New treatment strategy after neoadjuvant chemoradiotherapy in low rectal cancer

doi:10.3760/cma.j.issn.1673-422X.2018.10.012

Abstract

Abstract: Rectal cancer is one of the most common malignant tumor in our country, among them with highest incidence of low rectal cancer. With the further study on the biological behavior of rectal cancer and the development of diagnostic and therapeutic techniques, gastrointestinal oncologists have proposed a new treatment strategy local resection and wait-and-see. This strategy can better preserve anal function and improve the quality of life of patients without losing the good tumor control of the traditional standard treatment model.

Key words: Rectal neoplasms, Neoadjuvant therapy, Local excision, Wait-and-see

Liu Qi, Sun Weizi, Wei Yan, Peng Jin, Zhou Fuxiang. New treatment strategy after neoadjuvant chemoradiotherapy in low rectal cancer[J]. Journal of International Oncology, 2018, 45(10): 632-634.

References

［1］ Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015［J］. CA Cancer J Clin, 2016, 66(2): 115-132. DOI: 10.3322/caac.21338. ［2］卫洪波, 郑宗珩. 超低位直肠癌保肛手术技术及革新［J］. 国际外科学杂志, 2016, 43(1): 8-10. DOI: 10.3760/cma.j.issn.1673-4203.2016.01.003. ［3］中华人民共和国卫生和计划生育委员会医政医管局, 中华医学会肿瘤学分会. 中国结直肠癌诊疗规范(2017年版)［J］. 中华外科杂志, 2018, 56(4): 241-258. DOI: 10.3760/cma.j.issn.05295815.2018.04.001. ［4］ Paun BC, Cassie S, MacLean AR, et al. Postoperative complications following surgery for rectal cancer［J］. Ann Surg, 2010, 251(5): 807-818. DOI: 10.1097/SLA.0b013e3181dae4ed. ［5］ Marijnen CA. Organ preservation in rectal cancer: have all questions been answered?［J］. Lancet Oncol, 2015, 16(1): e13-e22. DOI: 10.1016/S1470-2045(14)70398-5. ［6］ Sauer R, Liersch T, Merkel S, et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase Ⅲ trial after a median followup of 11 years［J］. J Clin Oncol, 2012, 30(16): 1926-1933. DOI: 10.1200/JCO.2011.40.1836. ［7］ Lezoche E, Baldarelli M, Lezoche G, et al. Randomized clinical trial of endoluminal locoregional resection versus laparoscopic total mesorectal excision for T2 rectal cancer after neoadjuvant therapy［J］. Br J Surg, 2012, 99(9): 1211-1218. DOI: 10.1002/bjs.8821. ［8］ GarciaAguilar J, Renfro LA, Chow OS, et al. Organ preservation for clinical T2N0 distal rectal cancer using neoadjuvant chemoradiotherapy and local excision (ACOSOG Z6041): results of an openlabel, singlearm, multiinstitutional, phase 2 trial［J］. Lancet Oncol, 2015, 16(15): 1537-1546. DOI: 10.1016/S1470-2045(15)00215-6. ［9］德吉, 秦金玉, 王瑾, 等. 早期结直肠癌淋巴结转移的危险因素分析及内镜切除指征的探讨［J］. 中华消化内镜杂志, 2015, 32(6): 367-370. DOI: 10.3760/cma.j.issn.1007-5232.2015.06.003. ［10］ Yeo SG, Kim DY, Kim TH, et al. Pathologic complete response of primary tumor following preoperative chemoradiotherapy for locally advanced rectal cancer: longterm outcomes and prognostic significance of pathologic nodal status (KROG 0901)［J］. Ann Surg, 2010, 252(6): 998-1004. DOI: 10.1097/SLA.0b013e3181-f3f1b1. ［11］ Smith JJ, Chow OS, Gollub MJ, et al. Organ preservation in rectal adenocarcinoma: a phase Ⅱ randomized controlled trial evaluating 3year diseasefree survival in patients with locally advanced rectal cancer treated with chemoradiation plus induction or consolidation chemotherapy, and total mesorectal excision or nonoperative management［J］. BMC Cancer, 2015, 15: 767. DOI: 10.1186/s12885-015-1632-z. ［12］ Maas M, Nelemans PJ, Valentini V, et al. Longterm outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data［J］. Lancet Oncol, 2010, 11(9): 835844. DOI: 10.1016/S14702045(10)701728. ［13］ HabrGama A, Perez RO, Nadalin W, et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: longterm results［J］. Ann Surg, 2004, 240(4): 711-717, discussion 717-718. ［14］ Maas M, BeetsTan RG, Lambregts DM, et al. Waitandsee policy for clinical complete responders after chemoradiation for rectal cancer［J］. J Clin Oncol, 2011, 29(35): 4633-4640. DOI: 10.1200/JCO.2011.37.7176. ［15］ Renehan AG, Malcomson L, Emsley R, et al. Watchandwait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer (the OnCoRe project): a propensityscore matched cohort analysis［J］. Lancet Oncol, 2016, 17(2): 174-183. DOI: 10.1016/S14702045(15)00467-2. ［16］杨庆, 张涛. 直肠癌新辅助治疗后临床完全缓解的评估［J］. 现代肿瘤医学, 2016, 24(17): 2815-2819. DOI: 10.3969/j.issn.1672-4992.2016.17.043. ［17］ Ryan JE, Warrier SK, Lynch AC, et al. Assessing pathological complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer: a systematic review［J］. Colorectal Dis, 2015, 17(10): 849-861. DOI: 10.1111/codi.13081. ［18］ Rullier E, Rouanet P, Tuech JJ, et al. Organ preservation for rectal cancer (GRECCAR 2): a prospective, randomised, openlabel, multicentre, phase 3 trial［J］. Lancet, 2017, 390(10093): 469-479. DOI: 10.1016/S0140-6736(17)31056-5.

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