Optimal Time Intervals between Pre-Operative Radiotherapy or Chemoradiotherapy and Surgery in Rectal Cancer?
Optimal Time Intervals between Pre-Operative Radiotherapy or Chemoradiotherapy and Surgery in Rectal Cancer?
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直肠癌术前放疗或化放疗与手术之间的最佳时间间隔？
DOI：
10.3389/fonc.2014.00050
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发表时间：
2014
影响因子：
4.7
通讯作者：
Glimelius B
中科院分区：
文献类型：
--
作者：
Glimelius B
背景资料：在直肠癌治疗中，放疗或放化疗（RT/CRT）在术前被广泛使用，以（i）降低局部复发风险，（ii）允许对不可切除的肿瘤进行根治性手术，（iii）增加保肛手术或（iv）器官保存的机会。临床医生和科学家对延长RT/CRT到手术的间隔以实现最大肿瘤消退并减少手术期间的并发症越来越感兴趣。方法：严格评估根据术前RT/CRT的目的延迟手术的利弊。结果：根据不同的临床情况，需要一个时间间隔手术前，让肿瘤消退的变化。在第一种也是最常见的情况（i）中，不需要消退，并且超出周围组织中的急性辐射反应所需的任何延迟都可能是有害的。在短期RT（5Gyx 5）和立即手术后，最后一次放射部分之间的理想时间是2-5天，因为稍长的间隔似乎会增加手术并发症。延迟超过4周似乎是安全的;它导致肿瘤消退，包括病理学完全缓解，但尚未充分评价肿瘤学结局。在合理范围内（约4-12周），CRT-手术间隔似乎不会影响手术并发症，但尚未对此进行充分探讨。在直肠腺癌中，直到几个月后才可能看到最大的肿瘤消退;因此，如果计划进行有限的手术或不进行手术（如（iii）或（iv）），则比通常更长的延迟可能对反应良好的肿瘤有益，否则就不会。结论：CRT后较长的时间间隔在某些临床情况下无疑是有益的，但在大多数情况下可能适得其反。在短期RT后，临床试验的长期结果尚不可用于常规推荐超过2-5天的间隔，除非肿瘤在诊断时不可切除。
Background: In rectal cancer therapy, radiotherapy or chemoradiotherapy (RT/CRT) is extensively used pre-operatively to (i) decrease local recurrence risks, (ii) allow radical surgery in non-resectable tumors, and (iii) increase the chances of sphincter-saving surgery or (iv) organ-preservation. There is a growing interest among clinicians and scientists to prolong the interval from the RT/CRT to surgery to achieve maximal tumor regression and to diminish complications during surgery. Methods: The pros and cons of delaying surgery depending upon the aim of the pre-operative RT/CRT are critically evaluated. Results: Depending upon the clinical situation, the need for a time interval prior to surgery to allow tumor regression varies. In the first and most common situation (i), no regression is needed and any delay beyond what is needed for the acute radiation reaction in surrounding tissues to wash out can potentially only be deleterious. After short-course RT (5Gyx5) with immediate surgery, the ideal time between the last radiation fraction is 2–5 days, since a slightly longer interval appears to increase surgical complications. A delay beyond 4 weeks appears safe; it results in tumor regression including pathologic complete responses, but is not yet fully evaluated concerning oncologic outcome. Surgical complications do not appear to be influenced by the CRT-surgery interval within reasonable limits (about 4–12 weeks), but this has not been sufficiently explored. Maximum tumor regression may not be seen in rectal adenocarcinomas until after several months; thus, a longer than usual delay may be of benefit in well responding tumors if limited or no surgery is planned, as in (iii) or (iv), otherwise not. Conclusion: A longer time interval after CRT is undoubtedly of benefit in some clinical situations but may be counterproductive in most situations. After short-course RT, long-term results from the clinical trials are not yet available to routinely recommend an interval longer than 2–5 days, unless the tumor is non-resectable at diagnosis.