Neoadjuvant chemoradiation therapy and pathological complete response in rectal cancer

作     者：Linda Ferrari Alessandro Fichera 

作者机构：Division of General SurgeryDepartment of SurgeryUniversity of Washington Medical CenterSeattleWashington 98195USA 

出 版 物：《Gastroenterology Report》 (胃肠病学报道（英文）)

年 卷 期：2015年第3卷第4期

页      面：277-288,I0001页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：rectal cancer neoadjuvant chemoradiation therapy pathological complete response 

摘      要：The management of rectal cancer has evolved significantly in the last few *** improvements in local disease control were achieved in the 1990s,with the introduction of total mesorectal excision and neoadjuvant *** 1 evidence has shown that,with neoadjuvant chemoradiation therapy(CRT)the rates of local recurrence can be lower than 6%and,as a result,neoadjuvant CRT currently represents the accepted standard of *** approach has led to reliable tumor down-staging,with 15–27%patients with a pathological complete response(pCR)—defined as no residual cancer found on histological examination of the *** who achieve pCR after CRT have better long-term outcomes,less risk of developing local or distal recurrence and improved *** all these reasons,sphincter-preserving procedures or organ-preserving options have been suggested,such as local excision of residual tumor or the omission of surgery *** local recurrence rate has been stable at 5–6%with this multidisciplinary management method,distal recurrence rates for locally-advanced rectal cancers remain in excess of 25%and represent the main cause of death in these *** this reason,more recent trials have been looking at the administration of full-dose systemic chemotherapy in the neoadjuvant setting(in order to offer early treatment of disseminated micrometastases,thus improving control of systemic disease)and selective use of radiotherapy only in non-responders or for low rectal tumors smaller than 5 cm.