局部进展期直肠癌新辅助放化疗联合免疫治疗的回顾和展望

Review and prospect of neoadjuvant chemoradiotherapy combined with immunotherapy in locally advanced rectal cancer

对于局部进展期直肠癌(LARC),新辅助放化疗联合全直肠系膜切除术(TME)的标准治疗模式肿瘤退缩和保肛率仍有限,且无法降低远处转移率。放疗可促进机体免疫应答,放疗和免疫治疗联合具有良好的协同作用,有望突破微卫星稳定(MSS)型结肠直肠癌的治疗困境。近年来,新辅助放化疗联合免疫治疗的临床试验逐渐展开,大多获得满意的肿瘤完全缓解率,为MSS型中、低位LARC病人保留器官功能提供新的选择。未来仍需更多大样本随机对照研究进行验证,期待获得更好的保肛和远期生存获益。同时在放疗与免疫治疗模式、疗效准确评估等方面需进一步优化和努力。

For locally advanced rectal cancer(LARC),the standard treatment of neoadjuvant chemoradiotherapy(nCRT) followed by total mesorectal excision(TME) leaded to limited tumor regression grade and organ preservation rate,and didn't decrease the rate of distant metastasis.Radiotherapy can promote the immune response and has good synergistic effect with immunotherapy,which is likely to overcome the treatment difficulty of the microsatellite stable(MSS) colorectal cancer.Recently,multiple clinical trials are ongoing in terms of the combination of nCRT and immunotherapy in LARC.Most of them have achieved promising complete response rates,providing new treatment options for preservation of organ functions in mid-low MSS LARC.Large-scale randomized controlled trials are needed in the future to validate these findings and explore the benefit of organ preservation and long-term survival.In addition,studies are still needed on the optimal combination patterns of radiotherapy and immunotherapy and the precise efficacy evaluation,etc.