Zhao Y M, Wang L
Department of Gastrointestinal Cancer, Unit III, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Bejing 100142, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2020 Mar 25;23(3):237-242. doi: 10.3760/cma.j.cn.441530-20200224-00077.
Watch and wait (W&W) after neoadjuvant treatment of rectal cancer has been a focus in the field of rectal cancer in recent years. Many Chinese or international centers have accumulated valuable experience through conducting clinical research, but there are many disputes about the details of developing W&W, and there is also a problem of insufficient evidence level. Dozens of experts of gastrointestinal surgery, oncology, radiotherapy, pathology and radiology shared the experience of developing W&W and compiled the consensus on the W&W policy in rectal cancer patients after neoadjuvant treatment (2020). This article further analyzes and interprets 5 issues that are likely to cause confusion in consensus, including near-cCR and prolonged waiting time, the relationship between cCR and pCR, the role of biopsy in W&W, local resection, and contact X-ray brachytherapy, and at the same time explains the adjustments in the consensus based on national conditions.
近年来，直肠癌新辅助治疗后的观察等待（W&W）一直是直肠癌领域的焦点。许多中国或国际中心通过开展临床研究积累了宝贵经验，但在制定W&W的细节方面存在诸多争议，且证据水平也存在不足的问题。数十位胃肠外科、肿瘤学、放射治疗、病理学和放射学专家分享了制定W&W的经验，并编撰了《直肠癌新辅助治疗后患者W&W策略的共识（2020年）》。本文进一步分析并解读了共识中可能引发困惑的5个问题，包括接近临床完全缓解（cCR）和延长等待时间、cCR与病理完全缓解（pCR）的关系、活检在W&W中的作用、局部切除以及接触性X线近距离放疗，同时阐释了基于国情对共识所做的调整。
