Methodist Richardson Medical Center, 2805 E. President George Bush Highway, Richardson, TX, USA.
Swedish Medical Center, Seattle, WA, USA.
J Gastrointest Surg. 2021 Sep;25(9):2411-2422. doi: 10.1007/s11605-021-05042-w. Epub 2021 Jun 7.
The use of neoadjuvant pelvic radiotherapy was a major advance in oncologic care for locally advanced rectal cancer in the twentieth century. The extrapolation of the care of locally advanced rectal cancer to the management of rectal cancer with treatable liver metastases is controversial. The aim of this review is to examine the available data on the role of pelvic radiotherapy and chemoradiation in the setting of treatable metastatic liver disease.
A systematic search of MEDLINE was performed to report the landmark randomized controlled trials between 1993 and 2021.
Attaining liver clearance and total mesorectal excision with R0 margin remains the mainstay of cure. There is uncertainty regarding the sequencing of treatment. The literature lacks randomized clinical trials comparing the rectal first, liver first, interval strategy, and simultaneous surgical approaches. A multidisciplinary discussion regarding the utility of radiotherapy is emphasized to achieve the goals of treatment. Short-course radiotherapy has proved comparable disease-control outcomes to long-course chemoradiation with a significantly improved cost-performance. The implementation of short-course radiotherapy in the interval strategy and simultaneous surgical approach is promising. Neoadjuvant pelvic radiotherapy can be omitted in patients with metastatic rectal cancer if adequate margin clearance is achievable.
The use of radiotherapy in metastatic rectal cancer is popular but is based on limited data. Treatment should be tailored to the local extent of rectal cancer and priority of liver metastasis management. The optimal treatment strategy in patients with rectal cancer and synchronous liver metastatic disease needs to be studied in randomized trials.
在 20 世纪，新辅助盆腔放疗是局部晚期直肠癌肿瘤治疗的重大进展。将局部晚期直肠癌的治疗方法推广到可治疗肝转移的直肠癌的治疗中存在争议。本综述的目的是检查可用于治疗性肝转移疾病的盆腔放疗和放化疗的现有数据。
系统检索了 MEDLINE 数据库，以报告 1993 年至 2021 年期间的标志性随机对照试验。
实现肝清除和直肠系膜全切除并获得 R0 切缘仍然是治愈的主要方法。治疗的顺序存在不确定性。文献中缺乏比较直肠第一、肝第一、间隔策略和同期手术方法的随机临床试验。强调多学科讨论放疗的应用，以实现治疗目标。短程放疗与长程放化疗相比，具有相当的疾病控制效果，且具有显著改善的成本效益。短程放疗在间隔策略和同期手术中的应用具有广阔的前景。如果能够达到充分的切缘清除，则可以在转移性直肠癌患者中省略新辅助盆腔放疗。
尽管放疗在转移性直肠癌中的应用很普遍，但这主要基于有限的数据。治疗应根据直肠癌的局部程度和肝转移管理的优先级进行调整。需要在随机试验中研究同步肝转移疾病的直肠癌患者的最佳治疗策略。
