Khullar Karishma, Patel Nell Maloney, Anderson Cristan, Chundury Anupama, Carpizo Darren, Feingold Daniel, Grandhi Miral, Hochster Howard, Jani Krupa, Kennedy Timothy, Langan Russell, Spencer Kristen, August David, Jabbour Salma K
Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA.
Department of Surgery, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA.
Oncol Hematol Rev. 2020 Spring;16(1):43-51. Epub 2020 Apr 27.
Locally advanced rectal cancer has broadly been defined as T3, T4, or lymph node-positive disease. In the 1990s, adjuvant chemoradiation was considered the optimal management for locally advanced rectal cancer. However, the paradigm shifted when the German CAO/ARO/AIO-94 Rectal Cancer trial established neoadjuvant chemoradiation as the standard of care, based on reduced rates of toxicity and local recurrence, as well as higher rates of sphincter preservation compared with postoperative chemoradiation. Both short-course radiation and long-course chemoradiation are currently accepted methods for neoadjuvant treatment, with recent trials showing equivalence in outcomes. While surgery remains the cornerstone of treatment, there are data supporting the use of magnetic resonance imaging for risk stratification in rectal cancer and encouraging prospective data regarding nonoperative management. This review summarizes data on the evolution of treatment for locally advanced rectal cancer and discusses emerging evidence for nonoperative management.
局部晚期直肠癌广义上被定义为T3、T4或淋巴结阳性疾病。在20世纪90年代，辅助放化疗被认为是局部晚期直肠癌的最佳治疗方法。然而，当德国CAO/ARO/AIO-94直肠癌试验确立新辅助放化疗作为标准治疗方案后，这种模式发生了转变，该试验表明，与术后放化疗相比，新辅助放化疗的毒性和局部复发率降低，括约肌保留率更高。目前，短程放疗和长程放化疗都是新辅助治疗的公认方法，最近的试验表明两者疗效相当。虽然手术仍然是治疗的基石，但有数据支持使用磁共振成像对直肠癌进行风险分层，并且有关于非手术治疗的前瞻性数据令人鼓舞。本综述总结了局部晚期直肠癌治疗进展的数据，并讨论了非手术治疗的新证据。
