Mohiuddin Mohammed, Marks John, Marks Gerald
Geisinger Cancer Institute, Wilkes Barre, PA, USA.
Int J Radiat Oncol Biol Phys. 2008 Nov 1;72(3):636-43. doi: 10.1016/j.ijrobp.2008.05.069.
There is considerable debate on the optimum approach to neoadjuvant therapy in rectal cancer. This review of major published studies of short-course preoperative radiation and the more conventional approach of long-course neoadjuvant chemoradiation was undertaken in an effort to understand the potential advantages and disadvantages of each of these approaches. Studies were evaluated with regard to patient selection, clinical outcomes, and toxicities. Short-course preoperative radiation has shown a clear advantage over surgery alone in reducing local recurrence rates and improving survival of patients with rectal cancer. However, studies using short-course preoperative treatment have included a significant number of early (30%; Stage I/II) and more proximal cancers yet appear to have higher positive margin rates, higher abdominoperineal resection rates, and lower aggregate survival than patients treated with long-course neoadjuvant chemoradiation. Although long-course preoperative chemoradiation is associated with higher rates of reversible acute toxicity, there appears to be more significant and a higher rate of late gastrointestinal toxicity observed in short-course preoperative radiation studies. Patient convenience and lower cost of treatment, however, can be a significant advantage in using a short-course treatment schedule. Selective utilization of either of these approaches should be based on extent of disease and goals of treatment. Patients with distal cancers or more advanced disease (T3/T4) appear to have better outcomes with neoadjuvant chemoradiation, especially where downstaging of disease is critical for more complete surgical resection and sphincter preservation.
关于直肠癌新辅助治疗的最佳方法存在相当大的争议。本文对已发表的关于短程术前放疗和更传统的长程新辅助放化疗的主要研究进行了综述，旨在了解每种方法的潜在优缺点。从患者选择、临床结果和毒性方面对研究进行了评估。短程术前放疗在降低局部复发率和提高直肠癌患者生存率方面已显示出比单纯手术更明显的优势。然而，采用短程术前治疗的研究纳入了大量早期（30%；I/II期）和更靠近近端的癌症患者，但与接受长程新辅助放化疗的患者相比，其切缘阳性率更高、腹会阴联合切除术率更高且总生存率更低。尽管长程术前放化疗与更高的可逆性急性毒性发生率相关，但在短程术前放疗研究中观察到的晚期胃肠道毒性似乎更显著且发生率更高。然而，患者便利性和较低的治疗成本可能是采用短程治疗方案的一个显著优势。应根据疾病范围和治疗目标选择性地使用这两种方法。远端癌症或更晚期疾病（T3/T4）患者采用新辅助放化疗似乎有更好的结果，特别是在疾病降期对更彻底的手术切除和保留括约肌至关重要的情况下。
