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Abstract：
The management of locally advanced rectal cancer (LARC) suffered changes thanks to the development of improved surgical procedures, radiation delivery, and chemotherapy. Although treatment options improved individually, the optimal order is still debated. Neoadjuvant chemo-radiotherapy followed by total mesorectal excision (TME) has been the \"golden standard\" for locally advanced rectal cancer. There is no common ground in international guidelines on the indications of adjuvant chemotherapy (ADJCHT), with differences between the American, European, and Japanese guidelines. This paper studies the preferences of Romanian oncologists in prescribing ADJCHT. We conducted a single-institution, retrospective study of all nonmetastatic, ECOG 0-1 LARC patients staged II-III who underwent TME and were admitted to the Oncology or Radiotherapy Department of Colțea Clinical Hospital, Bucharest between January 2017 and March 2021. A total of 186 patients were included in the study. A positive correlation was found between ADJCHT and each of the following: (y)pT > 2, (y)pN > 0, and the presence of perineural invasion (PNI+). A strong positive correlation was found between ADJCHT and the presence of at least one risk factor: (y)pT > 2, (y)pN > 0, PNI+, lymphovascular invasion, positive margins, or tumor grade > 1. Tumor downstaging decreased the risk of metastases in the first 2 years and was associated with the use of neoadjuvant radiotherapy, while adding neoadjuvant chemotherapy increased the chance of nodal downstaging. ADJCHT practice for LARC in Romania follows either NCCN or ESMO guidelines, at the discretion of the oncologist, due to the lack of national guideline.
摘要：
由于改进的外科手术的发展，局部晚期直肠癌（LARC）的管理发生了变化，辐射输送，和化疗。尽管单独的治疗方案有所改善，最优顺序仍然存在争议。新辅助放化疗后全直肠系膜切除术（TME）一直是局部晚期直肠癌的“金标准”。关于辅助化疗（ADJCHT）适应症的国际指南没有共同点，美国人之间的差异，欧洲,日本的指导方针。本文研究了罗马尼亚肿瘤学家在处方ADJCHT方面的偏好。我们进行了一个单一的机构，所有非转移性的回顾性研究，ECOG0-1LARCII-III期患者接受了TME，并被纳入Colaetea临床医院肿瘤科或放射科，布加勒斯特，2017年1月至2021年3月。共有186名患者被纳入研究。发现ADJCHT与以下各项之间呈正相关：（y）pT>2，（y）pN>0以及存在神经周浸润（PNI）。ADJCHT与至少一个危险因素的存在之间存在强正相关：（y）pT>2，（y）pN>0，PNI，淋巴管浸润,正利润率，或肿瘤等级>1.肿瘤分期降低了前2年的转移风险，并且与新辅助放疗的使用有关。而增加新辅助化疗增加了淋巴结降级的机会。罗马尼亚LARC的ADJCHT实践遵循NCCN或ESMO准则，根据肿瘤学家的判断，由于缺乏国家指导方针。
