大腸直腸癌的輔助性化學治療

Adjuvant Chemotherapy of Colorectal Cancer

王照元(Jaw-Yuan Wang)

《中華民國癌症醫學會雜誌》 24卷3期 (2008/06) Pp. 180-184

https://doi.org/10.6588/JCOS.2008.24.3.6

摘要

大腸直腸癌是台灣第二常見的惡性腫瘤，也是位居第三名的癌症死亡病因。大約百分之七十五至八十的病人在診斷時疾病仍侷限在腸壁或是周遭淋巴結。過去十年來，由於手術、放射線治療與化學治療的進步使得侷限性大腸直腸癌的治療有明顯的進展。合併5-fluorouracil與leucovorin輔助性化學治療對於切除後第三期大腸癌的優點已經被確立，而近年來的研究更證實了使用包括oxaliplatin為基礎的化學治療會改善無疾病與整體存活率。而對於第二期大腸癌病患使用輔助性化學治療仍有疑義，因此僅建議使用於高危險復發病患。對於直腸癌病人，使用total mesorectal resection與術前之concurrent chemoradiotherapy皆有助於改善治療成果。現今許多隨機臨床試驗朝向合併一些現今可使用治療方法以達到最佳治療效果為目標；另外合併一些新的藥物（標靶治療）來增加腫瘤切除後的治癒率。

關鍵字

大腸直腸癌 ； 輔助性化學治療 ； fluorouracil ； 標靶治療

並列摘要

Colorectal cancer is the second most common malignancy in Taiwan and the third most frequent cause of cancer-related death. Approximately 75%-80% of patients are diagnosed with disease limited to the bowel wall or surrounding lymph nodes. Over the past decade, significant progress has been made in the treatment of localized colorectal cancer due to advances in surgery, radiotherapy, and chemotherapy. The benefit of adjuvant 5-fluorouracil and leucovorin has been well established in resected stage Ⅲ colon cancer, and recent data have shown to improve disease-free and overall survival through the inclusion of oxaliplatin into adjuvant treatment programs. For patients with stage Ⅱ colon cancer, the use of adjuvant chemotherapy remains controversial, but may be appropriate in a subset of individuals at high risk for disease recurrence. In the treatment of patients with rectal cancer, improved outcomes have been noted with the use of total mesorectal excision and preoperative concurrent chemoradiotherapy. Current randomized clinical trials in the adjuvant therapy of colorectal cancer are evaluating how best to combine currently available therapies, while smaller studies are evaluating new agents (targeted therapy), with the goal of continued progress in increasing cure rates among those with resectable disease.

並列關鍵字

colorectal cancer ； adjuvant chemotherapy ； fluorouracil ； target therapy