Department of Medical Oncology, School of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
New York University Langone Health, New York City, New York, USA.
Colorectal Dis. 2021 Jul;23(7):1662-1669. doi: 10.1111/codi.15669. Epub 2021 Apr 22.
While current neoadjuvant protocols have proven benefits on local control for majority of patients with locally advanced rectal cancer, there are certain clinical conditions that require future advances for improving the outcomes. Total neoadjuvant therapy incorporates systemic chemotherapy planned within standard neoadjuvant protocols either before or after radiotherapy for locally advanced rectal cancer as a whole. Enhanced compliance with planned oncological therapy, tumour downstaging, administration of chemotherapy at the earliest time in the disease course to help assessing chemosensitivity are the proposed benefits of total neoadjuvant therapy in patients with locally advanced rectal cancer. Patient selection criteria for administration of total neoadjuvant therapy in the recent guidelines are unclear. Since current literature is inconclusive for the optimal sequence and type of radiotherapy and chemotherapy, premature incorporation of total neoadjuvant therapy for all locally advanced rectal cancers may result in overtreatment and subsequently toxicity. This article aims to discuss the current literature and to propose a future perspective by considering real-life scenarios reflecting patients' needs for treatment of locally advanced rectal cancer.
虽然目前的新辅助治疗方案已被证明对大多数局部晚期直肠癌患者的局部控制有益，但仍存在某些临床情况需要进一步改进治疗效果。全新辅助治疗将系统化疗纳入局部晚期直肠癌的标准新辅助方案中，无论是在放疗前还是放疗后进行。全新辅助治疗在局部晚期直肠癌患者中的益处包括提高计划肿瘤治疗的依从性、肿瘤降期、在疾病早期给予化疗以帮助评估化疗敏感性。对于局部晚期直肠癌患者，最近的指南中全新辅助治疗的患者选择标准尚不清楚。由于目前的文献对于放疗和化疗的最佳顺序和类型尚无定论，过早地将全新辅助治疗用于所有局部晚期直肠癌患者可能会导致过度治疗和随后的毒性。本文旨在讨论当前的文献，并通过考虑反映患者对局部晚期直肠癌治疗需求的现实情况，提出未来的展望。
