Department of Clinical Oncology, Leiden University Medical Center, Leiden, Netherlands.
Lancet Oncol. 2015 Jan;16(1):e13-22. doi: 10.1016/S1470-2045(14)70398-5. Epub 2014 Dec 29.
Improved treatment strategies have eliminated local control as the major problem in rectal cancer. With increasing awareness of long-term toxic effects in survivors of rectal cancer, organ-preservation strategies are becoming more popular. After chemoradiotherapy, both watchful waiting and local excision are used as possible alternatives for radical surgery. Although these seem attractive strategies, many issues about the safety of organ preservation remain. Additionally, radiotherapy strategies are mainly aimed at intermediate and high-risk rectal tumours, and adaptation of this standard practice for a completely new treatment indication has yet to start. This Review will discuss the options and problems of organ preservation, and address the research questions that need to be answered in the coming years, with a specific focus on radiotherapy.
改良的治疗策略已经消除了直肠癌局部控制的主要问题。随着人们对直肠癌幸存者长期毒性影响认识的提高，保留器官的策略越来越受欢迎。在放化疗后，观察等待和局部切除都被用作根治性手术的可能替代方法。尽管这些方法似乎很有吸引力，但保留器官的安全性仍存在许多问题。此外，放疗策略主要针对中高危直肠肿瘤，这种标准治疗方法的应用尚未开始针对全新的治疗指征。本文将讨论保留器官的选择和问题，并讨论未来几年需要回答的研究问题，特别关注放疗。
