Angelita and Joaquim Gama Research Institute, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.
Semin Radiat Oncol. 2011 Jul;21(3):234-9. doi: 10.1016/j.semradonc.2011.02.010.
A neoadjuvant multimodality approach with chemoradiation therapy (CRT) is the preferred treatment strategy for most distal rectal cancers. Significant downstaging and complete pathologic response may develop after this strategy, and there is still controversy regarding the management of these patients. In this setting, a nonoperative approach has been suggested in select patients with complete clinical response after thorough clinical, endoscopic, and radiologic assessment. However, the assessment of these patients is not straightforward and remains complex. Available data regarding this approach are limited to a single institution's experience from retrospective analyses. Standardization of the assessment of tumor response and the development of radiological/molecular tools may clarify the role of no immediate surgery in patients with complete clinical response after neoadjuvant CRT. Advances in radiation and medical oncology could potentially lead to significant improvements in complete tumor regression rates, leading to an increase in importance of a minimally invasive approach in patients with rectal cancer.
新辅助放化疗（CRT）的多模态方法是大多数远端直肠癌的首选治疗策略。经过这种策略后，可能会出现明显的降期和完全病理缓解，并且对于这些患者的管理仍存在争议。在这种情况下，在经过彻底的临床、内镜和影像学评估后，对于完全临床缓解的特定患者，可以采用非手术方法。然而，对这些患者的评估并不简单，仍然很复杂。关于这种方法的可用数据仅限于单机构回顾性分析的经验。通过标准化肿瘤反应的评估和开发放射学/分子工具，可以明确在新辅助 CRT 后完全临床缓解的患者中，是否无需立即手术。放射治疗和肿瘤内科的进步可能会导致完全肿瘤消退率的显著提高，这使得在直肠癌患者中采用微创方法的重要性增加。
