| 特集名 | 消化器癌化学療法― 新たなエビデンスを求めて | |
|---|---|---|
| 題名 | 大腸癌周術期補助化学療法の新展開 | |
| 発刊年月 | 2013年 03月 | |
| 著者 | 桐田 圭輔 | 国立がん研究センター東病院消化管内科 |
| 著者 | 坂東 英明 | 国立がん研究センター東病院消化管内科 |
| 著者 | 吉野 孝之 | 国立がん研究センター東病院消化管内科 |
| 【 要旨 】 | 術後補助化学療法の適応はStage IIIと，議論の余地はあるがハイリスクStage IIである．術後補助化学療法としてのFOLFOX（XELOX）療法の有効性が証明されているが，種々の分子標的治療薬の併用療法は，いずれもFOLFOX療法単独を上回ることができなかった．現在遺伝子プロファイルによるリスク評価や至適治療期間の検討が行われている． 切除可能肝転移症例では，術前術後に行うFOLFOX療法が一定の有効性ありと見なされている．また切除不能肝転移症例では，化学療法により腫瘍縮小を得て根治切除を目指すconversion therapyが注目されている． 局所進行直腸癌に対する補助療法は，欧米では5-FU，カペシタビンを用いた術前放射線化学療法が主流であるが，オキサリプラチンの上乗せ効果について検証中である． |
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| Theme | Perspective for Chemotherapy in Gastrointestinal Malignancy Based on Current Evidence | |
|---|---|---|
| Title | New Developments of Perioperative Chemotherapy for Colorectal Cancer | |
| Author | Keisuke Kirita | Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East |
| Author | Hideaki Bando | Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East |
| Author | Takayuki Yoshino | Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East |
| [ Summary ] | Patients with resectable colon cancer may develop a resistance to adjuvant treatment. This is true of patients considered to be at stage III levels or even those considered to be high risk stage II. The effectiveness of FOLFOX and XELOX as adjuvant chemotherapy agents has been proven. Combination therapy with molecular targeted agents provides no better levels of treatment than therapy without molecular targeted agents. There are ongoing discussions concerning the optimal duration of these therapies and risk of recurrence. Genetic profiling is one method these treatments may be refined and implemented. FOLFOX is considered to be an effective neoadjuvant or adjuvant therapy for resectable colon cancer associated with liver metastases. On the other hand, cases which are considered to be unresectable, may receive conversion therapy with the aim of achieving radical cures through high reduction effects. In Western countries, local progression of rectal cancer is treated with neoadjuvant chemoradiotherapy combined with 5-FU. The addition of oxaliplatin to those therapies is also being investigated. |
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