1 Roswell Park Cancer Institute, Buffalo, NY 14263, USA ; 2 City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA.
J Gastrointest Oncol. 2014 Oct;5(5):362-73. doi: 10.3978/j.issn.2078-6891.2014.060.
Locally advanced rectal cancer remains a substantial public health problem. Historically, the disease has been plagued by high rates of both distant and local recurrences. The standardization of pre-operative chemoradiation and transmesorectal excision (TME) have greatly lowered the rates of local recurrence. Efforts to improve treatment through use of more effective radiosensitizing therapies have proven unsuccessful in rectal cancer. Presently, due to improved local therapies, distal recurrences represent the dominant problem in this disease. Adjuvant chemotherapy is currently of established benefit in colorectal cancer. As such, adjuvant chemotherapy, consisting of fluoropyrimidine and oxaliplatin, represent the standard of care for many patients. However, after pre-operative chemoradiotherapy and rectal surgery, the administration of highly effective chemotherapy regimens has proven difficult. For this reason, novel neoadjuvant approaches represent appealing avenues for investigation. Strategies of neoadjuvant chemotherapy alone, neoadjuvant chemotherapy followed by chemoradiation and neoadjuvant chemoradiation followed by chemotherapy are under investigation. Initial encouraging results have been noted, though definitive phase III data is lacking.
局部晚期直肠癌仍然是一个重大的公共卫生问题。从历史上看，该疾病的远处和局部复发率都很高。术前放化疗和经直肠系膜切除术（TME）的标准化大大降低了局部复发率。通过使用更有效的放射增敏疗法来提高治疗效果的努力在直肠癌中已被证明是不成功的。目前，由于局部治疗的改善，远端复发成为该疾病的主要问题。辅助化疗目前已被证实对结直肠癌有益。因此，氟嘧啶和奥沙利铂组成的辅助化疗方案是许多患者的标准治疗方法。然而，在术前放化疗和直肠手术后，给予高效的化疗方案已被证明具有挑战性。出于这个原因，新的新辅助方法代表了有吸引力的研究途径。单独新辅助化疗、新辅助化疗后放化疗和新辅助放化疗后化疗等策略正在研究中。已经注意到初步令人鼓舞的结果，但缺乏明确的 III 期数据。
