Das Prajnan, Crane Christopher H
Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 97, Houston, TX 77030, USA.
Curr Oncol Rep. 2009 May;11(3):167-74. doi: 10.1007/s11912-009-0025-3.
Many recent developments have taken place in the management of rectal cancer. Appropriate staging plays an increasingly important role in rectal cancer, because many treatment decisions must be based on preoperative staging. Also critical is the role of prognostic factors such as the pathologic T (tumor) and N (nodal) classification, circumferential resection margin, and response to preoperative therapy. For stage II and III rectal cancer, preoperative chemo-radiation and radiotherapy have been accepted widely as a standard of care. The German Rectal Cancer Trial demonstrated the superiority of preoperative chemoradiation over postoperative chemoradiation, whereas the trials from the European Organisation for Research and Treatment of Cancer and Fédération Francophone de Cancérologie Digestive showed the benefits of preoperative chemoradiation over preoperative long-course radiotherapy. Multiple randomized trials also have established the role of hypofractionated or short-course radiotherapy. For stage I rectal cancer, local excision is being used increasingly, but recent studies show the need for caution with the use of this technique. This article reviews recent studies on staging, prognostic factors, and therapy of localized rectal cancer.
直肠癌的治疗管理方面最近有许多进展。恰当的分期在直肠癌中发挥着越来越重要的作用，因为许多治疗决策必须基于术前分期。预后因素的作用也很关键，如病理T（肿瘤）和N（淋巴结）分类、环周切缘以及对术前治疗的反应。对于II期和III期直肠癌，术前放化疗已被广泛接受为标准治疗方案。德国直肠癌试验证明了术前放化疗优于术后放化疗，而欧洲癌症研究与治疗组织和法语国家消化道肿瘤联合会的试验表明术前放化疗优于术前长程放疗。多项随机试验也确立了短程分割放疗或短程放疗的作用。对于I期直肠癌，局部切除术的应用越来越多，但最近的研究表明使用该技术时需要谨慎。本文综述了局部直肠癌分期、预后因素及治疗方面的最新研究。
