基于循证医学依据的结肠癌辅助化疗_陈功.pdfVIP

《中国癌症杂志》2009年第19卷第1期 CHINA ONCOLOGY 2009 Vol.19 No.1 6565 基于循证医学依据的结肠癌辅助化疗 陈功 综述　万德森 审校 中山大学肿瘤医院腹科，广东 广州510060 　　［摘要］　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。 　　［关键词］　循证医学；　辅助化疗；　结肠癌 　　中图分类号：R735.3+7　　文献标识码：A　　文章编号：1007-3639(2009)01-0065-09 The evidence-based adjuvant chemotherapy for colon cancer　CHEN Gong,WAN De-sen (Department of Abdominal Surgery, Sun Yat-sen University Cancer Center, Guangzhou Guangdong 510060, China) Correspondence to：CHEN Gong　E-mail：chengong@ 　　［Abstract ］ 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 benefi t with addition of irinotecan to the adjuvant treatment, but increased risk of chemotherapy- related toxicity. Stage Ⅲ colon cancer is the main and defi nite indication for adjuvant chemotherapy, while adjuvant chemotherapy should not be routinely considered for stage colon cancer, except those with high risk factors including Ⅱ T4 tumor, obstruction, perforation, poor differentiation, invasion t