Bisson Eva, André Magali, Durand Bénédicte, Huguet Florence, Ta Minh-Hanh
Service d'oncologie-radiothérapie, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 75020 Paris, France.
Service d'oncologie-radiothérapie, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 75020 Paris, France.
Soins Gerontol. 2022 Mar-Apr;27(154):23-27. doi: 10.1016/j.sger.2021.12.006. Epub 2022 Jan 4.
Rectal cancer is a common disease of the elderly. Current treatment recommendations are established for young subjects in good general health condition, without taking into account the frailty, comorbidities and polymedications inherent in patients over 75 years old. For locally advanced lower and middle rectal cancers (T3, T4 or N+), these are based on variations of regimens including neoadjuvant chemoradiotherapy, surgery of the rectum with total removal of the mesorectum, and a possibility of adjuvant chemotherapy. This restrictive treatment presents a problem of compliance and is not without adverse effects. Treatment by short exclusive radiotherapy or chemoradiotherapy with close monitoring according to the Watch and Wait strategy can be proposed to fragile patients not eligible for surgery, even if there is a non-negligible risk of recurrence.
直肠癌是一种常见的老年疾病。目前的治疗建议是针对一般健康状况良好的年轻患者制定的，没有考虑到75岁以上患者固有的身体虚弱、合并症和多种药物治疗情况。对于局部晚期中低位直肠癌（T3、T4或N+），这些建议基于多种治疗方案的变体，包括新辅助放化疗、直肠系膜全切除术以及辅助化疗的可能性。这种限制性治疗存在依从性问题，且并非没有副作用。对于不适合手术的体弱患者，可以根据“观察等待”策略，在密切监测下采用短期单纯放疗或放化疗进行治疗，即使存在不可忽视的复发风险。
