Qian Yushen, Chin Alexander L, Toesca Diego A S, Koong Albert C, Chang Daniel T
Oncology (Williston Park). 2017 Oct 15;31(10):e13-e22.
Nonoperative management of rectal cancer is an emerging treatment approach that aims to enable carefully selected patients to avoid the morbidity of radical surgical resection, while benefiting from the same excellent rates of tumor control achieved with radical surgery-based combined-modality therapy. The success of nonoperative management in this setting is based on the accurate assessment of tumor eradication after chemoradiotherapy, without pathologic verification. Therefore, clinical evidence of complete response-based on physical examination, endoscopic procedures, and imaging-must be utilized as a marker to predict for pathologic complete response and thus help select the patients who are most appropriate for nonoperative management. Initial evidence from retrospective and prospective single-arm and cohort studies has demonstrated high rates of local control and disease-free survival with nonoperative management of rectal cancer, compared with historical results of combined-modality therapy. Several trials and registries are prospectively investigating nonoperative management vs standard treatment of rectal cancer. At this time, combined-modality therapy with total mesorectal excision remains the standard of care for patients with locally advanced rectal cancer; nonoperative management should not be routinely offered outside of clinical trials.
直肠癌的非手术治疗是一种新兴的治疗方法，旨在使经过精心挑选的患者避免根治性手术切除带来的并发症，同时能从基于根治性手术的综合治疗所达到的同样出色的肿瘤控制率中获益。在这种情况下，非手术治疗的成功基于在未进行病理验证的情况下对放化疗后肿瘤根除情况的准确评估。因此，基于体格检查、内镜检查和影像学检查的完全缓解的临床证据，必须用作预测病理完全缓解的指标，从而帮助选择最适合非手术治疗的患者。回顾性和前瞻性单臂及队列研究的初步证据表明，与综合治疗的历史结果相比，直肠癌非手术治疗的局部控制率和无病生存率很高。多项试验和登记研究正在前瞻性地调查直肠癌的非手术治疗与标准治疗。目前，全直肠系膜切除术的综合治疗仍然是局部晚期直肠癌患者的标准治疗；在临床试验之外，不应常规提供非手术治疗。
