直肠癌新辅助治疗进展
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CAO/ARO/AIO-94 Trial
术后放化疗增加短期和长期的毒副作用
Sauer, Rolf, et al. "Preoperative versus postoperative chemoradiotherapy for rectal cancer." New England Journal of Medicine 351.17 (2004): 1731-1740.
直肠癌新辅助治疗进展
II-III期直肠癌术前放疗和放化疗
术前放疗和单纯手术比较，降低了局部区域复发率，提高 了无病生存率和总生存率(I类) 术前放化疗和术前放疗比较，进一步降低了局部区域复发 率，但两组生存率相同(I类) 术前放化疗和术后放化疗比较，毒副作用低，显著降低了 局部区域复发率，生存率相似(I类) 术前放化疗之新辅助化疗，未提高近期疗效，生存率有待 长期随诊(III类)
CAO/ARO/AIO-94 Trial
术后的辅助放疗和化疗多数无法按疗程完成
Sauer, Rolf, et al. "Preoperative versus postoperative chemoradiotherapy for rectal cancer." New England Journal of Medicine 351.17 (2004): 1731-1740.
SEER Data
超过1/3的患者因为各种原因未能接受辅助化疗
Cancer. 2014 Apr 15;120(8):1162-70. doi: 10.1002/cncr.28545. Epub 2014 Jan 28. Postoperative chemotherapy use after neoadjuvant chemoradiotherapy for rectal cancer: Analysis of Surveillance, Epidemiology, and End Results-Medicare data, 1998-2007. Haynes AB1, You YN, Hu CY, Eng C, Kopetz ES, Rodriguez-Bigas MA, Skibber JM, Cantor SB, Chang GJ.
手术并发症的影响
手术并发症导致化疗推迟及预后不良
Tevis, Sarah E., et al. "Postoperative Complications in Patients With Rectal Cancer Are Associated With Delays in Chemotherapy That Lead to Worse Disease-free and Overall Survival." Diseases of the Colon & Rectum 56.12 (2013): 1339-1348.
手术并发症的影响
手术并发症导致化疗推迟及预后不良
Tevis, Sarah E., et al. "Postoperative Complications in Patients With Rectal Cancer Are Associated With Delays in Chemotherapy That Lead to Worse Disease-free and Overall Survival." Diseases of the Colon & Rectum 56.12 (2013): 1339-1348.
同步术前放化疗+化疗？
主要内容
1.单纯术前化疗 2.诱导化疗+放化疗 3.新辅助放化疗+化疗
单独应用新辅助化疗
新辅助放化疗（6 weeks) + （6-8weeks of recovery）+ 手术 +（4 weeks of recovery）+ 辅助化疗
EORTC 22921
Long-term results：术后辅助化疗不改善无病生存Fra Baidu bibliotek总生存
1、化疗依从性非常差： 术前依从率为82% 术后依从率为42.9%
2、化疗方案中不包括奥沙利铂
Bosset, Jean-François, et al. "Chemotherapy with preoperative radiotherapy in rectal cancer." New England Journal of Medicine 355.11 (2006): 1114-1123.
局部晚期直肠癌术前治疗模式的发展
Dutch Trial （2001）
术前放疗+TME手术优于单纯TME手术
CAO/AIO/ARO-94 & CR 07 Trial（2005）
术前放疗优于术后放疗
EORTC 22921 & FFCD9203 （2006）
5-FU同步术前放化疗优于单纯术前放疗
What’s the next?
辅助化疗-NCCN指南
EORTC 22921
Long-term results：术后辅助化疗不改善无病生存和总生存
无病生存时间
Bosset, Jean-François, et al. "Fluorouracil-based adjuvant chemotherapy after preoperative chemoradiotherapy in rectal cancer: long-term results of the EORTC 22921 randomised study." The lancet oncology 15.2 (2014): 184-190.
EORTC 22921
Long-term results：术后辅助化疗不改善无病生存和总生存
总生存时间
Bosset, Jean-François, et al. "Fluorouracil-based adjuvant chemotherapy after preoperative chemoradiotherapy in rectal cancer: long-term results of the EORTC 22921 randomised study." The lancet oncology 15.2 (2014): 184-190.