The multidisciplinary management of locally advanced rectal cancer.

IF 2.9 3区 医学 Q2 ONCOLOGY Expert Review of Anticancer Therapy Pub Date : 2024-07-01 Epub Date: 2024-04-30 DOI:10.1080/14737140.2024.2349137
Francesca De Felice, Michelangelo Miccini, Andrea Botticelli, Michela Roberto, Niccolò Petrucciani
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Abstract

Introduction: The classic paradigm for the management of locally advanced rectal cancer (LARC) consists of (chemo)radiotherapy (C)RT), total mesorectal excision, and adjuvant chemotherapy (CHT). At present, due to the high rate of distant metastasis (up to 30%), the total neoadjuvant therapy (TNT) with the administration of systemic CHT in the neoadjuvant setting has gained acceptance as standard of care.Our aim is to critically review the current literature on LARC management and summarize the different approaches recently proposed to improve clinical outcomes. It represents a starting step to develop an effective strategy that ultimately could harmonize the standard of care in daily clinical practice.

Areas covered: Studies reporting the impact of TNT approaches were deemed eligible. De-escalation strategies, including non-operative management (NOM) after TNT, as well as RT omission or systemic therapy alone, were also investigated.

Expert opinion: The year 2020 has seen promising new data from randomized phase III trials in the field of LARC management. Nowadays, TNT strategy has been accepted as the primary treatment for LARC. The role of de-escalation strategies is still unknown. The goal is to achieve better survival outcomes with improving quality of life. Only selected patients are likely to benefit from NOM or immunotherapy alone.

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局部晚期直肠癌的多学科治疗。
导言:治疗局部晚期直肠癌(LARC)的经典模式包括(化)放疗(C)RT、全直肠中胚层切除术和辅助化疗(CHT)。目前,由于远处转移率较高(高达 30%),在新辅助治疗中进行全身 CHT 的全新药辅助治疗(TNT)已被接受为标准治疗方法。我们的目的是批判性地回顾目前有关 LARC 治疗的文献,总结最近提出的改善临床疗效的不同方法。我们的目的是批判性地回顾目前有关 LARC 管理的文献,并总结最近提出的改善临床结果的不同方法,这是制定有效策略的第一步,最终可以协调日常临床实践中的护理标准:报告 TNT 方法影响的研究符合条件。专家意见:2020年,LARC治疗领域的随机III期试验取得了令人鼓舞的新数据。如今,TNT 策略已被接受为 LARC 的主要治疗方法。降级策略的作用尚不清楚。我们的目标是在改善生活质量的同时获得更好的生存结果。只有经过筛选的患者才有可能从单纯 NOM 或免疫疗法中获益。
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来源期刊
CiteScore
5.10
自引率
3.00%
发文量
100
审稿时长
4-8 weeks
期刊介绍: Expert Review of Anticancer Therapy (ISSN 1473-7140) provides expert appraisal and commentary on the major trends in cancer care and highlights the performance of new therapeutic and diagnostic approaches. Coverage includes tumor management, novel medicines, anticancer agents and chemotherapy, biological therapy, cancer vaccines, therapeutic indications, biomarkers and diagnostics, and treatment guidelines. All articles are subject to rigorous peer-review, and the journal makes an essential contribution to decision-making in cancer care. Comprehensive coverage in each review is complemented by the unique Expert Review format and includes the following sections: Expert Opinion - a personal view of the data presented in the article, a discussion on the developments that are likely to be important in the future, and the avenues of research likely to become exciting as further studies yield more detailed results Article Highlights – an executive summary of the author’s most critical points.
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