Wang Y Q, Zhang Z
Department of Radiation Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College of Fudan University, Shanghai 200032, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2020 Mar 25;23(3):252-257. doi: 10.3760/cma.j.cn.441530-20200224-00080.
For locally advanced (T3-4/N+M0) rectal cancer (LARC), radiation-based neoadjuvant therapy followed by total mesorectal excision (TME) is the standard treatment. For those who achieved clinical complete response (cCR), a non-operative management called "watch and wait" (W&W) strategery can preserve organ function and improve the life quality. For W&W strategy, radiotherapy is still the core part of neoadjuvant therapy. To increase the tumor response grade and cCR rate is the goal of optimized neoadjuvant regimens. In this review, we summarized the role of radiotherapy in the W&W strategy and discussed the advances of optimized radiation-based neoadjuvant therapy to achieve higher cCR rate, including new radiosensitizing agents, induction and consolidation chemotherapy, combination with immunotherapy, and prolonged interval time. All of the above efforts aim to improve patient survival and quality of life.
对于局部晚期（T3-4/N+M0）直肠癌（LARC），基于放疗的新辅助治疗后行全直肠系膜切除术（TME）是标准治疗方法。对于那些达到临床完全缓解（cCR）的患者，一种名为“观察等待”（W&W）的非手术管理策略可以保留器官功能并提高生活质量。对于W&W策略，放疗仍然是新辅助治疗的核心部分。提高肿瘤反应分级和cCR率是优化新辅助治疗方案的目标。在本综述中，我们总结了放疗在W&W策略中的作用，并讨论了优化基于放疗的新辅助治疗以实现更高cCR率的进展，包括新的放射增敏剂、诱导和巩固化疗、与免疫治疗联合以及延长间隔时间。上述所有努力旨在提高患者生存率和生活质量。
