新辅助治疗——对直肠癌现有治疗模式的挑战?

Neoadjuvant radiochemotherapy:A challenge for the treatment of rectal cancer?

近年来,新辅助治疗对于直肠癌的疗效得到进一步的肯定,已被公认为进展期直肠癌的标准治疗方法。一些研究甚至开始探讨新辅助治疗是否可以取代根治性手术成为主导治疗方式。放化疗后临床分期的准确度以及T分期与淋巴结阳性率的相关性这两个方面从理论上决定非根治性手术的可行性。尽管目前不乏新辅助治疗后不手术或行局部切除术结果满意的报告,但由于缺乏前瞻性研究,关于新辅助治疗在进展期直肠癌治疗中的地位仍存在争议。

Neoadjuvant radiochemotherapy is widely accepted as a standard treatment for advancedrectal cancer. Several studies have explored the possibility of using nonoperative treatment or local excision after neoadjuvant radiochemotherapy. However, the accuracy of clinical restaging after radiochemotherapy and the feasibility of using T stage to predict lymph node status remain two main problems. Although some retrospective studies have demonstrated satisfactory results of nonoperative treatment or local excision after radiochemotherapy, the treatment policy after neoadiuvant theranv is still controversial.