At the end of the past century, the introduction of Total Mesorectal Excision (TME), preceded by either short-course radiotherapy (SCRT) or chemoradiation (CRT), established the new standard of care for locally advanced rectal cancer (LARC). Recently, significant advancements were achieved for both dMMR/MSI and pMMR/MSS LARC patients. For the 2–3% of dMMR/MSI LARCs, ablative immunotherapy emerged as a curative approach, offering the possibility of avoiding chemotherapy (CT), radiotherapy, and surgery altogether. In pMMR/MSS LARCs, the intensification of preoperative treatments with Total Neoadjuvant Treatment (TNT) afforded three outcomes: (a) a reduction of distant metastases, positively impacting on survival endpoints, (b) a significant increase of complete clinical response (cCR) rate, paving the way for non-operative management (NOM), and (c) the selective omission of radiotherapy following induction CT. The choice of the most appropriate therapeutic strategy can only be made through the shared decision-making process between physician and patient based on risk stratification and patient preferences.
上世纪末，全直肠系膜切除术（TME）联合短程放疗（SCRT）或放化疗（CRT）的引入，确立了局部晚期直肠癌（LARC）治疗的新标准。近期，针对错配修复缺陷/微卫星高度不稳定（dMMR/MSI）与错配修复正常/微卫星稳定（pMMR/MSS）两类LARC患者均取得重要进展。对于占2-3%的dMMR/MSI型LARC，根治性免疫治疗已成为一种可完全避免化疗、放疗及手术的治愈性方案。在pMMR/MSS型LARC中，全新辅助治疗（TNT）强化了术前治疗，实现三重获益：（a）降低远处转移率，对生存终点产生积极影响；（b）显著提高临床完全缓解（cCR）率，为器官保留策略（NOM）创造条件；（c）在诱导化疗后选择性豁免放疗。最佳治疗策略的选择需基于风险分层与患者意愿，通过医患共同决策来确定。
A Comprehensive Approach to Neoadjuvant Treatment of Locally Advanced Rectal Cancer
肿瘤(癌症)患者之家