Department of General/Colorectal Surgery, Galway University Hospital, Galway H91 YR71, Ireland.
Department of Histopathology, Galway University Hospital, Galway H91 YR71, Ireland.
World J Gastroenterol. 2019 Sep 7;25(33):4850-4869. doi: 10.3748/wjg.v25.i33.4850.
Thirty per cent of all colorectal tumours develop in the rectum. The location of the rectum within the bony pelvis and its proximity to vital structures presents significant therapeutic challenges when considering neoadjuvant options and surgical interventions. Most patients with early rectal cancer can be adequately managed by surgery alone. However, a significant proportion of patients with rectal cancer present with locally advanced disease and will potentially benefit from down staging prior to surgery. Neoadjuvant therapy involves a variety of options including radiotherapy, chemotherapy used alone or in combination. Neoadjuvant radiotherapy in rectal cancer has been shown to be effective in reducing tumour burden in advance of curative surgery. The gold standard surgical rectal cancer management aims to achieve surgical removal of the tumour and all draining lymph nodes, within an intact mesorectal package, in order to minimise local recurrence. It is critically important that all rectal cancer cases are discussed at a multidisciplinary meeting represented by all relevant specialties. Pre-operative staging including CT thorax, abdomen, pelvis to assess for distal disease and magnetic resonance imaging to assess local involvement is essential. Staging radiology and MDT discussion are integral in identifying patients who require neoadjuvant radiotherapy. While Neoadjuvant radiotherapy is potentially beneficial it may also result in morbidity and thus should be reserved for those patients who are at a high risk of local failure, which includes patients with nodal involvement, extramural venous invasion and threatened circumferential margin. The aim of this review is to discuss the role of neoadjuvant radiotherapy in the management of rectal cancer.
所有结直肠肿瘤中有 30%发生在直肠。由于直肠位于骨盆骨内，且靠近重要结构，因此在考虑新辅助治疗选择和手术干预时，会带来重大的治疗挑战。大多数早期直肠癌患者可以单独通过手术得到充分治疗。然而，相当一部分直肠癌患者存在局部晚期疾病，在手术前可能会从降期治疗中获益。新辅助治疗包括多种选择，包括单独使用或联合使用放疗和化疗。新辅助放疗已被证明在根治性手术前可有效降低肿瘤负荷。直肠癌的金标准手术治疗旨在通过完整的中胚层包裹实现肿瘤和所有引流淋巴结的手术切除，以最大程度地减少局部复发。所有直肠癌病例都在由所有相关专业代表的多学科会议上进行讨论至关重要。术前分期包括胸部、腹部、骨盆 CT 以评估远处疾病和磁共振成像以评估局部受累情况，这是必不可少的。分期影像学检查和 MDT 讨论对于确定需要新辅助放疗的患者至关重要。虽然新辅助放疗可能有益，但也可能导致并发症，因此应保留给那些局部复发风险高的患者，包括淋巴结受累、壁外静脉侵犯和环形切缘受威胁的患者。本综述旨在讨论新辅助放疗在直肠癌治疗中的作用。
