Ketelaers Stijn H J, Jacobs Anne, Verrijssen An-Sofie E, Cnossen Jeltsje S, van Hellemond Irene E G, Creemers Geert-Jan M, Schreuder Ramon-Michel, Scholten Harm J, Tolenaar Jip L, Bloemen Johanne G, Rutten Harm J T, Burger Jacobus W A
Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands.
Department of Gerontology and Geriatrics, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands.
Cancers (Basel). 2022 May 11;14(10):2368. doi: 10.3390/cancers14102368.
Despite it being the optimal curative approach, elderly and frail rectal cancer patients may not be able to undergo a total mesorectal excision. Frequently, no treatment is offered at all and the natural course of the disease is allowed to unfold. These patients are at risk for developing debilitating symptoms that impair quality of life and require palliative treatment. Recent advancements in non-operative treatment modalities have enhanced the toolbox of alternative treatment strategies in patients unable to undergo surgery. Therefore, a proposed strategy is to aim for the maximal non-operative treatment, in an effort to avoid the onset of debilitating symptoms, improve quality of life, and prolong survival. The complexity of treating elderly and frail patients requires a patient-centred approach to personalise treatment. The main challenge is to optimise the balance between local control of disease, patient preferences, and the burden of treatment. A comprehensive geriatric assessment is a crucial element within the multidisciplinary dialogue. Since limited knowledge is available on the optimal non-operative treatment strategy, these patients should be treated by dedicated multidisciplinary rectal cancer experts with special interest in the elderly and frail. The aim of this narrative review was to discuss a multidisciplinary patient-centred treatment approach and provide a practical suggestion of a successfully implemented clinical care pathway.
尽管全直肠系膜切除术是最佳的治疗方法，但老年体弱的直肠癌患者可能无法接受该手术。通常情况下，这些患者根本得不到任何治疗，只能任由疾病自然发展。这些患者有出现导致身体衰弱症状的风险，这些症状会损害生活质量，需要进行姑息治疗。非手术治疗方式的最新进展增加了无法接受手术的患者可选择的替代治疗策略。因此，一种建议的策略是采取最大限度的非手术治疗，以避免出现使人衰弱的症状，提高生活质量，并延长生存期。治疗老年体弱患者的复杂性需要采取以患者为中心的方法来个性化治疗。主要挑战在于优化疾病局部控制、患者偏好和治疗负担之间的平衡。全面的老年综合评估是多学科讨论中的关键要素。由于关于最佳非手术治疗策略的知识有限，这些患者应由专门对老年体弱患者感兴趣的多学科直肠癌专家进行治疗。本叙述性综述的目的是讨论一种以患者为中心的多学科治疗方法，并提供一个成功实施的临床护理路径的实用建议。
