Corvò R
Recenti Prog Med. 2001 Jan;92(1):41-4.
Surgery is the common upfront treatment for patients who present with clinically resectable rectal cancer. Post-operative radiotherapy and/or chemotherapy are usual for resected rectal cancer in the United States, but in some European countries radiotherapy is preferred as preoperative modality. Preoperative radiotherapy, alone or combined with chemotherapy, increases the chances of tumor downstaging and downsizing and it is less toxic than postoperative combined therapy. More than 10 randomized trials of preoperative radiotherapy for resectable cancers have been recently published: eight trials have reported a significant decrease in local recurrence and two trials have found a significant improvement in survival. If the primary end-point of most clinical trials included survival, a further pivotal end-point included presentation of function of the sphincter in the attempt to improve quality of life. Approximately 70-80 percent of patients irradiated preoperatively are now able to undergo sphincter-preserving surgery. Current studies, focused on the interplay between biological properties of rectal cancer and radiation-induced response will clarify the actual role of preoperative radiotherapy and help select patients who may benefit from combined association of chemotherapy with radiotherapy.
对于表现为临床可切除直肠癌的患者，手术是常见的初始治疗方法。在美国，术后放疗和/或化疗是切除直肠癌的常用治疗方式，但在一些欧洲国家，放疗更倾向于作为术前治疗手段。术前放疗，单独使用或与化疗联合使用，可增加肿瘤降期和缩小的几率，且其毒性低于术后联合治疗。最近已发表了10多项关于可切除癌症术前放疗的随机试验：八项试验报告局部复发显著减少，两项试验发现生存率有显著提高。如果大多数临床试验的主要终点包括生存率，另一个关键终点则包括括约肌功能的表现，以试图改善生活质量。目前约70%至80%术前接受放疗的患者能够接受保留括约肌的手术。目前聚焦于直肠癌生物学特性与放射诱导反应之间相互作用的研究，将阐明术前放疗的实际作用，并有助于选择可能从化疗与放疗联合应用中获益的患者。
