PDF(Pubmed)
Abstract：
UNASSIGNED: Staging and treatment of rectal cancer have evolved over several decades with considerably fewer locoregional recurrences but no marked improved survival since systemic recurrence risks remain virtually unchanged. This development will briefly be summarised followed by a thorough discussion of two recent developments.
UNASSIGNED: A systematic approach towards the literature is aimed at focusing on organ preservation and the delivery of all non-surgical treatments prior to surgery or total neoadjuvant treatment (TNT).
UNASSIGNED: Organ preservation, that is to defer surgery if the tumour happens to disappear completely after any pre-treatment given to locally advanced tumours to decrease recurrence risks has increased in popularity and is, if not universally, widely accepted. To give neo-adjuvant treatment to intentionally obtain a clinically complete remission to avoid surgery is practised in some environments but is mostly still experimental. TNT, that is to provide both radiotherapy and chemotherapy aimed at killing microscopic disease in the pelvis or elsewhere has been subject to several trials. Collectively, they show that the chance of achieving a complete response, pathologically or clinically, has approximately doubled, increasing the chance for organ preservation, and the risk of distant metastasis has decreased at least in some trials. The best schedule remains to be established.
UNASSIGNED: To obtain substantial progress and also improve survival, the systemic treatments need to be improved even if preoperative delivery is more effective and better tolerated than postoperative. The locoregional treatment may be further optimised through better risk prediction.
UNASSIGNED: A systematic approach towards the literature is aimed at focusing on organ preservation and the delivery of all non-surgical treatments prior to surgery or total neoadjuvant treatment (TNT).
UNASSIGNED: Organ preservation, that is to defer surgery if the tumour happens to disappear completely after any pre-treatment given to locally advanced tumours to decrease recurrence risks has increased in popularity and is, if not universally, widely accepted. To give neo-adjuvant treatment to intentionally obtain a clinically complete remission to avoid surgery is practised in some environments but is mostly still experimental. TNT, that is to provide both radiotherapy and chemotherapy aimed at killing microscopic disease in the pelvis or elsewhere has been subject to several trials. Collectively, they show that the chance of achieving a complete response, pathologically or clinically, has approximately doubled, increasing the chance for organ preservation, and the risk of distant metastasis has decreased at least in some trials. The best schedule remains to be established.
UNASSIGNED: To obtain substantial progress and also improve survival, the systemic treatments need to be improved even if preoperative delivery is more effective and better tolerated than postoperative. The locoregional treatment may be further optimised through better risk prediction.
摘要：
直肠癌的分期和治疗已经发展了几十年，局部复发明显减少，但由于全身性复发风险几乎没有改变，因此生存率没有明显改善。将简要总结这一发展，然后对两个最近的发展进行彻底讨论。
■针对文献的系统方法旨在关注器官保存和在手术或全新辅助治疗（TNT）之前的所有非手术治疗的实施。
■器官保存，如果在对局部晚期肿瘤进行任何减少复发风险的预处理后肿瘤恰好完全消失，那就是推迟手术，如果不是普遍的，被广泛接受。在一些环境中实施给予新辅助治疗以有意获得临床完全缓解以避免手术,但大多仍是实验性的。TNT,即提供放射治疗和化学疗法，旨在杀死骨盆或其他部位的微观疾病，已经接受了几项试验。总的来说，他们表明获得完整回应的机会，病理或临床，大约翻了一番，增加器官保存的机会，至少在一些试验中，远处转移的风险已经降低。最佳时间表有待确定。
■为了取得实质性进展并提高生存率，即使术前分娩比术后分娩更有效且耐受性更好,也需要改善全身治疗.可以通过更好的风险预测来进一步优化局部治疗。
■针对文献的系统方法旨在关注器官保存和在手术或全新辅助治疗（TNT）之前的所有非手术治疗的实施。
■器官保存，如果在对局部晚期肿瘤进行任何减少复发风险的预处理后肿瘤恰好完全消失，那就是推迟手术，如果不是普遍的，被广泛接受。在一些环境中实施给予新辅助治疗以有意获得临床完全缓解以避免手术,但大多仍是实验性的。TNT,即提供放射治疗和化学疗法，旨在杀死骨盆或其他部位的微观疾病，已经接受了几项试验。总的来说，他们表明获得完整回应的机会，病理或临床，大约翻了一番，增加器官保存的机会，至少在一些试验中，远处转移的风险已经降低。最佳时间表有待确定。
■为了取得实质性进展并提高生存率，即使术前分娩比术后分娩更有效且耐受性更好,也需要改善全身治疗.可以通过更好的风险预测来进一步优化局部治疗。
