直肠癌新辅助放化疗后临床完全缓解的诊治策略选择：＂观察等待＂是否安全？

Diagnosis and treatment strategy for clinical complete responders after chemoradiotherapy for rectal cancer： is watch-and-wait policy safe？

根据目前的指南,新辅助放化疗后获得临床完全缓解的局部进展期中低位直肠癌患者,推荐的治疗方法仍是全直肠系膜切除术.少数研究结果显示,对新辅助放化疗后达到临床完全缓解的患者采用＂观察等待＂策略,从肿瘤学角度而言具有安全性,而且可以为患者保留更好的肛门直肠功能和生活质量.当然,如果采用＂观察等待＂策略,患者必须接受严密的观察和随访.由于尚无足够证据证明＂观察等待＂策略的肿瘤学效果,因此不能在临床实践中对其进行广泛推广,未来还需要进一步的前瞻性研究来评估患者的风险与获益.

Neo-adjuvant chemoradiotherapy （NACRT） combined with total mesorectal excision （TME） surgery is the main treatment for locally advanced middle-low rectal cancer, and NACRT significantly improves the local control rate of rectal cancer. According to the current guidelines, patients who receive clinical complete response （cCR） after NACRT are recommended for treatment with TME surgery. A few studies have shown that the watch-and-wait （WAW） policy is safe and could ensure anorectal function and quality of life in patients with cCR. In addition, such patients must be closely observed and followed up so as to enable salvage surgery for long periods of tumor re-growth. However, there is not enough evidence to provide a clear answer to the oncological effect of the WAW policy. As a result, WAW policy is not widely available in clinical practice, and further prospective studies are needed to assess its risk and benefit for the patients.