Division of Colon and Rectal Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA.
Ann Surg Oncol. 2023 Sep;30(9):5489-5494. doi: 10.1245/s10434-023-13651-9. Epub 2023 Jun 7.
Multimodality treatment for locally advanced rectal cancer is the standard of care. Treatments include surgery, radiation, and chemotherapy, with medical therapies now being favored in the neoadjuvant setting. Various regimens continue to be studied and defined in prospective randomized trials. The PRODIGE 23 and RAPIDO trials showed improved disease-free survival and pathologic complete response rates for split chemotherapy/radiation treatment and short-course radiation with consolidation chemotherapy, respectively; both compared with traditional neoadjuvant long course chemoradiation, surgery, and adjuvant chemotherapy. Furthermore, new regimens are yielding a higher rate of complete clinical response, allowing for non-operative management. Circulating tumor DNA provides a potential novel option for monitoring response to treatment and rectal cancer surveillance. This manuscript summarizes some of the key clinical trials and studies that are defining clinical practice.
局部晚期直肠癌的多模态治疗是标准的治疗方法。治疗包括手术、放疗和化疗，目前新辅助治疗中更倾向于采用药物治疗。各种方案仍在进行前瞻性随机试验研究和定义。PRODIGE 23 和 RAPIDO 试验显示，与传统的新辅助长程放化疗、手术和辅助化疗相比，分割化疗/放疗和短程放疗联合巩固化疗分别提高了无病生存率和病理完全缓解率；此外，新的方案使完全临床缓解的比例更高，从而可以进行非手术治疗。循环肿瘤 DNA 为监测治疗反应和直肠癌监测提供了一种潜在的新选择。本文总结了一些正在定义临床实践的关键临床试验和研究。
