臨床外科67巻1号

2012年01月発行

特集 「切除困難例」への化学療法後の手術―根治切除はどこまで可能か

大腸癌に対する化学療法後の手術

著者： 石原聡一郎¹ 福島慶久¹ 赤羽根拓弥¹ 島田竜¹ 堀内敦¹ 端山軍¹ 山田英樹¹ 野澤慶次郎¹ 松田圭二¹ 渡邉聡明¹

所属機関： ¹帝京大学医学部外科

ページ範囲：P.32 - P.39

文献概要

【ポイント】

◆進行再発大腸癌に対する有効性が示された新しい抗癌剤・分子標的薬が術前補助療法にも取り入れられつつある．

◆局所進行直腸癌に対する術前化学放射線療法においては高い癌完全消失（CR）率が報告されるようになり，治療成績の向上が期待されている．

◆切除不能肝転移のconversion therapyに関する臨床試験によって良好な切除率と予後の改善が示されるようになった．

参考文献

1）大腸癌研究会編：大腸癌治療ガイドライン．医師用2010年版．金原出版，2010

2）野澤慶次郎，渡邉聡明：結腸癌．臨外 66：152-156，2011

3）Saiura A, Yamamoto J, Ueno M, et al：Long-term survival in patients with locally advanced colon cancer after en bloc pancreaticoduodenectomy and colectomy. Dis Colon Rectum 51：1548-1551, 2008

4）Sugihara K, Kobayashi H, Kato T, et al：Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum 49：1663-1672, 2006

5）Ishihara S, Hayama T, Yamada H, et al：Benefit of tegafur-uracil and leucovorin in chemoradiotherapy for rectal cancer. Hepatogastroenterology 58：756-762, 2011

6）Ishihara S, Watanabe T, Akahane T, et al：Prognostic significance of adverse events associated with preoperative radiotherapy for rectal cancer. Int J Colorectal Dis 26：911-917, 2011

7）Cellier P, Leduc B, Martin L, et al：Phase Ⅱ study of preoperative radiation plus concurrent daily tegafur-uracil（UFT）with leucovorin for locally advanced rectal cancer. BMC Cancer 16：98, 2011

8）Feliu J, Calvilio J, Escribano A, et al：Neoadjuvant therapy of rectal carcinoma with UFT-leucovorin plus radiotherapy. Ann Oncol 13：730-736, 2002

9）Giralt J, Tabernero J, Navalpotro B, et al：Pre-operative chemoradiotherapy with UFT and Leucovorin in patients with advanced rectal cancer：A phase Ⅱ study. Radiother Oncol 89：263-269, 2008

10）Chau I, Brown G, Cunningham D, et al：Neoadjuvant capecitabine and oxaliplatin followed by synchronous chemoradiation and total mesorectal excision in magnetic resonance imaging-defined poor-risk rectal cancer. J Clin Oncol 24：668-674, 2006

11）Mohiuddin M, Winter K, Mitchell E, et al：Randomized phase Ⅱ study of neoadjuvant combined-modality chemoradiation for distal rectal cancer：Radiation Therapy Oncology Group Trial 0012. J Clin Oncol 24：650-655, 2006

12）Ryan DP, Niedzwiecki D, Hollis D, et al：Phase Ⅰ/Ⅱ study of preoperative oxaliplatin, fluorouracil, and external-beam radiation therapy in patients with locally advanced rectal cancer：Cancer and Leukemia Group B 89901. J Clin Oncol 24：2557-2562, 2006

13）Sato T, Ozawa H, Hatate K, et al：A Phase Ⅱ trial of neoadjuvant preoperative chemoradiotherapy with S-1 plus irinotecan and radiation in patients with locally advanced rectal cancer：clinical feasibility and response rate. Int J Radiat Oncol Biol Phys 79：677-683, 2011

14）Dewdney A, Capdevila J, Glimelius B, et al：EXPERT-C：A randomized, phase Ⅱ European multicenter trial of neoadjuvant capecitabine plus oxaliplatin chemotherapy（CAPOX）and chemoradiation（CRT）with or without cetuximab followed by total mesorectal excision（TME）in patients with MRI-defined, high-risk rectal cancer. ASCO Meeting Abstracts. 29：3513（15_suppl）, 2011

15）安野正道：大腸癌の治療戦略　化学療法　高度大腸癌肝転移に対する化学療法後肝切除戦略（conversion therapy）．日臨 69：446-453（増刊号）, 2011

16）Nordlinger B, Van Cutsem E, Gruenberger T, et al：Combination of surgery and chemotherapy and the role of targeted agents in the treatment of patients with colorectal liver metastases：recommendations from an expert panel. Ann Oncol. 2009 20：985-992, 2009

17）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 240：644-657, discussion 657-658, 2004

18）Beppu T, Hayashi N, Masuda T, et al：FOLFOX enables high resectability and excellent prognosis for initially unresectable colorectal liver metastases. Anticancer Res 30：1015-1020, 2010

19）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

20）Baize N, Gerard B, Bleiberg H, et al：Long-term survival of patients downstaged by oxaliplatin and 5-fluorouracil combination followed by rescue surgery for unresectable colorectal liver metastases. Gastroenterol Clin Biol 30：1349-1353, 2006

21）Capussotti L, Muratore A, Mulas MM, et al：Neoadjuvant chemotherapy and resection for initially irresectable colorectal liver metastases. Br J Surg 93：1001-1006, 2006

22）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

23）Skof E, Rebersek M, Hlebanja Z, et al：Capecitabine plus Irinotecan（XELIRI regimen）compared to 5-FU/LV plus Irinotecan（FOLFIRI regimen）as neoadjuvant treatment for patients with unresectable liver-only metastases of metastatic colorectal cancer：a randomised prospective phase Ⅱ trial. BMC Cancer 9：120, 2009

24）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

25）Tournigand C, Andre 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

26）Colucci G, Gebbia V, Paoletti G, et al：Phase Ⅲ randomized trial of FOLFIRI versus FOLFOX4 in the treatment of advanced colorectal cancer：a multicenter study of the Gruppo Oncologico Dell'Italia Meridionale. J Clin Oncol 23：4866-4875, 2005

27）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

28）Goldberg RM, Sargent DJ, Morton RF, et al：A randomized controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer. J Clin Oncol 22：23-30, 2004

29）Klinger M, Eipeldauer S, Hacker S, et al：Bevacizumab protects against sinusoidal obstruction syndrome and does not increase response rate in neoadjuvant XELOX/FOLFOX therapy of colorectal cancer liver metastases. Eur J Surg Oncol 35：515-520, 2009

30）Nalluri SR, Chu D, Keresztes R, et al：Risk of venous thromboembolism with the angiogenesis inhibitor bevacizumab in cancer patients：a meta-analysis. JAMA 300：2277-2285, 2008