rectal cancer;
neoadjuvant therapy;
chemotherapy;
TOTAL MESORECTAL EXCISION;
POSTOPERATIVE ADJUVANT CHEMOTHERAPY;
COURSE PREOPERATIVE RADIOTHERAPY;
CLINICAL COMPLETE RESPONDERS;
MEDIAN FOLLOW-UP;
QUALITY-OF-LIFE;
COLORECTAL-CANCER;
INTERNATIONAL WATCH;
SEXUAL DYSFUNCTION;
RANDOMIZED-TRIAL;
D O I:
10.3390/curroncol31010024
中图分类号:
R73 [肿瘤学];
学科分类号:
100214 ;
摘要:
Local and metastatic recurrence are primary concerns following the treatment of locally advanced rectal cancer (LARC). Chemoradiation (CRT) can reduce the local recurrence rates and has subsequently moved to the neoadjuvant setting from the adjuvant setting. Pathological complete response (pCR) rates have also been noted to be greater in patients treated with neoadjuvant CRT prior to surgery. The standard approach to treating LARC would often involve CRT followed by surgery and optional adjuvant chemotherapy and remained the treatment paradigm for almost two decades. However, patients were often unable to complete adjuvant chemotherapy due to a decreased tolerance of chemotherapy following surgery, which led to upfront treatment with both CRT and chemotherapy, and total neoadjuvant therapy, or TNT, was created. The efficacy outcomes of local recurrence, disease-free survival, and pCR have improved in patients receiving TNT compared to the standard approach. Additionally, more recent data suggest a possible improvement in overall survival as well. Patients with a complete clinical response following TNT have the opportunity for watch-and-wait surveillance, allowing some patients to undergo organ preservation. Here, we discuss the clinical trials and studies that led to the adoption of TNT as the standard of care for LARC, with the possibility of watch-and-wait surveillance for patients achieving complete responses. We also review the possibility of overtreating some patients with LARC.
机构:
Acibadem Mehmet Ali Aydinlar Univ, Atakent Hosp, Dept Med Oncol, Sch Med, Istanbul, TurkeyAcibadem Mehmet Ali Aydinlar Univ, Atakent Hosp, Dept Med Oncol, Sch Med, Istanbul, Turkey
Ozer, Leyla
Yildiz, Ibrahim
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Acibadem Mehmet Ali Aydinlar Univ, Atakent Hosp, Dept Med Oncol, Sch Med, Istanbul, TurkeyAcibadem Mehmet Ali Aydinlar Univ, Atakent Hosp, Dept Med Oncol, Sch Med, Istanbul, Turkey
Yildiz, Ibrahim
Bayoglu, Vedat
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Acibadem Mehmet Ali Aydinlar Univ, Atakent Hosp, Dept Med Oncol, Sch Med, Istanbul, TurkeyAcibadem Mehmet Ali Aydinlar Univ, Atakent Hosp, Dept Med Oncol, Sch Med, Istanbul, Turkey
Bayoglu, Vedat
Bozkurt, Mustafa
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Acibadem Mehmet Ali Aydinlar Univ, Atakent Hosp, Dept Med Oncol, Sch Med, Istanbul, TurkeyAcibadem Mehmet Ali Aydinlar Univ, Atakent Hosp, Dept Med Oncol, Sch Med, Istanbul, Turkey
Bozkurt, Mustafa
Esen, Eren
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New York Univ Langone Hlth, New York, NY USAAcibadem Mehmet Ali Aydinlar Univ, Atakent Hosp, Dept Med Oncol, Sch Med, Istanbul, Turkey
Esen, Eren
Remzi, Feza H.
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New York Univ Langone Hlth, New York, NY USAAcibadem Mehmet Ali Aydinlar Univ, Atakent Hosp, Dept Med Oncol, Sch Med, Istanbul, Turkey
Remzi, Feza H.
Gogenur, Ismail
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机构:
Zealand Univ Hosp, Surg Sci Ctr, Dept Surg, Koege, DenmarkAcibadem Mehmet Ali Aydinlar Univ, Atakent Hosp, Dept Med Oncol, Sch Med, Istanbul, Turkey
Gogenur, Ismail
Aytac, Erman
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Acibadem Mehmet Ali Aydinlar Univ, Atakent Hosp, Sch Med, Dept Surg, Istanbul, TurkeyAcibadem Mehmet Ali Aydinlar Univ, Atakent Hosp, Dept Med Oncol, Sch Med, Istanbul, Turkey
机构:
Michael E DeBakey VA Med Ctr, Houston VA Ctr Innovat Qual Effectiveness & Safet, Houston, TX USA
Baylor Coll Med, Dept Med, Houston, TX 77030 USAMichael E DeBakey VA Med Ctr, Houston VA Ctr Innovat Qual Effectiveness & Safet, Houston, TX USA
Sada, Yvonne H.
Cao, Hop S. Tran
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机构:
Baylor Coll Med, Michael E DeBakey Dept Surg, Houston, TX 77030 USAMichael E DeBakey VA Med Ctr, Houston VA Ctr Innovat Qual Effectiveness & Safet, Houston, TX USA
Cao, Hop S. Tran
Chang, George J.
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机构:
Univ Texas MD Anderson Canc Ctr, Dept Surg Oncol, Houston, TX 77030 USAMichael E DeBakey VA Med Ctr, Houston VA Ctr Innovat Qual Effectiveness & Safet, Houston, TX USA
Chang, George J.
Artinyan, Avo
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机构:
Baylor Coll Med, Michael E DeBakey Dept Surg, Houston, TX 77030 USAMichael E DeBakey VA Med Ctr, Houston VA Ctr Innovat Qual Effectiveness & Safet, Houston, TX USA
Artinyan, Avo
Musher, Benjamin L.
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机构:
Baylor Coll Med, Dept Med, Houston, TX 77030 USAMichael E DeBakey VA Med Ctr, Houston VA Ctr Innovat Qual Effectiveness & Safet, Houston, TX USA
Musher, Benjamin L.
Smaglo, Brandon G.
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机构:
Baylor Coll Med, Dept Med, Houston, TX 77030 USAMichael E DeBakey VA Med Ctr, Houston VA Ctr Innovat Qual Effectiveness & Safet, Houston, TX USA
Smaglo, Brandon G.
Massarweh, Nader N.
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h-index: 0
机构:
Michael E DeBakey VA Med Ctr, Houston VA Ctr Innovat Qual Effectiveness & Safet, Houston, TX USA
Baylor Coll Med, Michael E DeBakey Dept Surg, Houston, TX 77030 USAMichael E DeBakey VA Med Ctr, Houston VA Ctr Innovat Qual Effectiveness & Safet, Houston, TX USA
机构:
Mem Sloan Kettering Canc Ctr, Dept Surg, 1275 York Ave, New York, NY 10021 USAMem Sloan Kettering Canc Ctr, Dept Surg, 1275 York Ave, New York, NY 10021 USA
机构:
Univ Western Australia, UWA Med Sch, Perth, WA 6009, Australia
Sir Charles Gairdner Hosp, Dept Med Oncol, Nedlands, WA 6009, AustraliaUniv Western Australia, UWA Med Sch, Perth, WA 6009, Australia
Oey, Oliver
Lin, Chak Pan
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h-index: 0
机构:
Mater Hosp, Brisbane, Qld 4101, AustraliaUniv Western Australia, UWA Med Sch, Perth, WA 6009, Australia
Lin, Chak Pan
Khattak, Muhammad Adnan
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h-index: 0
机构:
Fiona Stanley Hosp, Dept Med Oncol, Murdoch, WA 6150, AustraliaUniv Western Australia, UWA Med Sch, Perth, WA 6009, Australia
Khattak, Muhammad Adnan
Ferguson, Thomas
论文数: 0引用数: 0
h-index: 0
机构:
Fiona Stanley Hosp, Dept Med Oncol, Murdoch, WA 6150, AustraliaUniv Western Australia, UWA Med Sch, Perth, WA 6009, Australia
Ferguson, Thomas
Theophilus, Mary
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h-index: 0
机构:
St John God Midland Hosp, Dept Gen Surg, Midland, WA 6056, AustraliaUniv Western Australia, UWA Med Sch, Perth, WA 6009, Australia
Theophilus, Mary
Tiong, Siaw Sze
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机构:
Icon Canc Ctr, Midland, WA 6056, AustraliaUniv Western Australia, UWA Med Sch, Perth, WA 6009, Australia
Tiong, Siaw Sze
Ali, Sayed
论文数: 0引用数: 0
h-index: 0
机构:
St John God Midland Hosp, Dept Med Oncol, Midland, WA 6056, AustraliaUniv Western Australia, UWA Med Sch, Perth, WA 6009, Australia
Ali, Sayed
Khan, Yasir
论文数: 0引用数: 0
h-index: 0
机构:
St John God Midland Hosp, Dept Med Oncol, Midland, WA 6056, Australia
Peel Hlth Campus, Mandurah, WA 6210, AustraliaUniv Western Australia, UWA Med Sch, Perth, WA 6009, Australia