Garcia-Aguilar Julio, Glynne-Jones Rob, Schrag Deborah
From the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medical Oncology, Mount Vernon Centre for Cancer Treatment, London, United Kingdom; Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
Am Soc Clin Oncol Educ Book. 2016;35:92-102. doi: 10.1200/EDBK_159221.
A series of clinical trials in the last several decades has resulted in the development of multimodality treatment of locally advanced rectal cancer that includes neoadjuvant (preoperative) chemoradiotherapy, total mesorectal excision, and postoperative adjuvant chemoradiotherapy. Owing to this regimen, patients with locally advanced rectal cancer have better survival rates than patients with colon cancer, but at the cost of substantial morbidity and reduced quality of life. The challenge is to identify treatment approaches that maintain or even improve oncologic outcomes while preserving quality of life. We have identified different tumor characteristics that are associated with recurrence and probability of survival for locally advanced rectal cancer. This risk stratification, based on baseline clinical staging and tumor response to chemoradiotherapy, has led us to question whether all patients with locally advanced rectal cancer require every component of the multimodal regimen. In this article, we will review recent evidence that some patients with locally advanced rectal cancer can be spared one or more treatment modalities without compromising long-term oncologic outcomes and while preserving quality of life.
在过去几十年里，一系列临床试验促成了局部晚期直肠癌多模式治疗方法的发展，该方法包括新辅助（术前）放化疗、全直肠系膜切除术以及术后辅助放化疗。由于采用了这种治疗方案，局部晚期直肠癌患者的生存率高于结肠癌患者，但代价是出现大量并发症且生活质量下降。目前面临的挑战是确定在保持生活质量的同时能够维持甚至改善肿瘤治疗效果的治疗方法。我们已经确定了与局部晚期直肠癌复发和生存概率相关的不同肿瘤特征。基于基线临床分期和肿瘤对放化疗的反应进行的这种风险分层，让我们开始质疑是否所有局部晚期直肠癌患者都需要多模式治疗方案的每个组成部分。在本文中，我们将综述近期的证据，即一些局部晚期直肠癌患者可以省去一种或多种治疗方式，而不会影响长期肿瘤治疗效果，同时还能保持生活质量。
