Weiser Martin R, Zhang Zhen, Schrag Deborah
From the Memorial Sloan Kettering Cancer Center, New York, NY; Shanghai Cancer Center, Fudan University, Shanghai, China; Dana-Farber Cancer Institute, Boston, MA.
Am Soc Clin Oncol Educ Book. 2015:e192-6. doi: 10.14694/EdBook_AM.2015.35.e192.
The year 2015 marks the 30th anniversary of the publication of NSABP-R01, a landmark trial demonstrating the benefit of adding pelvic radiation to the treatment regimen for locally advanced rectal cancer with a resultant decrease in local recurrence from 25% to 16%. These results ushered in the era of multimodal therapy for rectal cancer, heralding modern treatment and changing the standard of care in the United States. We have seen many advances over the past 3 decades, including optimization of the administration and timing of radiation, widespread adoption of total mesorectal excision (TME), and the implementation of more effective systemic chemotherapy. The current standard is neoadjuvant chemoradiation with 5-fluorouracil (5-FU) and a radiosensitizer, TME, and adjuvant chemotherapy including 5-FU and oxaliplatin. The results of this regimen have been impressive, with a reported local recurrence rate of less than 10%. However, the rates of distant relapse remain 30% to 40%, indicating room for improvement. In addition, trimodality therapy is arduous and many patients are unable to complete the full course of treatment. In this article we discuss the current standard of care and alternative strategies that have evolved in an attempt to individualize therapy according to risk of recurrence.
2015年是NSABP-R01试验结果发表30周年，该试验具有里程碑意义，证明了在局部晚期直肠癌治疗方案中加入盆腔放疗的益处，使局部复发率从25%降至16%。这些结果开启了直肠癌多模式治疗的时代，引领了现代治疗方法，并改变了美国的治疗标准。在过去30年里，我们见证了许多进展，包括放疗给药方式和时机的优化、全直肠系膜切除术（TME）的广泛应用以及更有效的全身化疗的实施。目前的标准是新辅助放化疗，使用5-氟尿嘧啶（5-FU）和一种放疗增敏剂、TME以及包括5-FU和奥沙利铂的辅助化疗。该方案的结果令人印象深刻，据报道局部复发率低于10%。然而，远处复发率仍为30%至40%，这表明仍有改进空间。此外，三联疗法很艰巨，许多患者无法完成整个疗程。在本文中，我们讨论了当前的治疗标准以及为根据复发风险实现个体化治疗而发展出的替代策略。
