Gandini Annalice, Sciallero Stefania, Martelli Valentino, Pirrone Chiara, Puglisi Silvia, Cremante Malvina, Grassi Massimiliano, Andretta Valeria, Fornarini Giuseppe, Caprioni Francesco, Comandini Danila, Pessino Annamaria, Mammoliti Serafina, Sobrero Alberto, Pastorino Alessandro
Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
Cancers (Basel). 2025 Jan 20;17(2):330. doi: 10.3390/cancers17020330.
At the end of the past century, the introduction of Total Mesorectal Excision (TME), preceded by either short-course radiotherapy (SCRT) or chemoradiation (CRT), established the new standard of care for locally advanced rectal cancer (LARC). Recently, significant advancements were achieved for both dMMR/MSI and pMMR/MSS LARC patients. For the 2-3% of dMMR/MSI LARCs, ablative immunotherapy emerged as a curative approach, offering the possibility of avoiding chemotherapy (CT), radiotherapy, and surgery altogether. In pMMR/MSS LARCs, the intensification of preoperative treatments with Total Neoadjuvant Treatment (TNT) afforded three outcomes: (a) a reduction of distant metastases, positively impacting on survival endpoints, (b) a significant increase of complete clinical response (cCR) rate, paving the way for non-operative management (NOM), and (c) the selective omission of radiotherapy following induction CT. The choice of the most appropriate therapeutic strategy can only be made through the shared decision-making process between physician and patient based on risk stratification and patient preferences.
在上个世纪末，全直肠系膜切除术（TME）的引入，在短程放疗（SCRT）或放化疗（CRT）之后，确立了局部晚期直肠癌（LARC）的新治疗标准。最近，错配修复缺陷/微卫星高度不稳定（dMMR/MSI）和错配修复功能正常/微卫星稳定（pMMR/MSS）的LARC患者都取得了重大进展。对于2%-3%的dMMR/MSI LARC患者，消融性免疫疗法成为一种治愈方法，提供了完全避免化疗（CT）、放疗和手术的可能性。在pMMR/MSS LARC患者中，采用全新辅助治疗（TNT）强化术前治疗产生了三个结果：（a）远处转移减少，对生存终点产生积极影响；（b）完全临床缓解（cCR）率显著提高，为非手术治疗（NOM）铺平了道路；（c）诱导CT后选择性省略放疗。最合适的治疗策略只能通过医生和患者基于风险分层和患者偏好的共同决策过程来选择。
