Evolution of Neoadjuvant Chemoirradiation in Rectal Cancer

Abstract

The treatment of rectal cancer is evolving and it nicely demonstrates the beauty of multimodality treatment. Unlike total mesorectal excision in surgery, which has probably marked the climax in the advancement of surgical treatment of rectal cancer, neoadjuvant chemoirradiation has an ever-expanding role. Based on the success of neoadjuvant 5-fluorouracil chemoirradiation, the use of capecitabine in the same setting has proven to be an equivalent, if not better, option. However, the improvement in local control has not been convincingly translated into survival benefit, and patients continue to die of distant metastasis. To tackle this problem, various approaches to intensifying systemic treatment have been tested in phase 3 clinical trials. Unfortunately, the addition of oxaliplatin or cetuximab has not shown early promise. Whether novel use of induction chemotherapy will provide additional benefit is also not known at this time. This article serves to review the available evidence and to speculate on the best strategy for treatment of rectal cancer.

直腸癌的治療正在不斷發展，這些治療體現了綜合治療的好處。全直腸繫膜切除手術標誌著手術治 療直腸癌的極點。與全直腸繫膜切除手術不同，新輔助放射治療結合化療治理直腸癌有不斷擴展的 空間。藉著新輔助5-fluorouracil化療結合放射治療的成功，利用capecitabine在同一環境下作化療的成 效已證明有過之而無不及。可惜的是，改良了的局部控制並不代表能提高病人存活率，直腸癌患者 仍然因遠處轉移癌而死亡。為解決這問題，在第三期臨床試驗中實施了針對全身治療的不同方案。 可是，新增的oxaliplatin或cetuximab還是不能改善情況。使用誘導化療是否能提供額外的好處到目前 為止仍是未知之數。本文回顧現有的實證，並推斷治療直腸癌的最佳策略。