Rödel Claus, Fokas Emmanouil, Gani Cihan
Department of Radiotherapy and Oncology, University of Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany.
Innov Surg Sci. 2017 Dec 28;3(1):47-53. doi: 10.1515/iss-2017-0041. eCollection 2018 Mar.
With the increasing use of preoperative treatment rather than upfront surgery, it has become evident that the response of rectal carcinoma to standard chemoradiotherapy (CRT) shows a great variety that includes histopathologiocally confirmed complete tumor regression in 10-30% of cases. Adaptive strategies to avoid radical surgery, either by local excision or non-operative management, have been proposed in these highly responsive tumors. A growing number of prospective clinical trials and experiences from large databases, such as the European Registration of Cancer Care (EURECCA) watch-and-wait database, or the recent Oncological Outcome after Clinical Complete Response in Patients with Rectal Cancer (OnCoRe) project, will provide more information on its safety and efficacy, and help to select appropriate patients. Future studies will have to establish appropriate inclusion criteria and optimize CRT regimens in order to maximize the number of patients achieving complete response. Standardized re-staging procedures have to be investigated to improve the prediction of a sustained complete response, and long-term close follow-up with thorough documentation of failure patterns and salvage therapies will have to prove the oncological safety of this approach.
随着术前治疗而非直接手术的使用日益增加，很明显直肠癌对标准放化疗（CRT）的反应具有很大差异，其中包括10%-30%的病例经组织病理学证实肿瘤完全消退。对于这些高反应性肿瘤，已经提出了通过局部切除或非手术治疗来避免根治性手术的适应性策略。越来越多的前瞻性临床试验以及来自大型数据库（如欧洲癌症护理登记（EURECCA）观察等待数据库或近期的直肠癌患者临床完全缓解后的肿瘤学结局（OnCoRe）项目）的经验，将提供更多关于其安全性和有效性的信息，并有助于选择合适的患者。未来的研究必须建立适当的纳入标准并优化CRT方案，以最大限度地增加实现完全缓解的患者数量。必须研究标准化的重新分期程序，以改善对持续完全缓解的预测，并且长期密切随访并详细记录失败模式和挽救治疗，将必须证明这种方法的肿瘤学安全性。
