Division of Colorectal Surgery, University of Rochester Medical Center, Rochester, New York 14642, USA.
Dis Colon Rectum. 2011 Jul;54(7):901-12. doi: 10.1007/DCR.0b013e31820eeb37.
The optimal type of neoadjuvant therapy regimen in rectal cancer is contentious.
This study aimed to review the impact of neoadjuvant therapy on oncological outcomes and complications (short and long term) in patients undergoing total mesorectal excision for rectal cancer.
An electronic search of MEDLINE, PubMed, EMBASE, and the Cochrane Database of Collected Reviews was performed through March 2010.
Key-word combinations including rectal cancer, total mesorectal excision, radiotherapy, chemotherapy, endorectal ultrasound, and magnetic resonance imaging were used to identify randomized control trials where chemotherapy and/or radiotherapy were deployed before resectional surgery.
INTERVENTION(S): Patients underwent total mesorectal excision for rectal cancer who did and did not receive preoperative chemotherapy and/or radiotherapy.
The main outcome measures comprised the impact of the addition of neoadjuvant therapy to total mesorectal excision on the perioperative complication rate, the pathological complete response rate, the rate of local recurrence, and long-term treatment-related complications.
A total of 12 randomized control trials involving 9410 patients were included. Both short-course radiotherapy and long-course chemoradiation can offer a relative risk reduction of 50% in local recurrence in appropriately selected patients with stage II and III rectal cancer. This oncological benefit comes at the cost of a relative risk increase of 50% in both acute treatment-related toxicity and long-term anorectal dysfunction.
Preoperative staging provides only an estimate of the "true" tumor stage that can only be determined by histological assessment of the tumor specimen which renders appropriate patient selection challenging.
The current treatment trade-off of a relative risk reduction of local recurrence of 50% at the cost of a relative increase of 50% in treatment-related complications underpins the need for more accurate patient staging and more precise delivery of neoadjuvant therapy.
直肠癌新辅助治疗方案的最佳类型存在争议。
本研究旨在综述直肠癌患者行全直肠系膜切除术(total mesorectal excision，TME)前行新辅助治疗对肿瘤学结局和（短期和长期）并发症的影响。
通过 2010 年 3 月对 MEDLINE、PubMed、EMBASE 和 Cochrane 收集的评价数据库进行电子检索。
使用包括直肠癌、TME、放疗、化疗、腔内超声和磁共振成像等关键词组合，对在切除术前使用化疗和/或放疗的随机对照试验进行了检索。
对接受 TME 治疗的直肠癌患者，根据是否行术前化疗和/或放疗进行分组。
主要观察指标包括新辅助治疗联合 TME 对围手术期并发症发生率、病理完全缓解率、局部复发率以及长期治疗相关并发症发生率的影响。
共纳入 12 项包含 9410 例患者的随机对照试验。短程放疗和长程放化疗均可使Ⅱ期和Ⅲ期直肠癌患者的局部复发率相对降低 50%，但也会导致急性治疗相关毒性和长期肛肠功能障碍的相对风险增加 50%。
术前分期仅能对“真实”肿瘤分期做出估计，且只能通过肿瘤标本的组织学评估来确定，这使得患者选择具有挑战性。
局部复发相对风险降低 50%，治疗相关并发症相对风险增加 50%，是当前直肠癌新辅助治疗的治疗取舍平衡点，这突显了更准确的患者分期和更精确的新辅助治疗方法的必要性。
