Duke Cancer Center, Medicine Circle, Duke University Hospital, Box 3085, Durham, NC, 27710, USA.
Curr Oncol Rep. 2018 Apr 11;20(6):43. doi: 10.1007/s11912-018-0689-7.
Colorectal cancer has a high global incidence, and standard treatment employs a multimodality approach. In addition to cure, minimizing treatment-related toxicity and improving the therapeutic ratio is a common goal. The following article addresses the potential of omitting radiotherapy in select rectal cancer patients.
Omission of radiotherapy in rectal cancer is analyzed in the context of historical findings, as well as more recent data describing risk stratification of stage II-III disease, surgical optimization, imaging limitations, improvement in systemic chemotherapeutic agents, and contemporary studies evaluating selective omission of radiotherapy. A subset of rectal cancer patients exists that may be considered low to intermediate risk for locoregional recurrence. With appropriate staging, surgical technique, and possibly improved systemic therapy, it may be feasible to selectively omit radiotherapy in these patients. Current imaging limitations as well as evidence of increased locoregional recurrence following radiotherapy omission lend us to continue supporting the standard treatment of approach of neoadjuvant chemoradiation therapy followed by surgical resection until additional improvements and prospective evidence can support otherwise.
结直肠癌在全球发病率较高，标准治疗采用多模式方法。除了治愈，尽量减少治疗相关的毒性并提高治疗比率是一个共同的目标。本文探讨了选择性直肠癌患者中省略放疗的可能性。
在历史数据的背景下，以及更近期描述 II-III 期疾病风险分层、手术优化、影像学限制、全身化疗药物改善以及评估选择性省略放疗的当代研究数据中，分析了直肠癌中省略放疗的问题。存在一部分直肠癌患者，其局部区域复发的风险可能较低或中等。通过适当的分期、手术技术，以及可能改善的全身治疗，选择性省略放疗可能在这些患者中是可行的。目前的影像学限制以及放疗后局部区域复发增加的证据使我们继续支持新辅助放化疗后手术切除的标准治疗方法，直到有更多的改进和前瞻性证据支持其他方法。
