Распространенный РПК

ЛТ при РПК в большинстве случаев носит паллиативный характер, однако метод может иметь значение при использовании его в предоперационном периоде. Паллиативный эффект может быть достигнут приблизительно у 10—20% больных при использовании 5-ФУ. В нескольких клинических исследованиях продемонстрировано повышение частоты достижения эффекта и облегчения тяжести симптомов заболевания при сочетании 5-ФУ с лейковорином, однако улучшения показателей выживаемости не выявлено ни в одном из них [44—50]. Иринотекан (СРТ-11) был одобрен Управлением по контролю за качеством пищевых продуктов и лекарственных препаратов (FDA) США для лечения пациентов, рефрактерных к ХТ 5-ФУ [51—54]. Участие пациентов в клинических исследованиях по применению этого препарата оправданно. Проводятся также испытания и оценка ряда других лекарственных препаратов по изучению эффективности лечения РТК [55]. Оксалиплатин в самостоятельном режиме или сочетании с 5-ФУ и лейковорином также проявил активность у больных, рефрактерных к 5-ФУ [56—59]


1. American Cancer Society. Cancer Facts and Figures 2007. Atlanta, Ga: American Cancer Society, 2007. Also available online. Last accessed September 7, 2007.
2. Snady H., Merrick M.A. Improving the treatment of colorectal cancer: the role of EUS. Cancer Invest 1998;16(8):572—81.
3. Colon and rectum. In: American Joint Committee on Cancer. AJCC Cancer Staging Manual. 6th ed. NY, Springer; 2002. p. 113—24.
4. Compton C.C., Greene F.L. The staging of colorectal cancer: 2004 and beyond. CA Cancer J Clin 2004;54(6):295—308.
5. Nelson H., Petrelli N., Carlin A. et al. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst 2001;93(8):583—96.
6. Swanson R.S., Compton C.C., Stewart A.K. et al. The prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann Surg Oncol 2003;10(1):65—71.
7. Le Voyer T.E., Sigurdson E.R., Hanlon A.L. et al. Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol 2003;21(15):2912—9.
8. Prandi M., Lionetto R., Bini A. et al. Prognostic evaluation of stage B colon cancer patients is improved by an adequate lymphadenectomy: results of a secondary analysis of a large scale adjuvant trial. Ann Surg 2002;235(4):458—63.
9. Tepper J.E., O'Connell M.J., Niedzwiecki D. et al. Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol 2001;19(1):157—63.
10. McLeod H.L., Murray G.I. Tumour markers of prognosis in colorectal cancer. Br J Cancer 1999;79(2):191—203.
11. Jen J., Kim H., Piantadosi S. et al. Allelic loss of chromosome 18q and prognosis in colorectal cancer. N Engl J Med 1994;331(4):213—21.
12. Lanza G., Matteuzzi M., Gafa ’ R. et al. Chromosome 18q allelic loss and prognosis in stage II and III colon cancer. Int J Cancer 1998;79(4):390—5.
13. Gryfe R., Kim H., Hsieh E.T. et al. Tumor micro satellite instability and clinical outcome in young patients with colorectal cancer. N Engl J Med 2000;342(2):69—77.
14. Dignam J.J., Colangelo L., Tian W. et al. Outcomes among African-Americans and Caucasians in colon cancer adjuvant therapy trials: findings from the National Surgical Adjuvant Breast and Bowel Project. J Natl Cancer Inst 1999;91(22):1933—40.
15. Heald R.J., Ryall R.D. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1986;1(8496): 1479—82.
16. De Haas-Kock D.F., Baeten C.G., Jager J.J. et al. Prognostic significance of radial margins of clearance in rectal cancer. Br J Surg 1996;83(6):781—5.
17. Cannon-Albright L.A., Skolnick M.H., Bishop D.T. et al. Common inheritance of susceptibility to colonic adenomatous polyps and associated colorectal cancers. N Engl J Med
18. Thorson A.G., Knezetic J.A., Lynch H.T. A century of progress in hereditary nonpolyposis colorectal cancer (Lynch syndrome). Dis Colon Rectum 1999;42(1):1—9.
19. Smith R.A., von Eschenbach A.C., Wender R. et al. American Cancer Society guidelines for the early detection of cancer: update of early detection guidelines for prostate, colorectal, and endometrial cancers. Also: update 2001 — testing for early lung cancer detection. CA Cancer J Clin 2001;51(1):38—75; quiz 77—80.
20. Watson P., Lin K.M., Rodriguez-Bigas M.A. et al. Colorectal carcinoma survival among hereditary nonpolyposis colorectal carcinoma family members. Cancer 1998;83(2):259—66.
21. Ransohoff D.F., Lang C.A. Screening for colorectal cancer. N Engl J Med 1991;325(1):37—41.
22. Fuchs C.S., Giovannucci E.L., Colditz G.A. et al. A prospective study of family history and the risk of colorectal cancer. N Engl J Med 1994;331(25):1669—74.
23. Winawer S.J. Screening for colorectal cancer. Cancer: Principles and Practice of Oncology Updates 1987;2(1):1—16.
24. Martin E.W. Jr., Minton J.P., Carey L.C. CEA-directed second-look surgery in the asymptomatic patient after primary resection of colorectal carcinoma. Ann Surg 1985;202(3):310—7.
25. Bruinvels D.J., Stiggelbout A.M., Kievit J. et al. Follow-up of patients with colorectal cancer. A meta-analysis. Ann Surg 1994;219(2):174—82.
26. Lautenbach E., Forde K.A., Neugut A.I. Benefits of colonoscopic surveillance after curative resection of colorectal cancer. Ann Surg 1994;220(2):206—11.
27. Khoury D.A., Opelka F.G., Beck D.E. et al. Colon surveillance after colorectal cancer surgery. Dis Colon Rectum 1996;39(3):252—6.
28. Safi F., Link K.H., Beger H.G. Is follow-up of colorectal cancer patients worthwhile? Dis Colon Rectum 1993;36(7):636—43; discussion 643—4.
29. Moertel C.G., Fleming T.R., Macdonald J.S. et al. An evaluation of the carcinoembryonic antigen (CEA) test for monitoring patients with resected colon cancer. JAMA 1993;270(8):943—7.
30. Rosen M., Chan L., Beart R.W. Jr. et al.: Follow-up of colorectal cancer: a meta-analysis. Dis Colon Rectum 1998;41(9): 1116—26.
31. Desch C.E., Benson A.B. 3rd, Smith T.J. et al. Recommended colorectal cancer surveillance guidelines by the American Society of Clinical Oncology. J Clin Oncol 1999;17(4):1312.
32. Benson A.B. 3-d, Desch C.E., Flynn P.J. et al. 2000 update of American Society of Clinical Oncology colorectal cancer surveillance guidelines. J Clin Oncol 2000;18(20):3586—8.
33. Clinical practice guidelines for the use of tumor markers in breast and colorectal cancer. Adopted on May 17, 1996 by the American Society of Clinical Oncology. J Clin Oncol 1996;14(10):2843—77.
34. Lechner P., Lind P., Goldenberg D.M. Can postoperative surveillance with serial CEA immunoscintigraphy detect respectable rectal cancer recurrence and potentially improve tumor-free survival? J Am Coll Surg 2000;191(5):511—8.
35. Roth J.A. p53 prognostication: paradigm or paradox? Clin Cancer Res 1999;5(11):3345.
36. O'Connell M., Wieand H., Krook J. et al. Lack of value for methyl-CCNU (MeCCNU) as a component of effective rectal cancer surgical adjuvant therapy: interim analysis of intergroup
protocol 86-47-51. Proc Am Soc Clin Oncol 1991;10:A—403,134.
37. Radiation therapy and fluorouracil with or without semustine for the treatment of patients with surgical adjuvant adenocarcinoma of the rectum. Gastrointestinal Tumor Study Group. J Clin Oncol 1992;10(4):549—57.
38. Moertel C.G. Chemotherapy for colorectal cancer. N Engl J Med 1994;330(16):1136—42.
39. Kachnic L.A., Willett C.G. Radiation therapy in the management of rectal cancer. Curr Opin Oncol 2001;13(4):300—6.
40. Improved survival with preoperative radiotherapy in respectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med 1997;336(14):980—7.
41. Kollmorgen C.F., Meagher A.P., Wolff B.G. et al. The longterm effect of adjuvant postoperative chemoradiotherapy for rectal carcinoma on bowel function. Ann Surg 1994;220(5):676—82.
42. Koelbl O., Richter S., Flentje M. Influence of patient positioning on dose-volume histogram and normal tissue complication probability for small bowel and bladder in patients receiving pelvic irradiation: a prospective study using a 3D planning system and a radiobiological model. Int J Radiat Oncol Biol Phys 1999;45(5):1193—8.
43. Gunderson L.L., Russell A.H., Llewellyn H.J. et al. Treatment planning for colorectal cancer: radiation and surgical techniques and value of small-bowel films. Int J Radiat Oncol Biol Phys
44. Petrelli N., Douglass H.O. Jr., Herrera L. et al. The modulation of fluorouracil with leucovorin in metastatic colorectal carcinoma: a prospective randomized phase III trial. Gastrointestinal Tumor Study Group. J Clin Oncol 1989;7(10):1419—26.
45. Erlichman C., Fine S., Wong A. et al. A randomized trial of fluorouracil and folinic acid in patients with metastatic colorectal carcinoma. J Clin Oncol 1988;6(3):469—75.
46. Doroshow J.H., Multhauf P., Leong L. et al. Prospective randomized comparison of fluorouracil versus fluorouracil and high-dose continuous infusion leucovorin calcium for the treatment of advanced measurable colorectal cancer in patients previously unexposed to chemotherapy. J Clin Oncol 1990;8(3):491—501.
47. Poon M.A., O'Connell M.J., Wieand H.S. et al. Biochemical modulation of fluorouracil with leucovorin: confirmatory evidence of improved therapeutic efficacy in advanced colorectal cancer. J Clin Oncol 1991;9(11):1967—72.
48. Valone F.H., Friedman M.A., Wittlinger P.S. et al. Treatment of patients with advanced colorectal carcinomas with fluorouracil alone, high-dose leucovorin plus fluorouracil, or sequential methotrexate, fluorouracil, and leucovorin: a randomized trial of the Northern California Oncology Group. J Clin Oncol 1989;7(10):1427—36.
49. Borner M.M., Castiglione M., Bacchi M. et al. The impact of adding low-dose leucovorin to monthly 5-fluorouracil in advanced colorectal carcinoma: results of a phase III trial. Swiss Group for Clinical Cancer Research (SAKK). Ann Oncol 1998;9(5):535—41.
50. Modulation of fluorouracil by leucovorin in patients with advanced colorectal cancer: evidence in terms of response rate. Advanced Colorectal Cancer Meta-Analysis Project. J Clin Oncol 1992;10(6):896—903.
51. Rothenberg M.L., Eckardt J.R., Kuhn J.G. et al. Phase II trial of irinotecan in patients with progressive or rapidly recurrent colorectal cancer. J Clin Oncol 1996;14(4):1128—35.
52. Conti J.A., Kemeny N.E., Saltz L.B. et al. Irinotecan is an active agent in untreated patients with metastatic colorectal cancer. J Clin Oncol 1996;14(3):709—15.
53. Rougier P., van Cutsem E., Bajetta E. et al. Randomised trial of irinotecan versus fluorouracil by continuous infusion after fluorouracil failure in patients with metastatic colorectal cancer. Lancet 1998;352(9138):1407—12.
54. Cunningham D., PyrhЪnen S., James R.D. et al. Randomised trial of irinotecan plus supportive care versus supportive care alone after fluorouracil failure for patients with metastatic colorectal cancer. Lancet 1998;352(9138):1413—8.
55. Von Hoff D.D. Promising new agents for treatment of patients with colorectal cancer. Semin Oncol 1998;25(5, Suppl 11):47—52.
56. de Gramont A., Vignoud J., Tournigand C. et al. Oxaliplatin with high-dose leucovorin and 5-fluorouracil 48-hour continuous infusion in pretreated metastatic colorectal cancer. Eur J Cancer 1997;33(2):214—9.
57. Bleiberg H., de Gramont A. Oxaliplatin plus 5-fluorouracil: clinical experience in patients with advanced colorectal cancer. Semin Oncol 1998;25(2, Suppl 5):32—9.
58. Cvitkovic E., Bekradda M. Oxaliplatin: a new therapeutic option in colorectal cancer. Semin Oncol 1999;26(6):647—62.
59. Giacchetti S., Perpoint B., Zidani R. et al. Phase III multicenter randomized trial of oxaliplatin added to chronomodulated fluorouracil-leucovorin as first-line treatment of metastatic colorectal cancer. J Clin Oncol 2000;18(1):136—47.