结直肠癌篇08—肠癌化疗办法怎么选？必要多少周期？
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">一<span style="color: black;">初期</span>结直肠癌术后辅助化疗</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">日前</span><span style="color: black;">能够</span>用于肠癌术后辅助化疗的<span style="color: black;">药品</span><span style="color: black;">重点</span>是三个：氟尿嘧啶、奥沙利铂和卡培他滨。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这三个<span style="color: black;">药品</span><span style="color: black;">摆列</span>组合出2种<span style="color: black;">方法</span>：</p>①FOLFOX <span style="color: black;">方法</span>：氟尿嘧啶+奥沙利铂，每2周<span style="color: black;">1星期</span>期，共12个周期②XE-LOX（CapeOx） <span style="color: black;">方法</span>：卡培他滨+奥沙利铂， 每3周<span style="color: black;">1星期</span>期，共8个周期<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这两类<span style="color: black;">方法</span>，<span style="color: black;">运用</span>哪一种<span style="color: black;">通常</span>取决于<span style="color: black;">病人</span>对不同<span style="color: black;">药品</span>副反应的耐受性<span style="color: black;">评定</span>和<span style="color: black;">大夫</span>的用药习惯。</p>③<span style="color: black;">另一</span>，有些<span style="color: black;">病人</span><span style="color: black;">因为</span>病期较早或年龄<span style="color: black;">很强</span>，<span style="color: black;">亦</span><span style="color: black;">能够</span>采用“单药化疗”：只<span style="color: black;">运用</span>氟尿嘧啶或卡培他滨（不单用奥沙利铂）。<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">针对</span>辅助化疗<span style="color: black;">方法</span>和化疗周期的<span style="color: black;">选取</span>有以下<span style="color: black;">原因</span><span style="color: black;">必须</span>参考：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2期结直肠癌，如伴有高危<span style="color: black;">原因</span>（清扫淋巴结数目<span style="color: black;">少于</span>12个，神经侵犯，脉管癌栓，术前梗阻，穿孔，切缘阳性，组织学分化差（不<span style="color: black;">包含</span>微卫星高不稳定），<span style="color: black;">意见</span>辅助化疗。单个高危<span style="color: black;">原因</span>：<span style="color: black;">意见</span>单药口服卡培他滨，<span style="color: black;">通常</span>半年时间。合并多个高危<span style="color: black;">原因</span>：<span style="color: black;">意见</span>应用联合化疗<span style="color: black;">方法</span>FOLFOX（奥沙利铂+亚叶酸钙+氟尿嘧啶）3期结肠癌（伴有淋巴结转移），<span style="color: black;">必要</span>术后辅助化疗，标准化疗时间半年，NCCN指南：低危3期结肠癌<span style="color: black;">病人</span>（pT1-3N1期）辅助化疗时间三个月。XELOX（奥沙利铂+口服卡培他滨）<span style="color: black;">方法</span>可<span style="color: black;">思虑</span>3个月，FOLFOX<span style="color: black;">方法</span><span style="color: black;">必须</span>6个月。高危3期结肠癌<span style="color: black;">病人</span>（T4N1-2<span style="color: black;">或</span>TanyN2期），<span style="color: black;">日前</span>XELOX、FOLFOX化疗<span style="color: black;">方法</span>都<span style="color: black;">举荐</span>标准的半年辅助化疗。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic2.zhimg.com/80/v2-4c0ccde5f8a1af081b3d007e3b13ee3d_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic2.zhimg.com/80/v2-d802cfb6354cb4bc3e928ee6131efa39_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">二晚期或转移性结直肠癌化疗<span style="color: black;">方法</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">总体原则：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">①<span style="color: black;">针对</span>初诊晚期，不可手术<span style="color: black;">或</span><span style="color: black;">没</span>潜在手术机会的晚期<span style="color: black;">病人</span>，基本<span style="color: black;">无</span>根治性手术机会，治疗目的是<span style="color: black;">经过</span><span style="color: black;">药品</span>治疗，联合必要的局部治疗手段（射频消融或介入治疗或冷冻治疗），达到<span style="color: black;">没</span>瘤状态，尽可能延长<span style="color: black;">病人</span><span style="color: black;">存活</span>。在治疗初<span style="color: black;">意见</span>完善KRAS/NRAS/BRAF/HER-2等基因检测，<span style="color: black;">按照</span>基因突变<span style="color: black;">状况</span><span style="color: black;">选取</span>合适的靶向药。</p><span style="color: black;">针对</span>KRAS/NRAS基因野生型，身体<span style="color: black;">情况</span>较好的<span style="color: black;">病人</span>，<span style="color: black;">举荐</span>：<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">“FOLFOX+西妥昔单抗<span style="color: black;">或</span>帕尼单抗”；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">“XELOX+贝伐单抗”；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">“FOLFIRI+贝伐单抗”；</p><span style="color: black;">针对</span>体质较弱，<span style="color: black;">不可</span>耐受联合化疗和靶向治疗的<span style="color: black;">病人</span>：<span style="color: black;">意见</span>单药应用“氟尿嘧啶或卡培他滨或伊立替康<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">②部分局部晚期<span style="color: black;">或</span>潜在可切除的单发肝/肺转移<span style="color: black;">病人</span>的新辅助化疗<span style="color: black;">方法</span><span style="color: black;">选取</span>一般与术后辅助化疗<span style="color: black;">方法</span>类似，常用FOLFOX或XE-LOX<span style="color: black;">方法</span>。<span style="color: black;">倘若</span>化疗有效，转为根治手术，术后继续原<span style="color: black;">方法</span>化疗。<span style="color: black;">倘若</span>肿瘤<span style="color: black;">没</span>缩小，化疗<span style="color: black;">没</span>效，<span style="color: black;">必须</span>更换化疗<span style="color: black;">方法</span>，<span style="color: black;">同期</span><span style="color: black;">必须</span>联合靶向<span style="color: black;">药品</span>治疗</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">③化疗<span style="color: black;">药品</span><span style="color: black;">包含</span>：氟尿嘧啶、奥沙利铂、卡培他滨和伊立替康。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">一线治疗：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1三药<span style="color: black;">方法</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">FOLFIRI：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">伊立替康 165 mg/m2，静脉输注，d1 ；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">奥沙利铂 85 mg/m2，静脉输注</p>
“沙发”（SF，第一个回帖的人）
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