Cattedra di Radioterapia, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2010 Apr;14(4):334-41.
In the last two decades we have seen major advances in the strategy of the treatment of rectal cancer. Important studies were published to confirm the role of imaging MRI in the treatment plan and in detecting the prognostic factors, the improved outcome of the new surgical technique based on total mesorectal excision and the combined treatments. Many studies demonstrated that MRI is equivalent to histology in measurement of extramural depth, is also highly accurate in staging advanced rectal cancer, in the assessment of mesorectal fascia infiltration and to distinguish cT3 from cT4, in the measuring the distance from the anorectal ring. With the introduction of total mesorectal excision the local recurrence rate is dramatically reduced, especially in selected centres. Preoperative radiotherapy +/- in combination with chemotherapy still reduces this rates respect to only surgery or postoperative treatment. In this time of changing therapeutic approaches, a common standard for large heterogeneous patient groups will likely be substituted by more individualised therapies. It will depend from new evidence of more tailored diagnosis, surgery, radiotherapy and chemotherapy.
在过去的二十年中，我们看到直肠癌治疗策略取得了重大进展。重要的研究结果证实了影像学 MRI 在治疗计划和检测预后因素中的作用，基于全直肠系膜切除术的新手术技术和联合治疗改善了治疗效果。许多研究表明，MRI 在测量壁外深度方面与组织学相当，在分期进展期直肠癌、评估直肠系膜筋膜浸润以及区分 cT3 和 cT4、测量肛直肠环距离方面也具有高度准确性。随着全直肠系膜切除术的引入，局部复发率显著降低，特别是在选定的中心。术前放疗 +/- 联合化疗与单纯手术或术后治疗相比，仍能降低局部复发率。在治疗方法不断变化的时代，针对大型异质患者群体的通用标准可能会被更个体化的治疗方法所取代。这将取决于更个体化的诊断、手术、放疗和化疗的新证据。
