Vendrely V, Denost Q, Charleux T, Brouquet A, Huguet F, Rullier E
Service de radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac, France.
Service de chirurgie viscérale, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac, France.
Cancer Radiother. 2018 Oct;22(6-7):558-563. doi: 10.1016/j.canrad.2018.06.004. Epub 2018 Aug 28.
Standard treatment consisting of chemoradiotherapy followed by radical surgery with total mesorectal excision, resulting in good oncologic local control but high morbidity and poor functional results. The same treatment applied to all patients presenting with low or mid T3-4 rectal tumors could result in overtreatment of small tumors. However, it remains insufficient (or unsatisfactory?) for locally advanced tumors regarding metastatic recurrence rate. Treatment is decided by a multidisciplinary board on the basis of initial staging, including MRI which allows for resection margin prediction and post-treatment response evaluation. The therapeutic strategy is changing towards upfront chemotherapy and therapeutic desescalation omitting radiotherapy or surgery in a rectal preservation strategy. Moreover, tumor response leads to new multidisciplinary board discussion and treatment adaptation.
标准治疗包括先进行放化疗，然后行根治性手术并完全切除直肠系膜，其能实现良好的肿瘤局部控制，但发病率高且功能结果不佳。对所有低或中T3-4期直肠肿瘤患者采用相同的治疗方法可能会导致小肿瘤的过度治疗。然而，对于局部晚期肿瘤，就转移复发率而言，该治疗方法仍不充分（或不尽人意？）。治疗由多学科团队根据初始分期决定，包括MRI，MRI可用于预测切缘和评估治疗后反应。治疗策略正朝着新辅助化疗和治疗降阶梯转变，在保留直肠的策略中省略放疗或手术。此外，肿瘤反应会引发新的多学科团队讨论和治疗调整。
