Over the past decade, the treatment of rectal cancer has changed considerably. The implementation of TME surgery has, in addition to decreasing the number of local recurrences, improved surgical morbidity and mortality. At the same time, the optimisation of radiotherapy in the preoperative setting has improved oncological outcomes even further, although higher perineal infection rates have been reported. Radiotherapy regimens have evolved through the adjustment of radiotherapy techniques and fields, increased waiting intervals, and, for more advanced tumours, adding chemotherapy. Concurrently, imaging techniques have significantly improved staging accuracy, facilitating more precise selection of advanced tumours. Although chemoradiotherapy does lead to the downsizing and -staging of these tumours, a very clear effect on sphincter-preserving surgery and the negative resection margin has not been proven. Aiming to decrease distant metastasis and improve overall survival for locally advanced rectal cancer, systemic chemotherapy can be added to radiotherapy, known as total neoadjuvant treatment (TNT). High complete response rates, both pathological (pCR) and clinical (cCR), are reported after TNT. Patients who follow a Watch & Wait program after a cCR can potentially avoid surgical morbidity and colostomy. For both early and more advanced tumours, trials are now investigating optimal regimens in an attempt to offer organ preservation as much as possible. Multidisciplinary deliberation should include patient preference, treatment toxicity, and likelihood of end colostomy, but also the burden of intensive surveillance in a W&W program.
过去十年间，直肠癌的治疗模式发生了显著变革。全直肠系膜切除术（TME）的实施不仅降低了局部复发率，同时改善了手术并发症与死亡率。与此同时，术前放疗方案的优化进一步提升了肿瘤学疗效，尽管有研究报道会阴部感染率可能升高。放疗方案的演进体现在技术参数与照射野的调整、等待间隔的延长，以及对进展期肿瘤联合化疗等方面。影像学技术的显著进步提升了分期准确性，为精准筛选进展期肿瘤提供了支持。虽然放化疗确实能实现肿瘤降期与体积缩小，但其对保肛手术率及阴性切缘率的明确影响尚未得到证实。为降低局部进展期直肠癌的远处转移风险并提高总生存率，可在放疗基础上联合全身化疗，即全新辅助治疗（TNT）。研究显示TNT治疗后病理完全缓解（pCR）与临床完全缓解（cCR）率显著提升。达到cCR后进入"观察等待"方案的患者，有望避免手术并发症及结肠造口风险。当前针对早期及进展期肿瘤的临床试验，正致力于探索最佳治疗方案以最大程度实现器官保留。多学科诊疗决策需综合考量患者意愿、治疗毒性、永久性造口可能性，以及观察等待方案中强化随访监测带来的负担。
肿瘤(癌症)患者之家