectal carcinoma revisited: updated results of the CAO/ARO/AIO-94 trial. Published online ahead of print at www.jco.org on April 21, 2014.

Park IJ, Eng C, You YN, et al. Exploratory analysis of adjuvant chemotherapy effects after preoperative chemoradiotherapy and radical resection for rectal cancer. J Clin Oncol 30, 2012 (suppl 4; abstr 557).

Petersen SH, Harling H, Kirkeby LT, Wille-Jorgensen P, Mocellin S. Postoperative adjuvant chemotherapy in rectal cancer operated for cure. Cochrane Database Syst Rev 2012;3: CD004078.

QUASAR Collaborative Group. Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study. Lancet 2007; 370: 2020–29.

Bosset JF, Collette L, Calais G, et al: Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355:1114–1123, 2006.

Bosset JF, Calais G, Mineur L, et al: Enhanced tumorocidal effect of preoperative radiotherapy on rectal cancer by adding chemotherapy: Results from the 22921 EORTC randomized trial. J Clin Oncol 23:5620–5627, 2005.

Bosset JF, Calais G, Mineur L, et al. Fluorouracil-based adjuvant chemotherapy after preoperative chemoradiotherapy in rectal cancer: long-term results of the EORTC 22921 randomised study. Lancet Oncol 2014; 15: 184–90.

Bosset JF, Collette L, Calais G, et al: Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355:1114–1123, 2006.

Cionini L, Sainato A, De Paoli A, et al. Final results of randomized trial on adjuvant chemotherapy after preoperative chemoradiation in rectal cancer. Radiother Oncol 2010; 96 (suppl 1): S113.

Breugom AJ, van den Broek CBM, van Gijn W et al. The value of adjuvant chemotherapy in rectal cancer patients after preoperative radiotherapy or chemotherapy followed by TME-surgery: the PROCTOR/SCRIPT study. Eur J Cancer 2013; 49 (suppl 3): S1.

Glynne-Jones R, Counsell N, Quirke P, et al. Chronicle: results of a randomised phase III trial in locally advanced rectal cancer after neoadjuvant chemoradiation randomising postoperative adjuvant capecitabine plus oxaliplatin (XELOX) versus control. Ann Oncol. 2014 Jul;25 (7):1356–62

Hofheinz RD, Wenz F, Post S, et al. Chemoradiotherapy with capecitabine versus fl uorouracil for locally advanced rectal cancer: a randomised, multicentre, non-inferiority, phase 3 trial. Lancet Oncol 2012; 13: 579–88.

Ngan SY, Burmeister B, Fisher RJ, et al. Randomised trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: Trans-Tasman Radiation Oncology Group Trial 01.04. J Clin Oncol 2012; 30: 3827–33.

Gresham G, Speers C, Woods R, et al. Association of time to adjuvant chemotherapy (TTAC) and overall survival among patients with rectal cancer treated with preoperative radiation. J Clin Oncol 30: 2012 (suppl 34; abstr 461).

Hong Y S, Nam B H, Jung K H, et al. Adjuvant chemotherapy with oxaliplatin/5-fluorouracil/leucovorin (FOLFOX) versus 5-fluorouracil/leucovorin (FL) in patients with locally advanced rectal cancer after preoperative chemoradiotherapy followed by surgery: A randomized phase II study (The ADORE). J Clin Oncol 31, 2013 (suppl; abstr 3570).

Федянин М. Ю., Трякин А. А., Тюляндин С. А. Адъювантная химиотерапия после химиолучевого лечения рака прямой кишки. Онкологическая колопроктология 2014, № 2, стр. 5–12.

Fietkau R, Barten M, Klautke G, et al: Adjuvant chemotherapy may not be necessary for patients with ypN0-category after neoadjuvant chemoradiotherapy of rectal cancer. Dis Colon Rectum 49:1284–1292, 2006.

Pereira VSA, Reig O et al. Do we need adjuvant therapy in rectal cancer with complete pathologic response (ypT0N0) after induction chemoradiation and laparoscopic mesorectal excision? J Clin Oncol. Presented at the 2012 ASCO Annual Meeting, June 2012. 2012; suppl: abstr 3536.

Govindarajan A, Reidy D, Weiser MR, et al. Recurrence rates and prognostic factors in ypN0 rectal cancer after neoadjuvant chemoradiation and total mesorectal excision. Ann Surg Oncol (2011) 18:3666–3672.

Capirci C, Valentini V, Cionini L et al (2008) Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer: long-term analysis of 566 ypCR patients. Int J Radiat Oncol Biol Phys 72 (1):99–107.

Beets GL, Maas M, Nelemans PJ, et al. Evaluation of response after chemoradiation for rectal cancer as a predictive factor for the benefit of adjuvant chemotherapy: A pooled analysis of 2,724 individual patients. J Clin Oncol 29: 2011 (suppl 4; abstr 361).

Ravi P, Kiran, MD, Hasan T. Kirat, et al. Is adjuvant chemotherapy really needed after curative surgery for rectal cancer patients who are node-negative after neoadjuvant chemoradiotherapy? Ann Surg Oncol (2012) 19:1206–1212.

Huh JW, Kim HR (2009) Postoperative chemotherapy after neoadjuvant chemoradiation and surgery for rectal cancer: is it essential for patients with ypT0–2N0? J Surg Oncol 100:387–391.

You KY, Huang R, Ding PR, et al. Selective use of adjuvant chemotherapy for rectal cancer patients with ypN0. Int J Colorectal Dis DOI 10.1007/ s00384–014–1831–0.

Kiran RP, Nisar PJ, Pelley RJ, et al. Role of routine adjuvant chemotherapy after neoadjuvant chemoradiotherapy and resection in low-risk patients with rectal cancer. J Clin Oncol 29: 2011 (suppl; abstr e14032).

Chan AK, Wong AO, Langevin J, et al. Preoperative chemotherapy and pelvic radiation for tethered or fixed rectal cancer: a phase II dose escalation study. Int J Radiat Oncol Biol Phys. 2000;48 (3):843–56.

Hong Y. S., Nam B. H., Kim K. P., et al. Adjuvant chemotherapy with oxaliplatin/5-fluorouracil/leucovorin (FOLFOX) versus 5-fluorouracil/leucovorin (FL) for rectal cancer patients whose postoperative yp stage 2 or 3 after preoperative chemoradiotherapy: Updated results of 3-year disease-free survival from a randomized phase II study (The ADORE). JClinOncol 32:5s, 2014 (suppl; abstr 3502).

VickersMM, Mercer J, Kumar A, et al. Association of adjuvant chemotherapy with clinical outcomes in patients treated with neoadjuvant chemoradiation for locally advanced rectal cancer. JClinOncol 32:5s, 2014 (suppl; abstr 3628).

The authors declare that there are no conflicts of interest present.