结直肠癌 - 避免手术?
1Department of Surgery, Coimbra University Hospital, Coimbra, Portugal.
概括
非手术治疗直肠癌,包括全新辅助治疗 (TNT) 和观察和等待 (WW),显示出希望,但需要仔细考虑复发风险和治疗毒性.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 胃肠病学 胃肠病学
背景情况:
- 不手术治疗直肠癌越来越多地被采用.
- 全新辅助治疗 (TNT) 和观察和等待 (WW) 策略正在探索局部晚期直肠癌.
研究的目的:
- 评估非手术性直肠癌治疗的不断变化的格局.
- 讨论与TNT和WW战略相关的好处和风险.
- 为了比较当前关于新辅助治疗和手术干预的指导方针建议.
主要方法:
- 审查最近的临床试验和关于直肠癌治疗的注册数据.
- 对无病生存率,局部复发率和远程转移的分析.
- 国家综合癌症网络 (NCCN) 和欧洲医学瘤学会 (ESMO) 准则的比较.
主要成果:
- 在一些试验中,TNT显示出无疾病生存优势.
- 拉皮多试验表明TNT增加了局部复发风险,建议对不响应者进行手术.
- 一项注册研究显示,在完全临床响应后,WW的复发率高,远程转移率增加.
结论:
- 虽然非手术方法提供了潜在的好处,但仔细的患者选择和监测至关重要.
- 由于局部复发和远程转移的风险,需要对推迟手术进行持续评估.
- 与手术结果平衡治疗毒性仍然是直肠癌管理中的一个关键考虑因素.
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