The management of locally advanced rectal cancer has undergone significant transformations over the decades and optimal treatment approaches continue to evolve. There have been numerous advances in surgery, chemotherapy, and radiation therapy from the first description of the abdominoperineal resection in 1908, timing of chemotherapy and radiation therapy in the late 20th and early 21st century, and most recently, the introduction of organ preservation or nonoperative management in 2004. Alongside these advancements, the concept of shared decision making in medicine has evolved, prompting a focus on patient-centered care. This evolution in practice has been fueled by a growing recognition of the importance of patient autonomy and the alignment of treatment options with patients’ values and preferences. With the growing number of possible treatment options, variability in patient counseling exists, highlighting the need for a standardized approach to shared decision making in locally advanced rectal cancer. This narrative review will describe the evolution of treatment options of locally advanced rectal cancer as well as the concept of shared decision making and decision aids, and will introduce a decision aid for patients with locally advanced rectal cancer who have achieved a complete clinical response and are eligible for watch and wait.
局部进展期直肠癌的治疗策略在过去数十年间经历了显著变革，其最佳治疗方案仍在持续演进。自1908年首次描述腹会阴联合切除术以来，外科手术、化学治疗与放射治疗领域均取得长足进步——从20世纪末至21世纪初放化疗时序的优化，到2004年器官保留策略与非手术治疗的提出，无不体现治疗理念的革新。与此同时，医学领域的共同决策理念逐步发展，推动医疗模式向以患者为中心的方向转变。这一实践演变源于对患者自主权重要性的日益认知，以及对治疗方案与患者价值观及偏好相匹配的追求。随着可选治疗方案的不断增加，临床医患沟通存在显著差异，这凸显了在局部进展期直肠癌治疗中建立标准化共同决策模式的必要性。本文将通过叙述性综述，系统阐述局部进展期直肠癌治疗方案的演进历程、共同决策理念及决策辅助工具的发展，并针对达到临床完全缓解且符合观察等待条件的局部进展期直肠癌患者，提出一套临床决策辅助方案。
肿瘤(癌症)患者之家