Neoadjuvant Therapy in Rectal Cancer
Neoadjuvant Therapy in Rectal Cancer
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DOI：
10.1007/dcr.0b013e31820eeb37
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发表时间：
2011-07-01
影响因子：
3.9
通讯作者：
Monson, John R. T.
中科院分区：
文献类型：
--
作者：
Fleming, Fergal J.;Pahlman, Lars;Monson, John R. T.
背景：直肠癌新辅助治疗方案的最佳类型存在争议。目的：本研究旨在回顾新辅助治疗对直肠癌全肠系膜切除术患者的肿瘤预后和并发症（短期和长期）的影响。数据来源：通过2010年3月对MEDLINE、PubMed、EMBASE和Cochrane综述收集数据库进行电子检索。研究选择：使用关键词组合，包括直肠癌、全肠系膜切除术、放疗、化疗、直肠内超声和磁共振成像，以确定在切除手术前部署化疗和/或放疗的随机对照试验。干预(S)：接受直肠癌全肠系膜切除术的患者，术前接受或未接受化疗和/或放疗。主要观察指标：主要观察指标包括在全肠系膜切除术基础上加用新辅助治疗对围手术期并发症发生率、病理完全缓解率、局部复发率和长期治疗相关并发症的影响。结果：共纳入12项随机对照试验，纳入9410例患者。在适当选择的II期和III期直肠癌患者中，短期放疗和长期放化疗均可使局部复发的相对风险降低50%。这种肿瘤益处是以急性治疗相关毒性和长期肛肠功能障碍的相对风险增加50%为代价的。局限性：术前分期仅提供了“真实”肿瘤分期的估计，只能通过肿瘤标本的组织学评估来确定，这使得适当的患者选择具有挑战性。结论：目前的治疗权衡是局部复发相对风险降低50%，而治疗相关并发症相对增加50%，这表明需要更准确的患者分期和更精确的新辅助治疗。
BACKGROUND: The optimal type of neoadjuvant therapy regimen in rectal cancer is contentious.OBJECTIVE: This study aimed to review the impact of neoadjuvant therapy on oncological outcomes and complications (short and long term) in patients undergoing total mesorectal excision for rectal cancer.DATA SOURCES: An electronic search of MEDLINE, PubMed, EMBASE, and the Cochrane Database of Collected Reviews was performed through March 2010.STUDY SELECTION: Key-word combinations including rectal cancer, total mesorectal excision, radiotherapy, chemotherapy, endorectal ultrasound, and magnetic resonance imaging were used to identify randomized control trials where chemotherapy and/or radiotherapy were deployed before resectional surgery.INTERVENTION(S): Patients underwent total mesorectal excision for rectal cancer who did and did not receive preoperative chemotherapy and/or radiotherapy.MAIN OUTCOME MEASURES: The main outcome measures comprised the impact of the addition of neoadjuvant therapy to total mesorectal excision on the perioperative complication rate, the pathological complete response rate, the rate of local recurrence, and long- term treatment-related complications.RESULTS: A total of 12 randomized control trials involving 9410 patients were included. Both short-course radiotherapy and long-course chemoradiation can offer a relative risk reduction of 50% in local recurrence in appropriately selected patients with stage II and III rectal cancer. This oncological benefit comes at the cost of a relative risk increase of 50% in both acute treatment-related toxicity and long-term anorectal dysfunction.LIMITATIONS: Preoperative staging provides only an estimate of the "true" tumor stage that can only be determined by histological assessment of the tumor specimen which renders appropriate patient selection challenging.CONCLUSIONS: The current treatment trade-off of a relative risk reduction of local recurrence of 50% at the cost of a relative increase of 50% in treatment-related complications underpins the need for more accurate patient staging and more precise delivery of neoadjuvant therapy.