J Natl Compr Canc Netw. 2018 Jul;16(7):909-915. doi: 10.6004/jnccn.2018.7032.
Locally advanced rectal cancer (LARC) carries higher risks of local and distant recurrence when treated with surgical resection alone. Multiple treatment strategies have been investigated to reduce recurrence risk and improve survival. Currently, there are 3 primary strategies for managing LARC: (1) preoperative long-course radiotherapy (RT) combined with radiosensitizing chemotherapy, which is better tolerated than postoperative chemoradiotherapy and provides tumor downstaging and improved pathologic complete response (pCR), followed by postoperative chemotherapy; (2) preoperative short-course RT alone as an alternative strategy for reducing the risk of local recurrence, followed by adjuvant postoperative chemotherapy; and (3) total neoadjuvant therapy with induction chemotherapy followed by chemoradiotherapy to improve pCR and reduce the difficulty of delivering chemotherapy in the postoperative setting. In addition to these currently recommended treatment paradigms, promising new strategies are available for treatment reduction. Neoadjuvant chemotherapy alone may allow for omission of RT in select patients with favorable LARC. For patients who have complete clinical responses to neoadjuvant chemotherapy and RT, nonoperative management is being considered for sphincter preservation, with surgery used as salvage. These are active areas of investigation in both institutional and cooperative group trials. The results are anticipated to provide better tailoring of neoadjuvant therapy based on patient tumor and disease response characteristics.
局部进展期直肠癌（LARC）单独接受手术切除治疗时，局部和远处复发的风险较高。已经研究了多种治疗策略来降低复发风险并提高生存率。目前，有 3 种主要策略可用于治疗 LARC：（1）术前长程放疗（RT）联合增敏化疗，其耐受性优于术后放化疗，并可使肿瘤降期和提高病理完全缓解率（pCR），随后进行术后化疗；（2）术前短程 RT 单独作为降低局部复发风险的替代策略，随后进行辅助术后化疗；（3）新辅助全程化疗加放化疗，以提高 pCR 并降低术后化疗的难度。除了这些目前推荐的治疗方案外，还有有希望的新策略可用于减少治疗。对于局部进展期直肠癌患者，新辅助化疗可能可以使部分患者免于放疗。对于对新辅助化疗和 RT 有完全临床反应的患者，正在考虑非手术治疗以保留肛门，手术用于挽救治疗。这些都是机构和合作组试验中正在积极研究的领域。预期这些结果将提供更好的根据患者肿瘤和疾病反应特征来定制新辅助治疗的方法。
