臨床外科68巻3号

2013年03月発行

特集 CRT時代の直腸癌手術―最善の戦略は何か 〔CRTに関する諸問題〕

術前CRT症例における術後の問題―術後補助化学療法の必要性と術後機能障害

著者： 秋吉高志¹ 上野雅資¹ 福長洋介¹ 長山聡¹ 藤本佳也¹ 小西毅¹ 山口俊晴¹

所属機関： ¹がん研有明病院消化器外科

ページ範囲：P.296 - P.300

【ポイント】

◆NCCNのガイドラインでは術前CRTを施行する全症例で術後補助化学療法が推奨されている．

◆術前CRTを施行した直腸癌に対する術後補助化学療法の有効性を示すエビデンスは十分ではない．

◆術前CRTによって性機能障害と排便機能障害は手術単独に比べて有意に増加する．

参考文献

1）Andre T, Boni C, Navarro M, et al：Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage Ⅱ or Ⅲ colon cancer in the MOSAIC trial. J Clin Oncol 27：3109-3116, 2009

2）Kuebler JP, Wieand HS, O' Connell MJ, et al：Oxaliplatin combined with weekly bolus fluorouracil and leucovorin as surgical adjuvant chemotherapy for stage Ⅱ and Ⅲ colon cancer：results from NSABP C-07. J Clin Oncol 25：2198-2204, 2007

3）Akasu T, Moriya Y, Ohashi Y, et al：Adjuvant chemotherapy with uracil-tegafur for pathological stage Ⅲ rectal cancer after mesorectal excision with selective lateral pelvic lymphadenectomy：a multicenter randomized controlled trial. Jpn J Clin Oncol 36：237-244, 2006

4）Gray R, Barnwell J, McConkey C, et al：Adjuvant chemotherapy versus observation in patients with colorectal cancer：a randomised study. Lancet 370：2020-2029, 2007

5）Rectal Cancer V.4. NCCN Clinical Practical Guidelines in Oncology 2013. （http://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf）

6）Glimelius B, Pahlman L, Cervantes A：Rectal cancer：ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 21 Suppl 5：v82-86, 2010

7）Valentini V, Aristei C, Glimelius B, et al：Multidisciplinary Rectal Cancer Management：2nd European Rectal Cancer Consensus Conference （EURECA-CC2）. Radiother Oncol 92：148-163, 2009

8）Sauer R, Becker H, Hohenberger W, et al：Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351：1731-1740, 2004

9）Bosset JF, Collette L, Calais G, et al：Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355：1114-1123, 2006

10）Bujko K, Glynne-Jones R, Bujko M：Does adjuvant fluoropyrimidine-based chemotherapy provide a benefit for patients with resected rectal cancer who have already received neoadjuvant radiochemotherapy? A systematic review of randomised trials. Ann Oncol 21：1743-1750, 2010

11）Quah HM, Chou JF, Gonen M, et al：Pathologic stage is most prognostic of disease-free survival in locally advanced rectal cancer patients after preoperative chemoradiation. Cancer 113：57-64, 2008

12）Park IJ, You YN, Agarwal A, et al：Neoadjuvant treatment response as an early response indicator for patients with rectal cancer. J Clin Oncol 30：1770-1776, 2012

13）Kim TH, Chang HJ, Kim DY, et al：Pathologic nodal classification is the most discriminating prognostic factor for disease-free survival in rectal cancer patients treated with preoperative chemoradiotherapy and curative resection. Int J Radiat Oncol Biol Phys 77：1158-1165, 2010

14）Bujko K, Michalski W, Kepka L, et al：Association between pathologic response in metastatic lymph nodes after preoperative chemoradiotherapy and risk of distant metastases in rectal cancer：An analysis of outcomes in a randomized trial. Int J Radiat Oncol Biol Phys 67：369-377, 2007

15）Capirci C, Valentini V, Cionini L, et al：Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer：long-term analysis of 566 ypCR patients. Int J Radiat Oncol Biol Phys 72：99-107, 2008

16）Maas M, Nelemans PJ, Valentini V, et al：Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer：a pooled analysis of individual patient data. Lancet Oncol 11：835-844, 2010

17）Kiran RP, Kirat HT, Burgess AN, et al：Is adjuvant chemotherapy really needed after curative surgery for rectal cancer patients who are node-negative after neoadjuvant chemoradiotherapy? Ann Surg Oncol 19：1206-1212, 2012

18）Collette L, Bosset JF, den Dulk M, et al：Patients with curative resection of cT3-4 rectal cancer after preoperative radiotherapy or radiochemotherapy：does anybody benefit from adjuvant fluorouracil-based chemotherapy? A trial of the European Organisation for Research and Treatment of Cancer Radiation Oncology Group. J Clin Oncol 25：4379-4386, 2007

19）Kapiteijn E, Marijnen CA, Nagtegaal ID, et al：Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345：638-646, 2001

20）Marijnen CA, van de Velde CJ, Putter H, et al：Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer：report of a multicenter randomized trial. J Clin Oncol 23：1847-1858, 2005

21）Peeters KC, van de Velde CJ, Leer JW, et al：Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer：increased bowel dysfunction in irradiated patients―a Dutch colorectal cancer group study. J Clin Oncol 23：6199-6206, 2005

22）Sebag-Montefiore D, Stephens RJ, Steele R, et al：Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer （MRC CR07 and NCIC-CTG C016）：a multicentre, randomised trial. Lancet 373：811-820, 2009

23）Stephens RJ, Thompson LC, Quirke P, et al：Impact of short-course preoperative radiotherapy for rectal cancer on patients' quality of life：data from the Medical Research Council CR07/National Cancer Institute of Canada Clinical Trials Group C016 randomized clinical trial. J Clin Oncol 28：4233-4239, 2010

24）Pucciarelli S, Del Bianco P, Efficace F, et al：Health-related quality of life, faecal continence and bowel function in rectal cancer patients after chemoradiotherapy followed by radical surgery. Support Care Cancer 18：601-608, 2010

25）Pucciarelli S, Del Bianco P, Efficace F, et al：Patient-reported outcomes after neoadjuvant chemoradiotherapy for rectal cancer：a multicenter prospective observational study. Ann Surg 253：71-77, 2011