新辅助治疗获得完全缓解后处理措施课件

Isthe"waitandsee"policyjustifiedtopatientswithrectalcancerachievingclinicalcompleteresponseafter

adjuvantCRT?

BackgroundItisreportedthatpreoperativechemoradiationtreatment(CRT)maybeassociatedwithlessacutetoxicity,greatertumorresponse/sensitivity,andhigherratesofsphincter-savingprocedureswhencomparedwithpostoperativecourse(BussePM1998).Preoperative(CRT)followedbytotalmesorectalexcision(TME)iscurrentlythestandardofcareinpatientswithlocallyadvancedrectalcancer(ROBERTHUGHES2010).BackgroundAproportionofpatients,whoreceivepreoperativeCRTforlocallyadvanced(T3,T4,NX)rectalcancerachieveaclinicalcompleteresponseandapathologiccompleteresponseintheregionof15to30percent(MehtaVK2003,Glynne-JonesR2006).SupportisgrowingintheUnitedKingdomfortheconceptof“waitingtosee”andnotproceedingtoradicalsurgerywhenacompleteclinicalresponseisobserved.Thepurposeofthisspeechwastodiscusswhetheritisfeasibletoobservepatientswhoachievecompleteclinicalresponseratherthanproceedtosurgery,whichonewillbenefitpatients.LocalradicalsurgeryProceedingtosurgerypointofviewWaitandseepolicy

1.Proceedingtosurgery

MostofthesurgeonssuggestpatientswhoobtainedCCRshouldundergoTME,reasonsasfollows:wecan’truleourthepossibilityoflymphnodemetastasisofpatientsobtainedCCR,especiallyforlymphnodebeyondradiationarea;CCRisn’tequivalenttoPCR,wecan’tmakesurepatientswithCCRalsoobtainedPCR,oncecolorectalcancerrelapse,itshowsdiffuseandinvasivegrowth,comparedwithprimarycarcinoma,itgoeswithlowerradicalcurerateandworseprognosis.2.WaitandseepolicyBasedontworelativestudies,Habr-GamapointoutthereisnosignificantdifferenceoflongtermsurvivalrateandlocalrecurrenceratebetweenpatientswithCCRunderwentTMEandreceivedwaitandseepolicy,theythinkpatientswithCCRcanreceivelongtermobservationandfollowup,eventhoughthecarcinomarelapse,remedialtreatmentmeasurescanbetakenwithoutinfluenceonoverallsurvivalofpatients(Habr-Gama1999;Habr-Gama2005).MoniqueMaasetal.alsopointoutunderstrictselectioncriteria,up-to-dateimagingtechniques,andfollow-up,waitandseepolicyisfeasibleandresultsinpromisingoutcomeatleastasgoodasthatofpatientswithaPCRaftersurgery(MoniqueMaas2011).ConditionsallowconsiderationofwaitandseepolicyforpatientswithrecatalcancerachievingCCRA.patientswithrectalcanceroflowdegreemalignancy,suchashighdifferentiationadenocarcinoma.B.lymphnodemetastasisbeyondradiationfieldisundiscoveredC.patientswithTIorT2rectalcancerD.patientswhoaresensitivetochemoraidcaltherapy,shorterthetimethepatientsachieveCCR,lowertheriskofrecurrenceandmetastasisafterCCRE.patientswhocanstrictlyobeyfollow-up.F.agedpatientsReferrenceBussePM,NgA,RechtA.Inductiontherapyforrectalcarcinoma.SeminSurgOncol.1998;15:120-125.ROBERTHUGHES,MARKHARRISON,ROBERTGLYNNE-JONES.CouldawaitandseepolicybejustifiedinT3/4rectalcancersafterchemo-radiotherapy?ActaOncologica,2010;49:378–381.MehtaVK,ChoC,FordJM,etal.PhaseIItrialofpreoperative3Dconformalradiotherapy,protractedvenousinfusion5-Fluorouracil,andweeklyCPT11,followedbysurgeryforultrasound-stagedT3rectalcancer.InternationalJournalofRadiationoncologyBiologyPhysics,2003;55:132-7.Glynne-JonesR,Sebag-MontefioreD,MaughanTS,etal.AphaseIdoseescalationstudyofcontinuousoralcapecitabineincombinationwithoxaliplatinandpelvicradiation(XELOX-RT)inpatientswithlocallyadvancedrectalcancer.Analsofoncology2006,17:50-6.Glynne·JonesR,WallaceM,LivingstoneJI,elal.Completeclinicalresponseafterpreoperativechemoradiationinrectalcancer：isa“waitandsee”policyjustified?DisColonRect