Valentini V, Cellini F
G Chir. 2014 May-Jun;35(5-6):113-6.
Rectal cancer management improved results in the last thirty-five applying new integrated treatment options. Preoperative radiochemotherapy or radiotherapy alone joined to the modern surgery gaining significant improvement of outcomes. Nevertheless, a definitive conclusion about superiority of one on the other in term of survival and toxicity is still lacking, and further improvement is in general required and seems obtainable. The need for a wide sharing of the accumulated knowledge is represented by the consensus conferences that over the years summarizes the state of the art for the management of rectal cancer. One of the most promising opportunities comes from the attempt of characterization of the tumor heterogeneity. An always-increasing number of new parameters come from different sources including genomic, imaging, pathological features and many others. The need of new informatics technologies able to handle and continuously incorporate new inputs derived from the evidences is also imperative. The combined use of large shared databases and "learning models" could allow generating and rapidly testing new hypotheses, providing further survival improvement in the next years.
在过去35年里，通过应用新的综合治疗方案，直肠癌的治疗效果得到了改善。术前放化疗或单纯放疗与现代手术相结合，显著提高了治疗效果。然而，在生存和毒性方面，关于哪种方法更具优势仍缺乏明确结论，总体上仍需要进一步改进且似乎有望实现。多年来的共识会议体现了广泛分享积累知识的必要性，这些会议总结了直肠癌治疗的最新进展。最有前景的机会之一来自对肿瘤异质性特征的研究。越来越多的新参数来自不同来源，包括基因组学、影像学、病理特征等诸多方面。能够处理并持续纳入来自证据的新输入的新信息技术也势在必行。大型共享数据库和“学习模型”的联合使用可以生成并快速检验新假设，在未来几年进一步提高生存率。
