直肠癌治疗理念更新——强调术前多学科评估

Multidisciplinary assessment:a new concept for treatment of rectal cancer

2009版NCCN直肠癌临床实践指南本年度共涉及14项更新,包括诊断、多学科评估、辅助化放疗、新辅助化放疗、晚期解救及靶向药物治疗等内容。其重点更新包括:直肠癌术前可切除性评估首次在正文中强调了应选择"硬性直肠镜"而非"直肠镜";明确K-ras基因野生型结直肠癌病人是靶向药物西妥昔单抗临床应用适应证人群;提出了微卫星不稳定性与预后和化疗敏感性的关系等。而2009年美国临床肿瘤学会年会主题所提出的"癌症医疗个体化(personalizing cancer care)"理念也在肿瘤领域引起重大反响,这一理念明确了除个体化治疗计划(personalized the rapy)外,"癌症医疗个体化"还包括了个体化癌症风险评估、个体化生存规划以及终末期病人姑息治疗和护理的个体化等内容。正确理解肿瘤诊治理念更新变化,强调科学客观的临床多学科评估,将成为推动直肠癌诊治水平的基础和保障。

NCCN Clinical Practice Guideline in Rectal Cancer （Version 2009） covers 14 updates, ranging from diagnosis, muhidisciplinary assessment, adjuvant chemoradiotherapy, neoadjuvant chemoradiotherapy, late-stage salvage treatment and targeted drugs, etc. It emphasizes the fact for the first time that the preoperative assessment of resectability for rectal cancer should choose rigid proctoscopy instead of proetoscopy, and ascertains that wide type KRAS gene is the only clinical indication of the targeted drug cetuximab for patients with rectal cancer, and proposes the relation between microsatellite instability （MSI） and prognosis and sensitivity of chemotherapy. The annual meeting of American Society of Clinical Oncology （ASCO） 2009 took the concept of ＂personalizing cancer care＂ as the subject, which evokes great resonance in oncological field. Besides personalized therapy, it includes personalized cancer risk evaluation, survival planning, palliative treatment for late-stage patients and personalized nursing, as well. Understanding the updates in oncology exactly and emphasizing a scientific muhidisciplinary assessment will provide a solid foundation for promoting the level of clinical practice in rectal eaneer.