中低位局部进展期直肠癌器官保留热点问题

局部进展期直肠癌标准治疗为新辅助放化疗后全直肠系膜切除术。临床上部分患者在新辅助治疗后可以达到临床完全缓解或者近临床完全缓解。对于该类患者,很多研究机构采取等待观察策略或者局部切除来代替传统的全直肠系膜切除术。临床上将该种代替治疗手段称之为器官保留。而器官保留自从诞生之日起,争论不断。作者就器官保留中的热点问题做一述评。     

局部进展期直肠癌新辅助治疗后器官保留策略进展

新辅助放化疗联合全直肠系膜切除术为分期T 3-T 4期或N+的局部进展期直肠癌(LARC)的标准治疗,但往往会带来一系列术后并发症,尤其是接受腹会阴联合直肠癌根治术(Mile′s术)不能保留肛门者,严重影响生活质量。对于新辅助治疗后肿瘤(近)临床完全缓解者,器官保留策略在与根治性手术达到相似治疗疗效...     

局部进展期胃癌的诊治

胃癌发病率在男性恶性肿瘤中仅次于肺癌占第二位,在女性恶性肿瘤中居第四位,而局部进展期胃癌占胃癌中大多数,提高其诊治水平是提高胃癌5年生存率的关键。近年来有关局部进展期胃癌的基础及临床研究均取得了一定的成果,现就局部进展期胃癌的诊断及治疗进展作一综述。     

局部进展期胃癌的诊治

胃癌发病率在男性恶性肿瘤中仅次于肺癌占第二位,在女性恶性肿瘤中居第四位,而局部进展期胃癌占胃癌中大多数,提高其诊治水平是提高胃癌5年生存率的关键。近年来有关局部进展期胃癌的基础及临床研究均取得了一定的成果,现就局部进展期胃癌的诊断及治疗进展作一综述。     

老年局部进展期直肠癌的治疗模式进展

直肠癌是我国最常见的恶性肿瘤之一,老年患者的比例也在不断增加。由于缺乏针对老年患者的前瞻性循证医学证据,其最佳治疗模式尚未达成共识。本文将对老年局部进展期直肠癌综合治疗策略的相关研究进行综述,为老年患者个体化治疗提供建议。     

老年局部进展期直肠癌的治疗模式进展

直肠癌是我国最常见的恶性肿瘤之一,老年患者的比例也在不断增加。由于缺乏针对老年患者的前瞻性循证医学证据,其最佳治疗模式尚未达成共识。本文将对老年局部进展期直肠癌综合治疗策略的相关研究进行综述,为老年患者个体化治疗提供建议。     

局部进展期直肠癌新辅助治疗研究进展

直肠癌是常见的消化道恶性肿瘤,手术难度大,术后并发症较为常见,局部复发率较高,尤其以局部进展期直肠癌(LARC)的治疗效果差。随着多学科综合治疗理念在恶性肿瘤诊疗过程中受到重视,局部进展期直肠癌患者的预后也在术前新辅助治疗的应用下得以改善。因新辅助放化疗能有效降低术后局部复发率,新辅助放化疗联合全直肠系膜切除术(TME)已成为局部进展期直肠癌国际公认的治疗模式,临床医生也逐渐重视该疾病的术前治疗。为探求更佳的直肠癌患者的综合治疗方案,通过阅读国内外相关文献,就直肠癌新辅助治疗的现状与研究进展进行综述。     

中国局部进展期直肠癌诊疗专家共识

大肠癌作为中国最常见的恶性肿瘤之一,在中国受到广泛的关注。在2012年确诊的全球136万例大肠癌中,中国大肠癌的新发病例数达到25.3万,占全球大肠癌新发病例的18.6%。中国作为全球大肠癌每年新发病例最多的国家,开展积极的肿瘤防治对策,对降低中国大肠癌的发病率和死亡率具有重要的意义。随着人们生活水平的提高和生活方式的改变,结肠癌的发病率正逐年上升,但目前在中国直肠癌发病人数仍然占大肠癌的多数。     

局部进展期直肠癌新辅助放化疗的研究进展

术前放化疗联合全系膜切除手术为局部晚期直肠癌患者治疗的标准模式,术前放化疗比术后放化疗提高了肿瘤降期率、保肛率及局部控制率,术前放化疗后达到病理完全缓解患者拥有更好的预后。本文就近年来术前放化疗的研究进展作一综述。     

局部进展期直肠癌新辅助放化疗的研究进展

术前放化疗联合全系膜切除手术为局部晚期直肠癌患者治疗的标准模式,术前放化疗比术后放化疗提高了肿瘤降期率、保肛率及局部控制率,术前放化疗后达到病理完全缓解患者拥有更好的预后。本文就近年来术前放化疗的研究进展作一综述。     

New standard in locally advanced rectal cancer

In the following review we intend to ascertain the optimal neoadjuvant therapy in patients with locally advanced rectal cancer. In 2004, a study revealed that chemoradiotherapy (CRT) resulted in better local control when performed preoperatively rather than postoperatively, thus neoadjuvant treatment was established as a standard treatment. Subsequently, the Polish study and the Trans-Tasman Radiation Oncology Group showed no statistically significant difference between concomitant CRT over 5 wk vs short-course radiotherapy (RT). Therefore, both were established as standard neoadjuvant treatments. Later, the Stockholm III study demonstrated that short-course RT had a higher complete pathological response than long-course RT. It also showed that a delay between RT and surgery presented fewer complications. This opened a window of time to provide an early and effective systemic treatment to prevent distant metastases. Studies show that short-course RT plus oxaliplatin-based chemotherapy could achieve this. When comparing this total neoadjuvant treatment (TNT) vs concomitant CRT, the former showed greater complete pathological response and lower acute toxicity. Studies presented during 2020 have also shown the benefits of TNT in terms of complete pathological response, as well as disease and metastasis-free survival. Our review suggests that probably TNT should be the new standard treatment for these patients. However, we will have to wait for the full text publications of these studies to confirm this statement.     

局部晚期直肠癌的放化疗

外科手术治疗是局部晚期直肠癌最主要的治疗手段,但术后局部复发率一直处于较高水平。直肠癌术前和术后放化疗降低了术后局部复发率,并提高了生存率及生命质量。目前辅助放化疗已成为局部晚期直肠癌的标准治疗。靶向药物、新的化疗药物以及高速发展的放疗技术为局部晚期直肠癌的治疗提供了更多的途径。     

直肠癌的新辅助治疗

局部晚期直肠癌单纯手术后局部复发率高,近年的随机对照Ⅲ期临床研究提示,局部晚期直肠癌的新辅助治疗可明显提高局部控制率,对于治疗后病理完全缓解者还可提高生存率,在欧美国家已成为局部晚期直肠癌的标准治疗.但化疗药物的选择、热疗等的应用等尚需进一步临床研究.     

Treatment strategy for locally recurrent rectal cancer

Despite radical surgery, up to 33% of patients with rectal cancer will develop locoregional relapse. The management of these patients is particularly challenging. Surgery is the mainstay of treatment for those with a mobile recurrence. However, the majority of patients develop recurrence involving the pelvic wall. In these patients, multimodality therapy including radical surgery and intraoperative radiotherapy have been reported with 5-year survival of up to 31% and local control rates of 50-71%. The most important factor for obtaining long-term local control and survival is R0 resection. Extended surgery such as abdomino-sacral resection has not been popular because of 5-year survival rates of 16-31%, and significant postoperative morbidity. Re-recurrence following surgery occurs locally and in the lung, and remains a significant problem. In surgical treatment for local recurrence, surgeon-related factors are crucial. A staging system using degree of fixation and other prognostic factors should be developed so that appropriate treatment modalities are applied to each case.     

新辅助治疗在局部晚期直肠癌中的作用

综合治疗在局部晚期直肠癌治疗中日益受到重视，术前同期放化疗具有降期、降级、保肛、提高局部控制率和生存率的优点，已逐步成为直肠癌综合治疗的标准方案用于临床。     

Chemoselection: a paradigm for optimization of organ preservation in locally advanced larynx cancer

Definitive chemoradiation (CRT) and laryngectomy followed by postoperative radiotherapy (RT) are both considered standard-of-care options for the management of advanced laryngeal cancer. While organ preservation with chemoradiotherapy is often the preferred up-front approach for appropriately selected candidates, the functional benefits of organ preservation must be carefully balanced against the considerable morbidity of salvage laryngectomy in patients who fail primary chemoradiation. Up-front identification of patients who are likely to require surgical salvage, therefore, is an important aim of any organ preserving approach in order to minimize morbidity while maximizing organ preservation. To this end, a strategy of ‘chemoselection’, using the primary tumor’s response after 1 cycle of induction chemotherapy as an in vivo method of selecting responders for definitive chemoradiation while reserving primary surgical management for non-responders, has been employed extensively at our institution. The rationale, treatment results and future directions of this approach are discussed.     

Feasibility study of a Response Surveillance Program in locally advanced mid and low rectal cancer to increase organ preservation

BackgroundAssessment of tumor response in rectal cancer after neoadjuvant treatment by MRI (Tumour Regression Grade, TRG 1–5) is well standardized. The overall timing and method of defining complete response (cCR) remain controversial. The aim of this work was to evaluate the feasibility of a defined Response Surveillance Program (RSP) to increase organ preservation for locally advanced rectal cancer after neoadjuvant treatment.MethodsA standardized program of clinical (CR), radiological (RR) and metabolic (MR) assessment of tumor response is defined over a 6 month period from completion of NACRT with formal assessment performed every 2 months (M). Patients with TRG1-3 at M2 and TRG1-2 at M4 continue in the program up to M6 assessment. Patients managed with this protocol from 2016 to 2020 were analyzed. The primary endpoint was rectal preservation rate. Secondary endpoints included disease-free survival and overall survival at 3 years.Result314 potentially suitable patients were enrolled in the RSP and 50 patients completed the six month program and were successfully enrolled into watch and wait. Fourteen (28%) were T2 tumor stage, 27 (54%) T3 and nine (18%) were T4. During watch and wait, patients with locoregional recurrence (n = 11) were treated with local excision (n = 3), endocavitary radiotherapy (n = 1), TME (n = 5) and APR (n = 2). With a median follow-up of 32 months, the rectal preservation rate was 88%, with a 3-year disease-free survival of 67% and an overall survival of 98%.ConclusionThis study validates the feasibility of the practical implementation of a Response Surveillance Program to increase organ preservation rates without compromising oncological outcomes in rectal cancer.