Медицинская литература. Новинки

 

 

 

 

 

 

Комбинированное лечение больных резектабельным раком общего желчного протока

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Представлен обзор научных работ, посвященных комбинированному лечению больных раком общего желчного протока. Освещена роль адъювантной терапии. Показано, что только капецитабин может быть рутинно назначен в послеоперационном периоде: медиана в общей группе больных билиарным раком составила 51 мес по сравнению с 36 мес в группе наблюдения (p = 0,028). Неоадъювантная терапия при раке общего желчного протока изучена в меньшей степени, в целом результаты работ негативны. В настоящее время предоперационную терапию первично операбельным больным вне рамок исследований применять не следует. Появился новый режим с включением гемцитабина, цисплатина и nab-паклитаксела, при котором частота частичного ответа у больных нерезектабельным раком желчных протоков достигает 45%. В ретроспективном исследовании показана положительная роль неоадъювантной радиотерапии в комбинации с гемцитабином: частичный ответ отмечен у 70% пациентов, выявлено достоверное улучшение безрецидивной (р = 0,0263) и общей выживаемости (р = 0,00187) по сравнению с пациентами без неоадъювантной химиолучевой терапии. Необходимо продолжить поиск новых схем дополнительного лечения больных раком общего желчного протока как в пред-, так и в послеоперационном периоде.

Ключевые слова:
печень, желчные протоки, общий желчный проток, рак, холангиокарцинома, комбинированное лечение, адъювантная терапия, неоадъювантная терапия, liver, bile ducts, common bile duct, cancer, cholangiocarcinoma, combination therapy, adjuvant therapy, neoadjuvant therapy

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Combined treatment options for resectable common bile duct cancer patients

This article demonstrates a review of scientific works enlightened to combined treatment options for common bile duct cancer patients. The role of adjuvant therapy is highlighted. It has been shown that only capecitabine can be routinely prescribed in the postoperative period: median survival rate in general group of patients consisted 51 month versus 36 month in control group, (p = 0.028). Neoadjuvant chemotherapy for common bile duct cancer patients is still less studied and the research works results are mostly negative. At present, preoperative chemotherapy for patients with primary resectable tumors should not be applied currently excepting the scientific research protocol boundaries. A new chemotherapy regimen including gemcitabine, cisplatine and nab-paclitaxel has appeared which demonstrates a partial response to therapy reaching 45% for the patients with unresectable biliary cancer. The data of the retrospective study showing the positive role of neoadjuvant radiotherapy combined with gemcitabine: 70% of patients had a partial response as well as reliable improvement of recurrence-free (p = 0.0263) and overall (p = 0.00187) survival rates was observed compared to the group of patients who had no neoadjuvant therapy. The necessity of search for new additional treatment options for the common bile duct cancer patients in preoperative and postoperative period leaves no doubt.

Keywords:
печень, желчные протоки, общий желчный проток, рак, холангиокарцинома, комбинированное лечение, адъювантная терапия, неоадъювантная терапия, liver, bile ducts, common bile duct, cancer, cholangiocarcinoma, combination therapy, adjuvant therapy, neoadjuvant therapy