摘要
多学科综合治疗（MDT）是肿瘤规范化以及实现个体化治疗的有效形式。在MDT治疗模式下，外科治疗联合化学治疗、放射治疗、靶向治疗、介入治疗及免疫治疗的综合治疗模式，使得结直肠癌的诊断和治疗都取得了里程碑式的进步。根治性手术联合辅助化疗的治疗模式是Ⅲ期可切除性结肠癌的标准治疗模式。而关于Ⅱ期结肠癌是否需要辅助化疗以及采用怎样的化疗方案，一直是备受争议的话题。单纯利用临床病理特征去决定Ⅱ期患者是否接受辅助化疗．似乎有所不足。建议医生应当针对肿瘤生物学行为和恶性程度向患者详细解释治疗的措施、疗效的相关证据及可能引起的不良反应，与患者讨论后决定是否行辅助化疗。新辅助放化疗后行根治性手术已经是局部晚期直肠癌的标准治疗方案．一些学者提出．新辅助放化疗后的肿瘤完全缓解可以“等待观察”替代手术治疗。但目前还没有足够的临床数据支持这种“等待与观察”治疗策略的常规应用。对于转移性结直肠癌治疗，应经过MDT的讨论以制定最佳治疗方案。MDT下判定可切除的标准为在保留足够正常肝储备功能的基础上是否能获得阴性手术切缘。对于可切除性肝转移围手术期化疗顺序的问题．根治性手术联合辅助化疗或新辅助化疗联合手术加辅助化疗两种模式都是可行的方案。随着医学技术的不断发展，MDT的未来将是以基因为导向．能够准确进行预后、疗效及不良反应预测的精准治疗体系。
Multi-disciplinary treatment （MDT） is an effective pattern to implement the standardized and individualized treatment for cancer. Under the pattern of MDT which integrates the surgery, chemotherapy, radiotherapy, interventional therapy, targeted therapy and immune therapy, there has been a landmark progress in the diagnosis and treatment of colorectal cancer. Curative resection followed by adjuvant chemotherapy has been established as a standard treatment for stage llI colon cancer, but it is still controversial about whether patients with stage II colon cancer should receive adjuvant chemotherapy and which regimen is preferred. Decision making regarding the use of adjuvant therapy for stage ]I patients should not only depend upon the clinicopathological features but also individualized discussion between patients and physicians about the biological behavior of the disease, evidence supporting the efficacy, and possible toxicity. Radical operation following neoadjuvant chemoradiotherapy is currently the standard modality for locally advanced rectal cancer, but the strategy of ＇Wait and See＇ is proposed by some researchers for those achieving complete response after chemoradiotherapy, although there is no sufficient supportive data yet. Patients with metastatic colorectal cancer should undergo an upfront evaluation and discussion by a muhidisciplinary team before the initial treatment. Achieving a negative surgical margin with adequate remanent liver reserve is the criteria for determining the resectability of liver metastasis. Both adjuvant and neoadjuvant chemotherapy are two alternatives for initially resectable liver metastasis. Concomitant with the progress of medicine, the MDT is moving toward a precise treatment system oriented by genes and being able to predict the prognosis, efficacy and side effects exactly.
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2016年第6期607-611,共5页
Chinese Journal of Gastrointestinal Surgery
基金
上海市科委课题（14140902200,14140902201）
上海申康医院发展中心课题（SHDC12014206）
