Current options for the management of rectal cancer.
Current options for the management of rectal cancer.
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DOI：
10.1007/s11864-007-0048-7
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发表时间：
2007-10-01
影响因子：
4.3
通讯作者：
Tepper, Joel E
中科院分区：
文献类型：
--
作者：
O'Neil, Bert H;Tepper, Joel E
被诊断为直肠癌的患者应接受经直肠内窥镜超声(EUS)或骨盆表面线圈阵列MRI(如果该技术可用)的局部区域分期。被认为有超过极早期(T1或T2)疾病的患者也应该接受腹部CT或MRI检查，胸部检查则采用CXR或最好是CT。直肠癌患者的护理应由经验丰富的多学科团队协调，以最大限度地增加治愈的机会，并将局部复发和治疗并发症降至最低。对于早期病变(T1N0或T2N0)的患者，局部切除加或不加放化疗可能是足够的治疗方法，但这些患者必须仔细选择，不应有任何不良预后因素。对于大多数T3N0或更大的直肠癌患者，标准治疗包括新辅助持续5-FU和放疗，然后手术和进一步化疗(使用5-FU、卡培他滨或FOLFOX)。卡培他滨、伊立替康和奥沙利铂在放射治疗中的应用前景看好，但仍有待III期研究的结果。新辅助治疗是首选，因为它减少了局部复发，与术后治疗相比，似乎可以改善术后的肠道功能。选择高(距肛缘10厘米)uT3N0肿瘤的患者，局部复发的风险可能足够低，因此可以省略放射治疗。对放射治疗有病理完全反应的患者仍应接受术后辅助化疗，以降低全身复发风险，直到有数据证明这是不必要的。IV期直肠癌患者可能仍然需要局部放射治疗或手术治疗，或者两者兼而有之；然而，对于这些患者，应该注意不要过度推迟化疗，因为这是这种情况下可以提高生存率的一种方式。
Patients diagnosed with rectal cancer should undergo locoregional staging with transrectal endoscopic ultrasound (EUS) or surface coil array MRI of the pelvis if that technique is available. Patients thought to have more than very early stage (T1 or T2) disease should undergo abdominal imaging as well by CT or MRI, and chest imaging with either CXR or preferably CT. The care of rectal cancer patients should be coordinated amongst an experienced multidisciplinary team to maximize the chance of cure and to minimize both local recurrence and complications of therapy. For patients with very early stage disease (T1N0 or T2N0), local resection with or without chemoradiation may be adequate therapy, but these patients must be selected carefully and should be without any poor prognostic factors. For the majority of patients with T3N0 or greater rectal cancer, standard therapy consists of neoadjuvant continuous 5-FU and radiation followed by surgery and further chemotherapy (either with 5-FU, capecitabine, or FOLFOX). The use of capecitabine, irinotecan, and oxaliplatin during radiotherapy shows promise, but remains investigational pending results of phase III studies. Neoadjuvant therapy is preferred because it decreases local recurrence and appears to result in improved postoperative bowel function in comparison with postoperative therapy. Select patients with high (>10 cm from the anal verge) uT3N0 tumors may be at sufficiently low risk of local recurrence to justify omission of radiotherapy. Patients who experience pathologic complete response to radiotherapy should still receive postoperative adjuvant chemotherapy to reduce systemic recurrence risk until data demonstrate that this is not necessary. Patients with stage IV rectal cancer may still require local therapy with radiation, surgery, or both; however, care should be taken in these patients that chemotherapy is not excessively delayed as this is the one modality in this case that can result in improved survival.