Vendrely V, Denost Q, Amestoy F, Célérier B, Smith D, Rullier A, Rullier É
Service de radiothérapie, hôpital Haut-Lévêque, avenue de Magellan, 33604 Pessac cedex, France.
Service de chirurgie viscérale, hôpital Saint-André, 1, rue Jean-Burguet, 33000 Bordeaux, France.
Cancer Radiother. 2015 Oct;19(6-7):404-9. doi: 10.1016/j.canrad.2015.05.009. Epub 2015 Aug 13.
For rectal cancers, the current standard of care consists of chemoradiation followed by radical surgery with total mesorectal excision. Oncologic results are good, especially regarding local recurrence rates, but at the cost of high morbidity rates and poor anorectal, urinary and sexual function results. Since chemoradiation yields 15 to 25% pathological complete response, the role of radical surgery is questioned for patients presenting with good response after chemoradiation and two organ preservation strategies have been offered: watch and wait strategy and local excision strategy. The aim of this review is to give the results of organ preservation after chemoradiotherapy series and to highlight different questions regarding initial patient's selection, complete clinical response definition, risk of mesorectal nodal involvement, follow-up modalities as well as oncologic and functional results.
对于直肠癌,目前的标准治疗方案包括先进行放化疗,然后行根治性手术并完全直肠系膜切除。肿瘤学结果良好,尤其是在局部复发率方面,但代价是高发病率以及较差的肛门直肠、泌尿和性功能结果。由于放化疗可产生15%至25%的病理完全缓解率,对于放化疗后反应良好的患者,根治性手术的作用受到质疑,并且已经提出了两种器官保留策略:观察等待策略和局部切除策略。本综述的目的是给出放化疗系列后器官保留的结果,并突出关于初始患者选择、完全临床反应定义、直肠系膜淋巴结受累风险、随访方式以及肿瘤学和功能结果的不同问题。