影像学对直肠癌新辅助治疗后分期的评估价值

Evaluation of current imaging in restaging rectal cancer after neoadjuvant therapy

局部进展期直肠癌的标准治疗方案是术前新辅助放化疗联合手术的综合治疗.高达30％的局部进展期直肠癌患者经过新辅助治疗后可以达到病理完全缓解（pCR）.研究显示,病理完全缓解的病例,局部复发率低、预后较好.故有学者提出,对新辅助治疗后达到部分或完全临床缓解（cCR）的病例,可分别采取手术局部切除术或严密随访的治疗方案,以避免根治性手术带来的风险或功能障碍.当前,影像学检查能对新辅助治疗前的直肠癌进行准确分期,但治疗所引起的肿瘤及周围组织的改变,会影响治疗后再分期的准确性,尤其是预测pCR的准确性一直比较低.如何在术前判定新辅助治疗后达到pCR,是目前人们关注的问题.本文以术后病理结果为标准,就当前常用影像学技术在直肠癌新辅助治疗后分期诊断中的价值及pCR的预测作一简要综述。

The combination of preoperative chemoradiotherapy and surgery has become the standard treatment for locally advanced rectal cancer.Up to 30% of patients received pathologic complete response （pCR） after neoadjuvant therapy,for whom low rates of local recurrence and improved outcome after surgery were achieved.Given that,some authors have recommended local resection for clinical extensive response or non operative ＆quot;wait and see＆quot; policy for clinical complete response （cCR） respectively,in which radical surgery-associated complication and dysfunction can be avoided.Current imaging can provide excellent accuracy in primary staging of rectal cancer,however,when used for restaging,the ability is less satisfactory,especially for pCR prediction,as a result of modification on tumor and surrounding tissue induced by neoadjuvant therapy.The question on how to identify patients with pCR before surgery has received more attention recently.On the basis of pathological findings after surgery,in this article,we review the reliability and predictive ability of current imaging for restaging and pCR after preoperative chemoradiotherapy in rectal cancer.