臨床外科65巻4号

2010年04月発行

特集 消化器癌neoadjuvant chemotherapyの新展開 〔根治性向上〕

進行大腸癌に対するneoadjuvant chemotherapyの適応と意義

著者： 飯合恒夫¹ 谷達夫¹ 皆川昌広¹ 黒﨑功¹ 野上仁¹ 亀山仁史¹ 畠山勝義¹ 瀧井康公² 丸山聡²

所属機関： ¹新潟大学大学院医歯学総合研究科消化器・一般外科 ²新潟県立がんセンター新潟病院外科

ページ範囲：P.486 - P.492

要旨：切除可能大腸癌に対する術前化学療法の効果についてのエビデンスはほとんどなく，標準治療になっていない．しかし，根治術を行っても予後の悪い群に関しては，術前化学療法に大きな可能性と期待がある．一方，切除不能大腸癌，特に切除不能肝転移に対する術前化学療法については，新規抗癌剤の出現とともにエビデンスが構築されつつあり，標準治療になりつつある．いわゆるdrug-lagが解消された現在，わが国でも術前化学療法のエビデンスを作って，世界に発信していく必要がある．

参考文献

1）Colorectal Cancer Chemotherapy Study Group of Japan-The 2nd Trial：Results of a randomized trial with or without 5-FU-based preoperative chemotherapy followed by postoperative chemotherapy in resected colon and rectal carcinoma. Jpn J Clin Oncol 33：288-296, 2003

2）大腸癌研究会（編）：大腸癌治療ガイドライン―医師用　2009年度版．金原出版，2009

3）Adam R, Delvart V, Pascal G, et al：Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy：a model to predict long-term survival. Ann Surg 240：644-658, 2004

4）Wein A, Riedel C, Köckerling F, et al：Impact of surgery on survival in palliative patients with metastatic colorectal cancer after first line treatment with weekly 24-hour infusion of high-dose 5-fluorouracil and folinic acid. Ann Oncol 12：1721-1727, 2001

5）Pozzo C, Basso M, Cassano A, et al：Neoadjuvant treatment of unresectable liver disease with irinotecan and 5-fluorouracil plus folinic acid in colorectal cancer patients. Ann Oncol 15：933-939, 2004

6）Alberts SR, Horvath WL, Sternfeld WC, et al：Oxaliplatin, fluorouracil, and leucovorin for patients with unresectable liver-only metastases from colorectal cancer：a North Central Cancer Treatment Group phase Ⅱ study. J Clin Oncol 23：9243-9249, 2005

7）Ho WM, Ma B, Mok T, et al：Liver resection after irinotecan, 5-fluorouracil, and folinic acid for patients with unresectable colorectal liver metastases：a multicenter phase Ⅱ study by the Cancer Therapeutic Research Group. Med Oncol 22：303-312, 2005

8）Masi G, Cupini S, Marcucci L, et al：Treatment with 5-fluorouracil/folinic acid, oxaliplatin, and irinotecan enables surgical resection of metastases in patients with initially unresectable metastatic colorectal cancer. Ann Surg Oncol 13：58-65, 2006

9）Falcone A, Ricci S, Brunetti I, et al：Phase Ⅲ trial of infusional fluorouracil, leucovorin, oxaliplatin, and irinotecan（FOLFOXIRI）compared with infusional fluorouracil, leucovorin, and irinotecan（FOLFIRI）as first-line treatment for metastatic colorectal cancer：the Gruppo Oncologico Nord Ovest. J Clin Oncol 25：1670-1676, 2007

10）Van Cutsem E, Rivera F, Berry S, et al：Safety and efficacy of first-line bevacizumab with FOLFOX, XELOX, FOLFIRI and fluoropyrimidines in metastatic colorectal cancer：the BEAT study. Ann Oncol 20：1842-1847, 2009

11）Folprecht G, Gruenberger T, Bechstein WO, et al：Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab：the CELIM randomised phase 2 trial. Lancet Oncol 11：38-47, 2010

12）Tournigand C, André T, Achille E, et al：FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer：a randomized GERCOR study. J Clin Oncol 22：229-237, 2004

13）Vauthey JN, Pawlik TM, Ribero D, et al：Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol 24：2065-2072, 2006

14）Nordlinger B, Sorbye H, Glimelius B, et al：Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer（EORTC Intergroup trial 40983）：a randomised controlled trial. Lancet 371：1007-1016, 2008

15）丸山　聡，瀧井康公，酒井靖夫，他：術前リンパ節転移陽性大腸癌に対するTS-1/CPT-11併用術前化学療法の検討（NCCSG-03）．日癌治療会誌 44：621，2009