目标导向的新辅助疗法:我们应该在每种情况下提供什么?
Bruna Borba Vailati1, Guilherme Pagin São Julião1, Leonardo Ervolino Corbi1
1Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Hospital Beneficencia Portuguesa, São Paulo, Brazil.
Cirugia espanola
|May 31, 2025
概括
结直肠癌的治疗已经随着先进的成像和疗法而发展. 个性化策略现在平衡有效性,器官保存和生活质量,以获得更好的患者结果.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 放射学 放射学是一门学科.
背景情况:
- 结直肠癌的管理已经显著发展.
- 整体半径切除 (TME) 和新辅助化学辐射 (nCRT) 是传统的标准.
- 在分期和理解瘤生物学方面的进步重新塑造了治疗范式.
研究的目的:
- 审查直肠癌管理的演变.
- 突出先进的成像和新的治疗策略的影响.
- 讨论向个性化,器官保存方法的转变.
主要方法:
- 审查分期技术的进步,特别是高分辨率磁共振成像 (MRI).
- 分析不断发展的治疗策略,包括新辅助化学辐射 (nCRT),全新辅助疗法 (TNT) 和器官保存选择.
- 包括最近的突破,如针对特定瘤亚型的免疫疗法.
主要成果:
- 高分辨率的MRI已经改善了局部区域分期和预后标记的识别 (例如,外壁静脉入侵[EMVI]).
- 完全临床响应 (cCR) 已经启用了器官保存策略 (观察和等待,过道局部切除).
- 总的新辅助疗法 (TNT) 显示出改善系统性结果的潜力,尽管最佳使用仍在争论中.
- 免疫疗法为微卫星不稳定性高的直肠瘤提供了新的非手术选择.
结论:
- 目前的直肠癌管理强调基于瘤特征和风险因素的个性化治疗.
- 器官保存策略越来越可行,平衡瘤控制与功能结果.
- 该领域正在向量身定制的方法迈进,以优化疗效,患者的生活质量和功能结果.
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