Rectal Cancer after Prostate Radiation: A Complex and Controversial Disease.
Rectal Cancer after Prostate Radiation: A Complex and Controversial Disease.
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放射治疗通常用于治疗前列腺癌，但它本身就是一种致癌物质。据报道，与手术治疗的患者相比，接受盆腔放射治疗的前列腺癌长期生存者发生直肠癌的风险增加。放射相关直肠癌的治疗具有挑战性，并且这种疾病背后的证据有限，而且往往相互矛盾。在这里，我们回顾了现有的文献，并讨论了治疗前列腺放疗后直肠癌患者的独特考虑。一小部分直肠腺癌是在使用盆腔放射治疗以前的癌症多年后发生的，这些直肠癌的发病率取决于从放射治疗结束后随访的时间。接受前列腺外照射放射治疗的患者发生放射相关直肠癌（RARC）的风险高于接受近距离放射治疗的患者。RARC的分子特征尚未得到充分研究，与未接受放射治疗的直肠癌患者相比，其生存率较低。最终，尚不清楚更差的结果是否与患者特征，治疗相关因素或肿瘤生物学的差异有关。放射广泛用于直肠腺癌的治疗;然而，RARC的盆腔再照射具有挑战性，并且具有较高的治疗并发症风险。虽然RARC可以在接受各种恶性肿瘤治疗的患者中发展，但在接受前列腺癌治疗的患者中最常见。本研究将回顾既往接受过放射治疗的前列腺癌患者中直肠腺癌的发病率、分子特征、临床病程和治疗结局。为清楚起见，我们将区分与前列腺癌无关的直肠癌（RCNAPC）、未接受放射治疗的前列腺癌患者中的直肠癌（RCNRPC）和接受放射治疗的前列腺癌患者中的直肠癌（RCRPC）。RARC代表了直肠癌的一个独特但研究不足的子集，因此需要更全面的调查，以改善其治疗和预后。
Radiation therapy is commonly used in the treatment of prostate cancer, but it is a carcinogen itself. Long-term survivors of prostate cancer who were treated with pelvic radiotherapy have been reported to be at increased risk for developing rectal cancer compared to those treated with surgery. The treatment of radiation-associated rectal cancer is challenging, and the evidence behind this disease is limited and often contradictory. Here, we review the available literature and discuss the unique considerations of treating patients with rectal cancer after prostate radiotherapy. A small proportion of rectal adenocarcinomas develop in patients many years after the treatment of a previous cancer using pelvic radiation, and the incidence of these rectal cancers depends on the length of follow-up from the end of radiotherapy. The risk of radiation-associated rectal cancer (RARC) is higher in patients treated with prostate external beam radiotherapy than it is in patients treated with brachytherapy. The molecular features of RARC have not been fully investigated, and survival is lower compared to non-irradiated rectal cancer patients. Ultimately, it is unclear whether the worse outcomes are related to differences in patient characteristics, treatment-related factors, or tumor biology. Radiation is widely used in the management of rectal adenocarcinoma; however, pelvic re-irradiation of RARC is challenging and carries a higher risk of treatment complications. Although RARC can develop in patients treated for a variety of malignancies, it is most common in patients treated for prostate cancer. This study will review the incidence, molecular characteristics, clinical course, and treatment outcomes of rectal adenocarcinoma in patients previously treated with radiation for prostate cancer. For clarity, we will distinguish between rectal cancer not associated with prostate cancer (RCNAPC), rectal cancer in non-irradiated prostate cancer patients (RCNRPC), and rectal cancer in irradiated prostate cancer patients (RCRPC). RARC represents a unique but understudied subset of rectal cancer, and thus requires a more comprehensive investigation in order to improve its treatment and prognosis.
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影响因子：
3.7
作者：
Guo, Tianhua;Zhang, Lei;Chang, Ning-En;Singer, Samuel;Maki, Robert G.;Antonescu, Cristina R.
通讯作者：
Antonescu, Cristina R.
DOI：
10.1016/j.ijrobp.2006.08.055
发表时间：
2007-01-01
影响因子：
7
作者：
Goldner, Gregor;Tomicek, Birgit;Poetter, Rochard
通讯作者：
Poetter, Rochard
影响因子：
6.6
作者：
Boorjian, Stephen;Cowan, Janet E.;Kane, Christopher J.
通讯作者：
Kane, Christopher J.
影响因子：
29.4
作者：
Baxter, NN;Tepper, JE;Virnig, BA
通讯作者：
Virnig, BA
DOI：
10.1016/s0360-3016(00)01528-5
发表时间：
2001-04-01
影响因子：
7
作者：
Haddock, MG;Gunderson, LL;Wolff, BG
通讯作者：
Wolff, BG