Wu Z H, Cheng Y, Hu H B, Zhang J W, Deng Y H
Department of Oncology, the Sixth Affiliated Hospital of Sun Yat-sen University, Biomedical Innovation Center, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2024 Apr 25;27(4):416-423. doi: 10.3760/cma.j.cn441530-20231231-00235.
Neoadjuvant therapy for locally advanced colorectal cancer has made great progress in the past 20 years, but there are still limitations such as side effects, organ dysfunction and unsatisfactory control of metastasis. In recent years, with the improvement of surgical techniques and further development of molecular research, how to further improve local control, reduce distant metastasis, and even avoid surgery according to clinical remission to achieve organ preservation, is the current demand and research goal. With the advancement of molecular research, colorectal cancer has different treatment strategies based on microsatellite status. For patients with microsatellite instability locally advanced colorectal cancer, immune checkpoint inhibitor therapy significantly increased the pathologic complete response rate, reduced the incidence of adverse events and improved organ function compared with conventional chemoradiotherapy. For patients with microsatellite stable locally advanced colon cancer, neoadjuvant therapy is still in the exploratory stage. The standard of care is surgery combined with perioperative chemotherapy. For microsatellite stable locally advanced rectal cancer, the complete response rate is improved by enhancing neoadjuvant therapy, which helps to preserve organs. On the other hand, selective radiotherapy preserves organ function and improves quality of life. This article reviews the neoadjuvant treatment strategies for locally advanced colorectal cancer based on organ-sparing strategies.
在过去20年中，局部晚期结直肠癌的新辅助治疗取得了巨大进展，但仍存在副作用、器官功能障碍和转移控制不理想等局限性。近年来，随着手术技术的改进和分子研究的进一步发展，如何进一步提高局部控制、减少远处转移，甚至根据临床缓解情况避免手术以实现器官保留，是当前的需求和研究目标。随着分子研究的进展，结直肠癌根据微卫星状态有不同的治疗策略。对于微卫星不稳定的局部晚期结直肠癌患者，与传统放化疗相比，免疫检查点抑制剂治疗显著提高了病理完全缓解率，降低了不良事件的发生率，并改善了器官功能。对于微卫星稳定的局部晚期结肠癌患者，新辅助治疗仍处于探索阶段。标准治疗方案是手术联合围手术期化疗。对于微卫星稳定的局部晚期直肠癌患者，通过强化新辅助治疗提高了完全缓解率，这有助于保留器官。另一方面，选择性放疗可保留器官功能并提高生活质量。本文基于器官保留策略综述了局部晚期结直肠癌的新辅助治疗策略。
