摘要
结直肠癌是最常见的恶性肿瘤之一。外科治疗是直肠癌治疗方式中最主要、最决定性的手段,全直肠系膜切除术的提出大大降低了中低位直肠癌的局部复发率。然而,直肠癌术后局部复发和远处转移仍然是直肠癌最主要的致死因素。以氟尿嘧啶(5-FU)为基础的新辅助放化疗方案在直肠癌治疗中的价值越来越得到认可,并已被诸多临床治疗指南推荐为局部进展期直肠癌的标准治疗模式。新辅助放疗后肿瘤常获得满意的降期,部分患者甚至达到病理完全缓解,对这部分患者是按照初始的临床分期还是术后病理来制定辅助治疗策略尚无定论,并且辅助化疗能否给这部分患者带来生存获益也尚无共识。这就给新辅助治疗后直肠癌辅助化疗的选择带来了较多争议。本文主要阐述直肠癌辅助化疗的循证医学证据、新辅助治疗模式的改变对辅助化疗的影响以及新辅助放化疗背景下辅助化疗的争议与思考。
Colorectal cancer is one of the most common malignant tumors worldwide. Surgical resection is the most important and decisive method in the treatment of rectal cancer. Total mesorectal excision (TME) has greatly reduced the local recurrence rate of middle and low rectal cancer. However, local recurrence and distant metastasis remain the leading cause of death in patients with rectal cancer. 5-fluorouracil (5-FU)-based neoadjuvant chemoradiotherapy has been widely accepted in locally advanced rectal cancer and was recommended by various clinical practice guidelines as the standard treatment option. Tumors often achieve satisfactory reduced stage after neoadjuvant radiotherapy, and some patients even achieve pathological complete regression, which brings much controversies to the choice of adjuvant chemotherapy. This article intends to introduce evidence-based evidences for adjuvant chemotherapy for rectal cancer, impact of current neoadjuvant models on choice of adjuvant chemotherapy strategies, controversies and considerations for adjuvant chemotherapy in the context of neoadjuvant radiotherapy.
作者
李心翔
李清国
Li Xinxiang;Li Qingguo(Department of Colorectal Surgery, Fudan University Shanghai Cancer Center,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China)
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2019年第6期594-596,共3页
Chinese Journal of Gastrointestinal Surgery
基金
国家自然科学基金(81702353、81772599).
关键词
直肠肿瘤
局部进展期
新辅助放化疗
辅助化疗
Rectal neoplasms, locally advanced
Neoadjuvant chemoradiotherapy
Adjuvant chemotherapy
