局部晚期直肠癌两种新辅助放化疗方案疗效的比较

新辅助放化疗联合TME手术是T3-4M0期直肠癌的标准治疗方案。本研究为ACCORD三期临床试验,对常规新辅助放疗（45Gy）加卡培他滨与强化的新辅助放疗（50Gy）加卡培他滨加奥沙利铂的疗效进行比较及其解并发症发生率。将584例直肠癌患者纳入分析,随机分为两组。第1组（Cap45组）293例,接受为期5周的放疗（总剂量为45Gy）．同时口服卡培他滨（800mg／m2,2次／d,每周5d,共5周）。第2组（Capox50组）291例,接受为期5周的放疗（总剂量为50Gy）．     

比较卡培他滨联合顺铂化疗与化疗联合放疗对D2胃癌根治术后疗效的ARTISTⅢ期临床试验

胃癌的辅助放化疗“ARTIST”试验是第一个研究胃癌D：根治术后的放化疗疗效的试验。该试验旨在比较术后卡培他滨联合顺铂化疗（XP组）与XP联合放疗、卡培他滨化疗（XP-XRT—XP组）的疗效。     

奥沙利铂联合卡培他滨或联合替吉奥新辅助化疗方案在进展期胃癌治疗中的安全性和有效性

目的:探讨奥沙利铂联合卡培他滨（CapeOX）或奥沙利铂联合替吉奥（SOX）新辅助化疗方案在局部进展期胃癌治疗中的安全性和有效性。方法:采用回顾性队列研究方法,收集2016年4月至2019年4月期间,于上海交通大学医学院附属瑞金医院予以新辅助化疗并接受标准腹腔镜下胃癌根治术的进展期胃癌患者的临床资料。病例纳入标准：（1...     

局部进展期直肠癌术前放化疗中新化疗药物应用进展

基于氟尿嘧啶的术前同期放化疗是局部进展期直肠癌标准治疗模式,而探讨新化疗药物如希罗达、奥沙利铂、伊立替康、贝伐单抗和西妥昔单抗在其新辅助放化疗中的作用越来越引起人们兴趣,并开展了一系列Ⅰ-Ⅲ期临床研究,部分取得了积极结果,而有些并不理想。希罗达在局部进展期直肠癌新辅助放化疗中的地位已普遍获得公认．且有取代常规氟尿嘧啶趋势,而奥沙利铂、伊立替康及生物靶向类药物在其中的作用却存在明确争议,临床获益有限。彼此药物之间或靶点药物与放射线之间的相互作用机制研究、新的治疗反应预测靶点及合适个体的筛选可能是今后发展方向。     

卡培他滨联合奥沙利铂治疗晚期结直肠癌的近远期效果观察

为观察卡培他滨联合奥沙利铂治疗晚期结直肠癌的近远期效果,将晚期结直肠癌患者60例随机分为对照组和观察组,每组30例。对照组患者采用卡培他滨联合奈达铂化疗方案治疗,观察组患者采用卡培他滨联合奥沙利铂(XELOX)化疗方案治疗,比较2组患者近期临床疗效、远期生存率以及观察治疗过程中2组患者出现的不良反应情况。结果显示,观察组患者的近期临床总有效率明显高于对照组(P <0.05)。随访1年,2组患者的远期生存率比较差异无统计学意义(P>0.05);随访2年观察组患者的远期生存率高于对照组(P <0.05),随访3年观察组患者的远期生存率明显高于对照组(P <0.05)。2组患者不良反应发生率比较差异无统计学意义(P>0.05)。结果表明,采用XELOX化疗方案治疗晚期结直肠癌患者可明显提高近期临床疗效和远期生存率,且药物的安全性良好,值得临床推广应用。     

晚期非小细胞肺癌的化疗

1．化疗联合靶向治疗：含铂双药化疗联合西妥昔单抗有可能成为晚期非小细胞肺癌标准一线治疗方案之一。2008年美国临床肿瘤学会（ASCO）年会上,多中心随机对照Ⅲ期临床研究FLEX显示：与长春瑞滨／顺铂单纯化疗相比,长春瑞滨／顺铂联合西妥昔单抗一线治疗表皮生长因子受体（EGFR）阳性的晚期NSCLC患者可显著显著延长总生存期（OS）和治疗失败时间（TTF）。     

贝伐单抗、卡培他滨、氨磷汀和术前超分割加速放射疗法在直肠癌中的应用:二期研究

Koukourakis、Giatromanolaki、Tsoutsou等为评估直肠癌患者术前放化疗联合贝伐单抗的可行性和有效性,对转移性直肠癌患者建立了贝伐单抗联合抗血管内皮生长因子增强放射治疗效果的治疗方案。对19例放射影像学诊断为T3期和(或)N+的直肠癌患者术前实施超分割放射治疗并联合氨磷汀+卡培他滨+贝伐单抗治疗,放疗结束后6周手术。以未用贝伐单     

卡培他滨和曲妥珠单抗联合全脑放疗治疗HER2阳性乳腺癌脑转移的疗效观察

目的探讨卡培他滨和曲妥珠单抗联合全脑放疗治疗人类表皮生长因子受体2(HER2)阳性乳腺癌脑转移患者的临床疗效。方法回顾性分析笔者所在医院2004年1月至2012年1月期间收治的60例HER2阳性乳腺癌脑转移患者的临床资料,其中使用卡培他滨和曲妥珠单抗联合全脑放疗患者32例作为观察组,使用卡培他滨和顺铂联合全脑放疗患者28例作为对照组。对比2组患者治疗后的疾病控制率、毒副反应发生率及生存率。结果观察组患者治疗后的疾病控制率和生存率明显高于对照组(P0.05),毒副反应发生率则显著低于对照组(P0.05)。结论卡培他滨和曲妥珠单抗联合全脑放疗治疗HER2阳性乳腺癌脑转移患者安全、有效,值得临床推广使用。     

�е�λֱ������ǰ�Ż�����״

尽管外科手术一直都是治疗直肠癌的主要手段,但单纯的手术疗法效果不尽人意。近年来,术前放、化疗在中低位直肠癌治疗中的作用已经在越来越多的临床实践中得到验证。新辅助疗法的引入,在降低肿瘤局部复发率、提高保肛率、延长病人的生存时间等方面均取得了明显进步。1术前放化疗方案术前化疗还没有统一方案,目前多数临床研究是以5-氟脲嘧啶(5-FU)为基础联合化疗方案。有研究表明,联合用药可以提高完全缓解率。联合应用较多的有甲酰四氢叶酸(LV)。近年,不少新药应用于直肠癌治疗,取得了良好的效果,如卡培他滨、雷替曲塞、奥沙利铂和伊立替…     

分子靶向药物在胃肠道肿瘤综合治疗中的应用

分子靶向药物在晚期胃肠道肿瘤治疗中,被证实可提高患者的客观缓解率并延长总生存期.因此,其在局部进展期胃肠道肿瘤综合治疗中的价值被逐渐重视.曲妥珠单抗用于HER-2基因阳性的局部进展期胃癌新辅助化疗中的临床研究正在进行中,结果值得期待.大量研究证明,西妥昔单抗联合化疗对于KRAS基因野生型潜在可切除的结直肠癌肝转移患者,能提高手术切除率并延长总生存期;而贝伐珠单抗在KRAS基因突变型结直肠癌肝转移术前转化治疗中的作用正在评估中.对于可切除的结直肠癌肝转移,虽现有的证据显示,分子靶向药物在新辅助治疗中未能带来长期生存益处,但最终结论仍存议甚多.对于局部进展期直肠癌患者,新辅助化疗中的西妥昔单抗在二期临床研究中未能显示治疗获益,贝伐珠单抗的作用同样需要在三期临床研究后进一步证实.与晚期肿瘤单一治疗模式不同,在肿瘤综合治疗中,需要系统评估分子靶向药物与细胞毒药物、手术以及放疗之间可能的相互影响及协同作用,制定出科学并适用于临床实践的综合治疗模式.     

2017��NCCN��ֱ�����ٴ�ʵ��ָ�ϡ�������β��ָ��½��

??Interpretation of surgical treatment part of updated NCCN clinical practice guideline for rectal cancer SHEN Zhan-long, YE Ying-jiang, ZHOU Jing, et al. Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing100044, China
Corresponding author: YE Ying-jiang, E-mail:yeyingjiang@
pkuph.edu.cn
Abstract NCCN??National Comprehensive Cancer Network) clinical practice guideline updated in many areas of diagnosis, treatment and follow-up in 2017. Main content include tumor budding is added to an adverse histological feature with adverse outcome after operation of malignant polyps; options of "watch and wait" after chemoradiation and chemotherapy is recommended to cT1N0M0 rectal cancer patients who underwent transanal local resection with unfavorable histopathological features; postoperative treatment of pT3-4N0M0 rectal cancer patients whose preoperative stage is cT1-2N0M0 could be "watch and wait" or chemotherapy; the patients underwent preoperative therapy is not necessary to get postoperative treatment; perioperative target therapy is deleted from the strategy of resectable synchronous liver metastasis of rectal cancer??short course radiotherapy is permitted in the treatment of primary tumor of resectable liver metastasis of rectal cancer; the effect of cytoreductive surgery combined with intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis of colorectal cancer is affirmed cautiously.     

Comparing pathological complete response rate using oral capecitabine versus infusional 5‐fluorouracil with preoperative radiotherapy in rectal cancer treatment

Background

Infusional 5‐fluorouracil (5‐FU) has been the standard radiation sensitizer in patients undergoing preoperative long‐course chemoradiotherapy (CRT) for locally advanced rectal cancer in Australia. Capecitabine (Xeloda) is an oral 5‐FU prodrug of comparable pharmacodynamic activity, currently preferred in place of 5‐FU infusion, its established counterpart in neoadjuvant CRT for rectal cancer. The few studies quantifying pathological complete response (pCR) of Xeloda versus 5‐FU have produced inconsistent results. We reviewed our own data to determine if the rates of pCR of oral capecitabine were non‐inferior to intravenous 5‐FU in patients undergoing neoadjuvant CRT for rectal cancer.

Methods

A retrospective study was performed from a prospectively kept database. Four hundred and fifty‐two patients received preoperative CRT from January 2006 to January 2016. Pelvic radiotherapy was delivered concurrently with capecitabine (n = 42) or infusional 5‐FU (n = 341). The remaining received different chemotherapy regimens. Surgery was performed 6–12 weeks of CRT completion. Pathological responses were assessed using Dworak regression grading score (0–4). Clinical outcomes were evaluated in terms of local control and recurrence‐free survival.

Results

The proportion of patients who had a tumour regression score of 4 (pCR) after CRT was 4/42 (9.5%) in the capecitabine group and 71/341 (20%) in the infusional 5‐FU group (P = 0.082). pCR was an independent predictor for survival in this group of patients (hazard ratio: 0.002, P = 0.0001, 95% confidence interval: 0.0001–0.027).

Conclusion

The use of capecitabine as neoadjuvant chemotherapy in patients with rectal cancer was associated with a reduced rate of pCR. However this difference did not achieve statistical significance.     

Chemotherapy for colorectal cancer

Colorectal cancer is the most commonly diagnosed cancer in the EU. Various randomised studies have shown a survival benefit with chemotherapy in the adjuvant setting. Adjuvant chemotherapy with 5-fluorouracil/folinic acid (5FU/FA) for 6 months after curatively resected node-positive colon cancer has become the standard practice. However, controversy still exists regarding the optimal regimen and whether to treat node-negative patients. The latest QUASAR trial results seem to strengthen the argument in favour of adjuvant treatment of Dukes B cancer. Patients with Dukes B tumours and any adverse prognostic indicator should be given the benefit of adjuvant therapy. A number of novel agents (oxaliplatin, irinotecan) showing activity in advanced disease are currently being evaluated in the adjuvant setting. A patient with metastatic colorectal cancer should today be expected to have a median survival of 18-20 months compared to that of 11-14 months only a few years ago. 5FU/FA has been the mainstay of therapy for metastatic colorectal cancer for over 40 years and confers a survival benefit over supportive care. The response rate of 5FU is improved by modulation with FA or by continuous infusional regimens (currently the best expected response rate is around 20-25%). As per the recent National Institute for Clinical Excellence guidelines, the oral agents capecitabine or tegafur with uracil (in combination with FA) can be used as first-line treatment in metastatic colorectal cancer and, although their response rate has not been directly compared to infusional 5FU, survival is unlikely to be inferior. Newer chemotherapeutic agents like irinotecan and oxaliplatin are now entering regular usage due to improved response rates (around 50% in 5FU/FA-containing doublets) and survival. Irinotecan monotherapy is second-line treatment approved by the National Institute for Clinical Excellence, although sequential infusional 5FU/FA irinotecan to infusional 5FU/FA oxaliplatin may convey the best survival with the least side effects. The position of combination chemotherapy before (to downstage) or after metastasectomy (usually from the liver) is still a topic of heated debate. Other routes (intrahepatic, intraperitoneal) are still to be proven and not recommendable outside the trial setting. The latest results of chemotherapy combinations with biological treatments (bevacuzimab and cetuximab) have been very promising indeed. Further improvements in survival, response and quality of life are expected. .     

��ֱ�������������о���չ

??Progression of targeted therapy for colorectal cancer LIN Feng, LI Yong. Guangdong Provincial People's Hospital ?? Guangdong Province Academy of Medical Sciences, Guangzhou 510080, China
Corresponding author??LIN Feng??E-mail: liyong-lucky@21cn.com
Abstract Colorectal cancer is one of the most common malignant tumors but the results of conventional chemotherapy have been discouraging. The recent successful development of targeted therapy has brought new hope for patients with colorectal cancer. Two monoclonal antibodies, bevacizumab and cetuximab, that block vascular endothelial growth factor and epithelial growth factor receptor are available widely in clinical practice. The addition of cetuximab or bevacizumab to the chemotherapy for metastatic colorectal cancer further improves the outcome. The combination of chemotherapy with cetuximab or bevacizumab has become standard regimens in advanced colorectal cancer and makes a striking step to prolong the survival time in the past few years. The major achievement for the cetuximab targeted therapy of mCRC is the correlation between k-ras status and the efficacy of anti-EGFR therapy. Molecular targeted therapy plays a more important role in treatment for colorectal cancer.     

2010���ֱ�������ι۵��ѧ���

??New opinions of colorectal cancer in 2010 LIU Yin-hua*,XU Ling,YAO Hong-wei. *Peking University the First Hospital, Beijing100034, China.
Corresponding author: XU Ling??E-mail??xuling_en@yahoo.com.cn
Abstract There are many updates about the diagnosis and treatment of colorectal cancer in 2010. Of these the most important event is the publication of the 7th Edition of the AJCC staging Manual. The new standard of staging can provide more precise information about the prognosis of colorectal cancer, and the emphases are the definitions of T4, N1, N2 and M1. The updates of NCCN clinical practice guidelines in oncology of colon cancer include: the TNM staging was updated to reflect the 7th Edition of the AJCC Staging Manual; there were no changes in the part of surgery; mismatch repair (MMR) testing was recommended in stage ?? patients who considers 5-Fu as adjuvant chemotherapy; the recommendation of BRAF mutation testing is added in metastatic colon cancer. Panitumumab which is a fully human monoclonal antibody should also be used on the basis of KRAS mutation testing; Bevacizumab, cetuximab and irinotecan should not be used for adjuvant chemotherapy and PET-CT should not be used to monitor progress of therapy. The update of NCCN guidelines of rectal cancer in surgery part is the transanal excision is only recommended for T1, N0.For many years the AJCC Staging Manual and NCCN clinical practice guidelines in oncology offer sufficient information for clinic. But due to the difference of race and region and the heterogeneity of tumor, the new updates would go better through the clinical practice.     

���й���ֱ�������ƹ淶��2017��棩�������ҽ��Ӧ��ע�����ݽ��

??Interpretation of main points for surgeons on Chinese Standard for Treatment of Colorectal Cancer (2017 edition) GU Jin. Peking University Shougang Hospital??Beijing 100144??China
Abstract In China??the majority of hospitals have possessed qualifications of providing medical care for the ??Colorectal Cancer??CRC patients. Due to socioeconomic disparities??medical conditions and skill levels??there is a big difference in the treatment of colorectal cancer. In October 11??2011??Ministry of Health of the People’s Republic of China released the National Guideline for treatment of colorectal cancer. It had fully strengthen national standardization in colorectal cancer treatment and ensure that higher quality care is available for the rectal patients especially in rural areas. The most serious problem is that surgical resection for colorectal cancer has been carried out without standard preoperative clinical evaluation. In accordance with Chinese and international guidelines??systemic treatment of advanced rectal cancer should include neoadjuvant chemoradiotherapy. At present the concept of preoperative chemotherapy has been accepted among Chinese doctors??but standard preoperative treatment could only be implemented in some teaching hospitals and cancer hospitals in big cities. At the same time??another problem indicated over treatment for stage ?? patients with low risk factors. In this paper??we focused on some misunderstandings in the field of colorectal cancer treatment in order to provide key points to surgeons based on our updated guideline.     

Evidence-based update of chemotherapy options for metastatic colorectal cancer

Colorectal carcinoma is one of the most common malignancies in the Western world. Although fluorouracil (5-FU) has been used for over 40 years, only in the last decade has its value been recognized in the treatment of advanced colorectal cancer. Early randomized studies explored the best possible doses and schedules of 5-FU and its modulators such as folinic acid or leucovorin (LV) in combination with respect to efficacy and side-effects. The development of oral fluoropyrimidines, in particular capecitabine, has made chemotherapy further accessible and acceptable. The introduction of newer cytotoxics irinotecan and oxaliplatin has achieved a significant improvement in survival rates with manageable toxicity. With appropriate selection of patients and proper sequencing of currently most efficient regimens, median survival durations of around 20 months can now be reached. Novel targeted therapies (bevacizumab, cetuximab and cyclooxygenase-2 (COX-2) inhibitors) in combination with most efficient chemotherapy regimens will probably push the median survival beyond the 2-year mark. The present article is an overview of most important studies that have substantially changed the approach to metastatic colorectal cancer and have given the patients and clinicians a wider range of options for treating this illness.     

Neo-adjuvant and adjuvant treatment of locally invasive bladder cancer

Since Sternberg et al. in 1985 first published preliminary results of polychemotherapy in patients with metastatic bladder cancer, it became apparent that transitional carcinoma of the bladder is highly responsive to chemotherapy. Response rates up to 70% with combination therapy regimens like methotrexate, vinblastine, doxorubicin or adriamycin and cisplatin promised that transitional carcinoma might be able to cure even in advanced stages. Chemotherapy has either been applied prior to the local treatment (such as radical cystectomy or radiotherapy) in a neo-adjuvant regimen, or after local therapy in an adjuvant regimen. Although a large number of studies have been published in the past 20 years, the role of the different chemotherapeutic approaches has not been clearly defined. Therefore, neither neo-adjuvant nor adjuvant chemotherapy can be recommended as 'gold standard' treatment for advanced bladder cancer.     

����ֲ����ת���Ըΰ��ٴ���ֵ������

??Liver transplantation for metastatic liver cancer ZHU Zhi-jun. Department of Liver Transplantation, Tianjin First Central Hospital, Tianjin 300192??China
Abstract Liver transplantation is an effective treatment for some patients with metastatic liver cancers which can’t be resected and are ineffective with other treatments. Since different tumor sources will lead to different clinical results after liver transplantation. The indication and optimal time for transplantation should be controlled strictly. Currently the source of neuroendocrine tumors, especially carcinoid, is the major indication for liver transplantation. The value of liver transplantation for liver metastases of colorectal cancer requires further research. Reports of other sources like breast cancer are very less.     

����ƽǶ�̸�����г��ֲ�����θ���������Ʋ���

??Treatment strategy for unresectable local advanced gastric cancer from a surgical point of view LIANG Han. Department of Gastric Cancer Surgery, Tianjin Medical University Cancer Institute & Hospital??National Clinical Research Center for Cancer??Tianjin 300060??China
Abstract According to Yoshida’s stage IV gastric cancer classification, for some patients with marginally resectable and potentially unresectable metastatic gastric cancer??neoadjuvant intraperitoneal plus systematic chemotherapy (NIPS)??cytoreductive surgery??CRS?? plus hyperthermic intraperitoneal chemotherapy (HIPEC)??palliative surgery plus chemotherapy??conversion therapy with docetaxel based three drug regimen and S1/paclitaxel chemotherapy plus apatinib may be benefited. For patients with moderate amount and more ascites??NIPS regimen may control the ascites, relieve symptoms and prolong the survival time. CRS+HIPEC has been demonstrated to provide survival benefit for patients with PCI (peritoneal cancer index) score≤6. It is still controvertial whether the palliative surgery followed by chemotherapy may benefit for patient or not??but judicious use of surgical resection both gastrectomy and metastasis before chemotherapy in metastatic gastric cancer patients may result in favorable treatment approach. Conversion therapy with docetaxel based three drug regimen and chemotherapy combined with apatinib may result a high conversion rate.