直肠癌新辅助放化疗

Neoadjuvant radiochemotherapy in treatment of rectal cancer

根治性手术结合术后放、化疗一度被作为国际公认的Ⅱ及Ⅲ期直肠癌的标准疗法。近年，新辅助放化疗逐渐得到广泛的关注。大量研究表明，与术后放化疗相比，新辅助放化疗结合根治性手术的多模式联合治疗在降低直肠癌的局部复发率、延长生存时间等方面均显示出更好的效果，特别是在提高保肛率方面具有突出的优势。目前认为，新辅助放化疗适用于局部进展期（T3-4）或有系膜内淋巴结转移的低位直肠癌患者（Ⅱ～Ⅲ期）。随着先进的诊断技术、更优化的放疗模式，以及更多有效的药物及新配伍方案的引入，对直肠癌患者采取个体化的术前新辅助治疗，将使直肠癌的治疗效果得到进一步提高。

Radical surgery combined with postoperative radiochemotherapy has ever been recommended as the standard treatment modality for stage- Ⅱ and Ⅲ rectal cancer. In recent years, neoadjuvant therapy has gained increasing interest. Many clinical trials suggest that in combination with radical surgery, neoadjuvant radiochemotherapy is more effective in decreasing local recurrence and increasing survival compared with postoperative modalities. And favoring sphincter preservation is one of its major advantages. At present, neoadjuvant radiochemotherapy is indicated in the locally advanced （T3-4） lower rectal cancer, or that with lymphatic metastasis in the mesentery （stage - Ⅱ and Ⅲ ）. With the introduction of more advanced diagnostic and radiation techniques and more effective novel chemotherapeutic agents with innovative ways of their combination, multimodal treatment with neoadjuvant radiochemotherapy will be applied individually in treating the selected patients, which is expected to further enhance the therapeutic effect of rectal cancer.