Adjuvant chemotherapy for small intestine adenocarcinoma

 

Abstract

Background

Although the small intestine represents 75% of the length and over 90% of the mucosal surface of the alimentary tract, it is the site of only about 2% of malignant gastrointestinal tumours. Adenocarcinoma is the most common histological subtype, accounting for about 40% of all malignant small intestinal tumours. The infrequent occurrence when compared with malignancies of the stomach and colon is accompanied by non-specific clinical symptoms. The consequences are a significant delay in diagnosis and the finding of advanced, incurable disease at operation. Wide surgical resection of early lesions is the only potentially curative treatment, but it is possible only in a minority of patients. The rare nature of adenocarcinomas of the small intestine has led to a paucity of information about the benefits of adjuvant chemotherapy but there are reports of overall better survival for those patients that receive combination treatment. Most chemotherapy regimens consist of 5-fluorouracil (5-FU), alone or in combination with a variety of other agents like doxorubicin, cisplatin, mitomycin C, cyclophosphamide and oxaliplatin.

Objectives

To determine the role of adjuvant chemotherapy in the management of adenocarcinoma of the small intestine compared to another adjuvant treatment, a placebo or no other adjuvant treatment.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to 2006), EMBASE (1974 to 2006), PubMed and CINHAL using the Cochrane highly sensitive search strategy for randomised controlled trials.

Selection criteria

Phase III randomised controlled trials comparing post-operative adjuvant chemotherapy for adenocarcinoma of the small intestine with other adjuvant therapies, placebo or no adjuvant treatment.

Data collection and analysis

No suitable trials were identified.

Main results

No studies fulfilled the inclusion criteria.

Authors' conclusions

There is a need for high quality randomised controlled trials to evaluate the effectiveness of adjuvant chemotherapy in the management of adenocarcinoma of the small intestine.

 

Plain language summary

Adjuvant chemotherapy for small intestine adenocarcinoma

Adenocarcinoma of the small intestine is an infrequently encountered tumour and, as such, knowledge of its clinical and pathological characteristics is limited. No suitable evidence was found to determine the role of adjuvant chemotherapy, when compared with placebo or any other or no adjuvant treatment, in the management of adenocarcinoma of the small intestine.
More research is needed.

 

摘要

背景

小腸腺癌的輔助化療背景

雖然小腸佔胃腸道全長的75%，其吸收營養的粘膜表面積約佔胃腸道表面積的90%以上，但是小腸惡性腫瘤僅佔胃腸道惡性腫瘤的2%。其中腺癌約佔小腸惡性腫瘤的40%，是最常見的組織亞型。小腸腺癌與胃部惡性腫瘤及結腸惡性腫瘤的發生率相較則較為少見，且無特定的臨床症狀。因此常會延誤診斷，發現時常已相對晚期無法治療了。大範圍切除早期病灶是唯一治療的方法，不過可能只適用於少數患者。小腸腺癌的罕見性也導致有關其輔助化療資訊的缺乏，不過有研究報告指出接受合併療法的患者有較佳的存活率。大多數化療所使用的藥物為5fluorouracil (5FU)，其可單獨或合併其它的藥劑，像是doxorubicin、cisplatin、mitomycin C、cyclophosphamide及oxaliplatin一起使用

目標

與使用另一種輔助療法、安慰劑或無使用其它輔助療法相較，測定輔助化學療法在治療小腸腺癌上所扮演的角色

搜尋策略

我們使用Cochrane的高靈敏搜尋策略於Cochrane Central Register of Controlled Trials (CENTRAL)、MEDLINE (1966年至2006年)、EMBASE(1974年至2006年)、PubMed 及CINHAL等資料庫上搜尋隨機對照試驗

選擇標準

與於小腸腺癌手術後，使用化學療法與使用其它輔助療法、安慰劑或無使用其它輔助療法來進行比較的第三期隨機臨床試驗

資料收集與分析

沒有找到適當的試驗

主要結論

沒有研究符合所設定的標準

作者結論

有必要進行高品質的隨機對照試驗以評估輔助化學療法對小腸腺癌的療效

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

小腸腺癌的輔助化學療法 小腸腺癌是一種少見的腫瘤，因此對其臨床和病理特性所知有限。並無證據可顯示若與使用安慰劑或其它輔助療法、或無使用其它輔助療法相較，輔助化學療法在治療小腸腺癌的作用性。 需要更多的研究