Lynn Patricio B, Strombom Paul, Garcia-Aguilar Julio
Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Clin Colon Rectal Surg. 2017 Nov;30(5):395-403. doi: 10.1055/s-0037-1606117. Epub 2017 Nov 27.
In recent years, organ preservation has been considered a feasible alternative to total mesorectal excision for patients with locally advanced rectal cancer with a clinical complete response to neoadjuvant therapy. However, the degree of tumor response to neoadjuvant therapy is variable. A fraction of the patients who did not achieve a complete response had grossly visible tumors. These patients, with clearly incomplete clinical response, need a total mesorectal excision. In addition, some patients with a significant tumor response still have some abnormalities in the bowel wall, such as superficial ulceration or tissue nodularity, which, while not conclusive for the presence of a tumor, are indicative of the possibility of a residual tumor in the bowel wall or in mesorectal lymph nodes. The management of patients with a so-called near-complete clinical response to neoadjuvant therapy is controversial. In this article, we will review the clinical and radiological criteria that define a clinical response to neoadjuvant therapy, possible treatment strategies, and follow-up protocols. We will also discuss patient and tumor characteristics that in our opinion can be useful in selecting the most appropriate treatment alternative. Although organ preservation and quality of life are important, the primary goal of treatment for these patients should be local tumor control and long-term survival.
近年来，对于新辅助治疗后临床完全缓解的局部晚期直肠癌患者，器官保留已被视为全直肠系膜切除术的一种可行替代方案。然而，肿瘤对新辅助治疗的反应程度存在差异。一部分未达到完全缓解的患者有肉眼可见的肿瘤。这些临床反应明显不完全的患者需要进行全直肠系膜切除术。此外，一些肿瘤反应显著的患者肠壁仍有一些异常，如浅表溃疡或组织结节，虽然这些表现不能确诊肿瘤的存在，但提示肠壁或直肠系膜淋巴结存在残留肿瘤的可能性。对于新辅助治疗所谓接近完全临床缓解的患者的管理存在争议。在本文中，我们将回顾定义对新辅助治疗临床反应的临床和影像学标准、可能的治疗策略以及随访方案。我们还将讨论我们认为有助于选择最合适治疗方案的患者和肿瘤特征。尽管器官保留和生活质量很重要，但这些患者治疗的主要目标应该是局部肿瘤控制和长期生存。
