Preview

Тазовая хирургия и онкология

Расширенный поиск

Неоадъювантная терапия при местно-распространенном раке прямой кишки

https://doi.org/10.17650/2686-9594-2022-12-2-36-45

Полный текст:

Аннотация

К началу 2000‑х годов сформировался определенный стандарт ведения пациентов с местно-распространенным раком прямой кишки – проведение предоперационной химиолучевой терапии с последующим, через 6–8 нед. с момента окончания лучевой терапии, хирургическим лечением. При этом четких данных, указывающих на эффективность адъювантной химиотерапии в данной клинической ситуации, получено не было. Однако за последние десятилетия концепция неоадъювантного лечения больных местно-распространенным раком толстой кишки поменялась за счет как более широкого применения гипофракционирования в лучевой терапии, так и переноса химиотерапевтического лечения с послеоперационного на предоперационный этап. Целью данного обзора литературы является изучение результатов исследований, посвященных неоадъювантному лечению при местно-распространенном раке толстой кишки, и сравнение эффективности и переносимости различных опций, которые имеются в настоящее время у онколога в лечении данной группы пациентов.

Об авторах

М. Ю. Федянин
ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н. Н. Блохина» Минздрава России
Россия

Михаил Юрьевич Федянин

115478 Москва, Каширское шоссе, 24



А. А. Трякин
ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н. Н. Блохина» Минздрава России
Россия

115478 Москва, Каширское шоссе, 24



Список литературы

1. Swedish Rectal Cancer Trial, Cedermark B., Dahlberg M. et al. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 1997;336:980–7.

2. Kapiteijn E., Marijnen C.A., Nagtegaal I.D. et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001;345:638–46.

3. Bosset J.F., Calais G., Mineur L. et al. Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer: preliminary results – EORTC 22921. J Clin Oncol 2005;23:5620–7.

4. Gerard J.P., Conroy T., Bonnetain F. et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3–4 rectal cancers: results of FFCD 9203. J Clin Oncol 2006;24:4620–5.

5. Sauer R., Becker H., Hohenberger W. et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351:1731–40.

6. Bujko K., Nowacki M.P., Nasierowska-Guttmejer A. et al. Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 2006;93:1215–23.

7. Ngan S.Y., Burmeister B., Fisher R.J. et al. Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: Trans-Tasman Radiation Oncology Group trial 01.04. J Clin Oncol 2012;30:3827–33.

8. Ansari N., Solomon M.J., Fisher R.J. et al. Acute adverse events and postoperative complications in a randomized trial of preoperative short-course radiotherapy versus long-course chemoradiotherapy for T3 adenocarcinoma of the rectum: Trans-Tasman Radiation Oncology Group Trial (TROG 01.04). Ann Surg 2017;265:882–8.

9. Erlandsson J., Holm T., Pettersson D. et al. Optimal fractionation of preoperative radiotherapy and timing to surgery for rectal cancer (Stockholm III): a multicentre, randomised, non-blinded, phase 3, non-inferiority trial. Lancet Oncol 2017;18:336–46.

10. Erlandsson J., Lorinc E., Ahlberg M. et al. Tumour regression after radiotherapy for rectal cancer – results from the randomised Stockholm III trial. Radiother Oncol 2019;135:178–86.

11. Van der Pas M.H., Meijer S., Hoekstra O.S. et al. Sentinel-lymph-node procedure in colon and rectal cancer: a systematic review and meta-analysis. Lancet Oncol 2011;12(6):540–50.

12. Glynne-Jones R., Wallace M., Livingstone J.I., Meyrick-Thomas J. Complete clinical response after preoperative chemoradiation in rectal cancer: is a “wait and see” policy justified? Dis Colon Rectum 2008;51(1):10–9.

13. Washington M.K., Berlin J., Branton P. et al. Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum. Arch Pathol Lab Med 2009; 133(10):1539–51.

14. Quirke P., Durdey P., Dixon M.F., Williams N.S. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 1986;2(8514):996–9.

15. Birbeck K.F., Macklin C.P., Tiffin N.J. et al. Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg 2002;235(4):449–57.

16. Bosset J.F., Collette L., Calais G. et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 2006;355(11):1114–23.

17. Roh M.S., Colangelo L.H., O’Connell M.J. et al. Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol 2009;27(31):5124–30.

18. Maas M., Nelemans P.J., 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 2010;11(9):835–44.

19. Chua Y.J. Pathological complete response: still a relevant endpoint in rectal cancer? Lancet Oncol 2010;11(9):807–8.

20. Dworak O., Keilholz L., Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Color Dis 1997;12(1):19–23.

21. Trakarnsanga A., Gönen M., Shia J. et al. Comparison of tumor regression grade systems for locally advanced rectal cancer after multimodality treatment. J Natl Cancer Inst 2014;106(10).

22. Minsky B.D., Rodel C. Identifying the most predictive postchemoradiation TRG system for rectal cancer. J Natl Cancer Inst 2014;106(10).

23. Mace A.G., Pai R.K., Stocchi L., Kalady M.F. American Joint Committee on Cancer and College of American Pathologists regression grade: a new prognostic factor in rectal cancer. Dis Colon Rectum 2015;58(1):32–44.

24. Mandard A.M., Dalibard F., Mandard J.C. et al. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinico-Pathologic Correlations. Cancer 1994;73:2680–6.

25. Rödel C., Martus P., Papadoupolos T. et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 2005;23(34):8688–96.

26. Quah H.M., Chou J.F., Gonen M. et al. Pathologic stage is most prognostic of disease-free survival in locally advanced rectal cancer patients after preoperative chemoradiation. Cancer 2008;113(1):57–64.

27. Лавникова Г.А., Гош Т.Е., Талалаева А.В. Гистологический метод количественной оценки степени лучевого повреждения опухоли. Медицинская радиология 1978;(3):6–9.

28. Лавникова Г.А. Гистологический метод количественной оценки терапевтического повреждения опухоли. М., 1979. 13 с.

29. Agarwal A., Chang G.J., Hu C.Y. et al. Quantified pathologic response assessed as residual tumor burden is a predictor of recurrence-free survival in patients with rectal cancer who undergo resection after neoadjuvant chemoradiotherapy. Cancer 2013;119:4231–41.

30. Park I.J., You Y.N., Agarwal A. et al. Neoadjuvant treatment response as an early response indicator for patients with rectal cancer. J Clin Oncol 2012;30(15):1770–6.

31. Fokas E., Liersch T., Fietkau R. et al. Tumor regression grading after preoperative chemoradiotherapy for locally advanced rectal carcinoma revisited: updated results of the CAO/ARO/AIO-94 trial. J Clin Oncol 2014;32(15):1554–62.

32. George T.J.Jr, Allegra C.J., Yothers G. Neoadjuvant rectal (NAR) score: a new surrogate endpoint in rectal cancer clinical trials. Curr Colorectal Cancer Rep 2015;11:275–80.

33. Valentini V., Van Stiphout R.G., Lammering G. et al. Nomograms for predicting local recurrence, distant metastases, and overall survival for patients with locally advanced rectal cancer on the basis of European randomized clinical trials. J Clin Oncol 2011;29:3163–72.

34. Yothers G., George T.J., Petrelli N.J. et al. Neoadjuvant rectal cancer (RC) score predicts survival: potential surrogate endpoint for early phase trials. J Clin Oncol 2014;32(Suppl):abstr.3533.

35. Raissouni S., Mercer J., Gresham G. et al. External validation of the neoadjuvant rectal (NAR) score and Valentini rediction nomogram (VPN): a multicenter study. J Clin Oncol 2014;32(Suppl):abstr.3532.

36. Van der Valk M.J.M., Vuijk F.A., Putter H. et al. Disqualification of neoadjuvant rectal score based on data of 6596 patients from the Netherlands Cancer Registry. Clin Colorectal Cancer 2019;18(2):e231– e236. DOI: 10.1016/j.clcc.2019.01.001.

37. Yothers G., George T.J., Allegra C.J. et al. Predictive validity of NeoAdjuvant Rectal (NAR) score and pathologic complete response (ypCR) for overall survival (OS) as surrogate endpoints in rectal cancer clinical trial. J Clin Oncol 2016;34(Suppl):abstr.3533.

38. Bosset J.-F., Calais G., Mineur L. et al. Fluorouracil-based adjuvant chemotherapy after preoperative chemoradiotherapy in rectal cancer: long-term results of the EORTC 22921 randomised study. Lancet Oncol 2014;15:184–90.

39. McCarthy K., Pearson K., Fulton R., Hewitt J. Pre-operative chemoradiation for non-metastatic locally advanced rectal cancer. Cochrane Database Syst Rev 2012;12:CD008368.

40. Gérard J.-P., Conroy T., Bonnetain F. et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3–4 rectal cancers: results of FFCD 9203. J Clin Oncol 2006;24:4620–5.

41. Latkauskas T., Pauzas H., Gineikiene I. et al. Initial results of a randomized controlled trial comparing clinical and pathological downstaging of rectal cancer after preoperative short-course radiotherapy or long-term chemoradiotherapy, both with delayed surgery. Colorectal Dis 2012;14:294–8.

42. Allegra C.J., Yothers G., O’Connell M.J. et al. Neoadjuvant 5-FU or capecitabine plus radiation with or without oxaliplatin in rectal cancer patients: a phase III randomized clinical trial. J Natl Cancer Inst 2015;107:djv248.

43. Aschele C., Cionini L., Lonardi S. et al. Primary tumor response to preoperative chemoradiation with or without oxaliplatin in locally advanced rectal cancer: pathologic results of the STAR-01 randomized phase III trial. J Clin Oncol 2011;29:2773–80.

44. Gérard J.-P., Azria D., Gourgou-Bourgade S. et al. Clinical outcome of the ACCORD12/0405 PRODIGE 2 randomized trial in rectal cancer. J Clin Oncol 2012;30:4558–65.

45. Schmoll H.-J., Haustermans K., Price T.J. et al. Preoperative chemoradiotherapy and postoperative chemotherapy with capecitabine and oxaliplatin versus capecitabine alone in locally advanced rectal cancer: disease-free survival results at interim analysis, ASCO Annual Meeting Proceedings. Ann Oncol 2014;32(Suppl):3501.

46. Deng Y., Chi P., Lan P. et al. Neoadjuvant modified FOLFOX6 with or without radiation versus fluorouracil plus radiation for locally advanced rectal cancer: final results of the Chinese FOWARC trial. J Clin Oncol 2019;37:3223–33.

47. Fontana E., Zichi C., Smyth E. et al. Neoadjuvant chemoradiation (CRT) for locally advanced rectal cancer (LARC) with or without oxaliplatin (OX): Individual patient data (IPD) metaanalysis of three randomized controlled trials (RCTs) with subgroup analyses of age cohorts. J Clin Oncol 2020;38:4074. DOI: 10.1200/JCO.2020.38.15_suppl.4074.

48. Sebag-Montefiore D., Adams R., Gollins S. et al. ARISTOTLE: A phase III trial comparing concurrent capecitabine with capecitabine and irinotecan (Ir) chemoradiation as preoperative treatment for MRI-defined locally advanced rectal cancer (LARC). J Clin Oncol 2020;38:4101.

49. George T.J., Yothers G., Hong T.S. et al. NRG-GI002: a phase II clinical trial platform using total neoadjuvant therapy (TNT) in locally advanced rectal cancer (LARC) – first experimental arm (EA) initial results. J Clin Oncol 2019;37:3505.

50. Rahma O., Yothers G., Hong T. et al. NRG-GI002: A phase II clinical trial platform using total neoadjuvant therapy (TNT) in locally advanced rectal cancer (LARC) –Pembrolizumab experimental arm (EA) primary results. J Clin Oncol 2019;37:8.

51. Salvatore L., Bensi M., Corallo S. et al. Phase II study of preoperative (PREOP) chemoradiotherapy (CTRT) plus avelumab (AVE) in patients (PTS) with locally advanced rectal cancer (LARC): The AVANA study. J Clin Oncol 2019;37:3511.

52. Inamori K., Togashi Y., Bando H. et al. Translational research of voltage-A1: Efficacy predictors of preoperative chemoradiotherapy and subsequent nivolumab monotherapy in patients with microsatellite-stable locally advanced rectal cancer. J Clin Oncol 2019;37:4073.

53. Garcia-Aguilar J., Chow O., Smith D. et al. Effect of adding mFOLFOX6 after neoadjuvant chemoradiation in locally advanced rectal cancer: a multicentre, phase 2 trial. Lancet Oncol 2015;16(8): 957–66. DOI: 10.1016/S1470-2045(15)00004-2.

54. Bujko K., Wyrwicz L., Rutkowski A. et al. Long-course oxaliplatin-based preoperative chemoradiation versus 5 × 5 Gy and consolidation chemotherapy for cT4 or fixed cT3 rectal cancer: results of a randomized phase III study. Ann Oncol 2016;27(5):834–42. DOI: 10.1093/annonc/mdw062.

55. Ciseł B., Pietrzak L., Michalski W. et al. Long-course preoperative chemoradiation versus 5 × 5 Gy and consolidation chemotherapy for clinical T4 and fixed clinical T3 rectal cancer: long-term results of the randomized Polish II study. Ann Oncol 2019;30(8):1298–303. DOI: 10.1093/annonc/mdz186.

56. Jin J., Tang Y., Hu Ch. et al. A multicenter, randomized, phase III trial of short-term radiotherapy plus chemotherapy versus long-term chemoradiotherapy in locally advanced rectal cancer (STELLAR): The final reports. J Clin Oncol 2021;37:3510.

57. Zhu J., Sun X., Liu A. et al. Long-term outcome of a phase III trial on neoadjuvant chemoradiation with capecitabine and irinotecan in patients with locally advanced rectal cancer: Updated results of the CinClare trial. J Clin Oncol 2021;37:3603.

58. Conroy T., Lamfichekh N., Etienne P.-L. et al. Total neoadjuvant therapy with mFOLFIRINOX versus preoperative chemoradiation in patients with locally advanced rectal cancer: Final results of PRODIGE 23 phase III trial, a UNICANCER GI trial. Am Soc Clin Oncol 2020;38:4007.

59. Conroy T., Bosset J., Etienne P. et al. Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol 2021;22(5):702–15. DOI: 10.1016/S1470-2045(21)00079-6.

60. Bahadoer R., Dijkstra E., van Etten B. et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol 2021;22(1):29–42. DOI: 10.1016/S1470-2045(20)30555-6.

61. Cercek A., Goodman K.A., Hajj C. et al. Neoadjuvant chemotherapy first, followed by chemoradiation and then surgery, in the management of locally advanced rectal cancer. J Natl Compr Cancer Ntwk 2014;12:513–9.

62. Cercek A., Roxburgh C.S.D., Strombom P. et al. Adoption of total neoadjuvant therapy for locally advanced rectal cancer. JAMA Oncol 2018;4:e180071.

63. Fokas E., Allgäuer M., Polat B. et al. Randomized Phase II Trial of Chemoradiotherapy Plus Induction or Consolidation Chemotherapy as Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer: CAO/ARO/AIO-12. J Clin Oncol 2019;37(34):3212–22. DOI: 10.1200/JCO.19.00308.

64. Thompson H., Ki Kim J., Yuval J. et al. Survival and organ preservation according to clinical response after total neoadjuvant therapy in locally advanced rectal cancer patients: A secondary analysis from the organ preservation in rectal adenocarcinoma (OPRA) trial. J Clin Oncol 2021;37:3509.

65. Deng Y., Chi P., Lan P. et al. Neoadjuvant modified FOLFOX6 with or without radiation versus fluorouracil plus radiation for locally advanced rectal cancer: final results of the Chinese FOWARC trial. J Clin Oncol 2019;37(34):3223–33. DOI: 10.1200/JCO.18.02309.

66. Ding P., Wang X., Li Y. et al. Neoadjuvant chemotherapy with oxaliplatin and capecitabine versus chemoradiation with capecitabine for locally advanced rectal cancer with uninvolved mesorectal fascia (CONVERT): Initial results of a multicenter randomised, open-label, phase III trial. Ann Oncol 2021;32(Suppl):S1283–S1346. DOI: 10.1016/annonc/annonc741.

67. Rouanet P. Tailored treatment strategy for locally advanced rectal carcinoma: Five-year results of the French phase II, randomized, multicenter GRECCAR4 trial. J Clin Oncol 2020:38:4014.

68. Kodama H., Terazawa T., Ishizuka Y. et al. Retrospective comparison of mFOLFOXIRI with XELOX/SOX as neoadjuvant chemotherapy for locally advanced rectal cancer. In Vivo 2021; 35(2):977–85. DOI: 10.21873/invivo.12340.

69. Schrag D., Weiser M.R., Goodman K.A. et al. Neoadjuvant chemotherapy without routine use of radiation therapy for patients with locally advanced rectal cancer: a pilot trial. J Clin Oncol 2014;32:513.

70. Tomida A., Uehara K., Hiramatsu K. et al. Neoadjuvant CAPOX and bevacizumab alone for locally advanced rectal cancer: long-term results from the N-SOG 03 trial. Int J Clin Oncol 2019;24(4):403–10. DOI: 10.1007/s10147-018-1372-6.

71. Fernandez-Martos C., Pericay C., Maurel J. et al. Phase II trial of neoadjuvant mFOLFOX 6 with panitumumab (P) in T3 rectal cancer with clear mesorectal fascia (MRF) and KRAS, NRAS, BRAF, PI3KCA wild type (4WT). GEMCAD 1601 PIER trial. J Clin Oncol 2021:39:3512.

72. Kennecke H., Brown C., Loree J. et al. CCTG CO.28 primary endpoint analysis: Neoadjuvant chemotherapy, excision and observation for early rectal cancer, the NEO trial. J Clin Oncol 2021:39:3508.

73. Jensen L.H., Poulsen L.Ø., Risum S.N. et al. Curative chemoradiation for low rectal cancer: Early clinical outcomes from a multicentre phase II trial. Ann Oncol 2020:31(Suppl 4):S409–S461. DOI: 10.1016/annonc/annonc270.


Рецензия

Для цитирования:


Федянин М.Ю., Трякин А.А. Неоадъювантная терапия при местно-распространенном раке прямой кишки. Тазовая хирургия и онкология. 2022;12(2):36-45. https://doi.org/10.17650/2686-9594-2022-12-2-36-45

For citation:


Fedyanin M.Yu., Tryakin A.A. Neoadjuvant therapy for locally advanced rectal cancer. Pelvic Surgery and Oncology. 2022;12(2):36-45. (In Russ.) https://doi.org/10.17650/2686-9594-2022-12-2-36-45

Просмотров: 87


Creative Commons License
Контент доступен под лицензией Creative Commons Attribution 4.0 License.


ISSN 2686-7435 (Print)
ISSN 2686-9594 (Online)

 



 

X