New treatment strategies for non-metastatic rectal cancer
| Autor: | Jérémie H. Lefevre, Stéphane Benoist, Antoine Brouquet, C. Penna, Solafah Abdalla |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Colorectal cancer medicine.medical_treatment 03 medical and health sciences 0302 clinical medicine medicine Humans Neoplasm Staging Salvage Therapy Transanal Excision Chemotherapy Proctectomy Rectal Neoplasms business.industry Standard treatment Induction chemotherapy Consolidation Chemotherapy Chemoradiotherapy General Medicine medicine.disease Neoadjuvant Therapy Radiation therapy Treatment Outcome 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Radiology Neoplasm Recurrence Local business |
| Zdroj: | Journal of Visceral Surgery. 158:497-505 |
| ISSN: | 1878-7886 |
| DOI: | 10.1016/j.jviscsurg.2021.04.001 |
| Popis: | The most widely practiced (standard) treatment of non-metastatic rectal cancer is based on proctectomy with mesorectal excision (partial or total according to the location of the tumor and commonly called TME). Surgery is preceded by CAP50-type chemoradiotherapy (capecitabineand 50 Grays radiation) and performed 6-8 weeks after the end of chemoradiotherapy. The development of new endoscopic, surgical, radiation-based and chemotherapeutic modalities leads surgeons to envisage customized treatment to find the best compromise between functional and oncologic results according to the locoregional extension of the tumor. Superficial lesions are amenable to transanal excision. T2-3 tumors4cm are amenable to rectal preservation when neoadjuvant treatment obtains a complete response, allowing local excision or close surveillance. Intensification endocavitary radiotherapy and induction and consolidation chemotherapy regimens to avoid recourse to salvage abdomino-perineal resection (APR) are under investigation. For locally advanced rectal cancers (T3-4 and all N+ irrespective of T), the following scenarios can be envisaged: for initially resectable tumors (T3N0, T1-T3N+, circumferential resection margin2mm), neoadjuvant chemotherapy alone aims to minimize the risk of local recurrence while avoiding the sequelae of radiotherapy. In case of initially non-resectable tumors (T4, circumferential resection margin1mm), induction chemotherapy before chemoradiotherapy and consolidation chemotherapy after short course radiotherapy provide better results than standard treatment in terms of complete response and recurrence-free survival, and should be routinely proposed in this indication. |
| Databáze: | OpenAIRE |
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