Hui Caressa, Vitzthum Lucas K, Chang Daniel T, Pollom Erqi L
Department of Radiation Oncology, Stanford University, Stanford, California.
Department of Radiation Oncology, Stanford University, Stanford, California.
Pract Radiat Oncol. 2023 Jan-Feb;13(1):e54-e60. doi: 10.1016/j.prro.2022.06.010. Epub 2022 Jul 5.
Trimodality therapy per the German Rectal Trial has led to excellent locoregional outcomes for locally advanced rectal cancer. Recent efforts have shifted toward improving distant control and health-related quality of life in this disease. To this end, total neoadjuvant therapy has become an increasingly used approach in which most, if not all, chemotherapy is delivered before surgery to improve compliance and to address micrometastases early. To avoid surgical morbidity, a "watch-and-wait" approach, in which total mesorectal excision is deferred, has also been studied for patients who achieve a clinical complete response after chemoradiation. These 2 concurrent treatment trends have raised many points of uncertainty in what used to be a relatively straightforward neoadjuvant treatment paradigm. We discuss here our approach to neoadjuvant therapy for locally advanced rectal cancer, based on the data we currently have and through shared decision-making with patients to help them select the treatment that best aligns with their preferences and values.
根据德国直肠癌试验，三联疗法已为局部晚期直肠癌带来了出色的局部区域治疗效果。最近的努力已转向改善该疾病的远处控制和与健康相关的生活质量。为此，全新辅助治疗已成为一种越来越常用的方法，即大部分（如果不是全部）化疗在手术前进行，以提高依从性并尽早处理微转移。为避免手术并发症，对于在放化疗后达到临床完全缓解的患者，也研究了一种“观察等待”方法，即推迟全直肠系膜切除术。这两种并行的治疗趋势在过去相对简单的新辅助治疗模式中引发了许多不确定因素。我们在此讨论基于我们目前所掌握的数据以及通过与患者共同决策来帮助他们选择最符合其偏好和价值观的治疗方法，对局部晚期直肠癌进行新辅助治疗的方法。
