Rectal cancer treatment: doing both addition to subtract reduction, radiotherapy technology is constantly being promoted2022-01-15 12:07:08 3 ℃
my country's 2020 new rectal cancer cases have reached 550,000, which leaps all the pathogenesis of all malignant tumors. The new death of colorectal cancer is 280,000, and rectal cancer is the most common major intestinal malignant tumor, so how Increasing the effectiveness of the treatment of colorectal cancer is an important part of today's tumor clinical work, and it is unfortunate.
In October 2020, the US Tumor Radiation Treatment Association (ASTRO) officially launched the rectal carcinoma radiotherapy clinical practice guidelines, the guide once again confirmed the preoperative radiotherapy in rectal cancer in the new adjuvant treatment (TNT) of the local progress period, Regardless of low recurrence risk tumors, high-repetitive risk tumors, preoperative radiotherapy is highly recommended for high-quality evidence; for rectal cancer in T1-2 N0 prevention orood demand, preoperative radiotherapy is also recommended to improve the retention of binder and may translate into retention anus. Effective means of rectal cancer.
Preoperative radiotherapy has obvious advantages over the postoperative radiotherapy:
1. Make the tumor period, improve the surgical resection rate and the aerial aging.
2, the tissue structure of unhanging surgery is rich in blood, and the tumor is sensitive to radiotherapy.
3, the preoperative pelvic structure is not destroyed, and the irradiated small intestine tissue in the pelvic cavity is less.
4. Preoperative radiotherapy can reduce the opportunity of tumor surgery.
5. Preoperative radiotherapy can thicken the membranable membrane fibrosis, the opportunity of intravenous veins in front of surgery, can improve surgery safety.
China's colorectal cancer treatment (2020 edition) also clarifies that the purpose of rectal cancer new auxiliary treatment is to improve the surgical resection rate, improve the preservation of the preservative period, and extend the patient's disease-free survival; its adapted certificate includes T3-4 or N1-2 period The anal cancer is less than 12 cm, through the preoperative new adjuvant treatment, it has reached a good tumor and reduced tumor load, which is a subsequent surgical resection, and therapeutic compliance is high, in subsequent surgery. Few of intestinal adhesion hemorrhage and other severe complications; The surgical resection rate, the anal anal process increased significantly, meeting the need for patients to retain anal need.
1, I. Tropicarcinoma is not recommended radiotherapy, but after local resection, there is one of the following factors. It is recommended that root-critical surgery, such as rejection or no surgery, suggests postoperative radiotherapy.
(1) Postoperative pathological staging is T2
(2) Tumor maximum diameter greater than 4cm
(3) Tumor station is more than 1/3
(4) Non-divided adenocarcinoma
(5) Neurobrror or vascular tumor
(6) Take the positive or tumor distance cut <3mm
2, clinical diagnosis is II / III colorectal cancer, recommended before radiotherapy or preoperative chemotherapy
3, the pathology of the radical surgery is II / III colorectal cancer, and if the preoperative chemotherapy is not treated, simultaneously alter the chemotherapy.
4, local advanced non-surgical resection rectal cancer (T4) must be re-evaluated before synchronous chemotherapy, radiation treatment, and strive for radical surgery.
5, IV genus Cancer: For removable or potentially eliminated IV colorectal cancer, it is recommended to chemotherapy + primary lesions and radiotherapy, re-evaluation after treatment, and transfer the stove if necessary.
6, local area recurrence retroreal cancer: can be removed local recurrence patients, it is recommended to surgery first surgery, and then consider whether or not the rhythmia, it is not possible to remove local recurrence patients. If it does not receive pelvic radiotherapy, it is recommended to simultaneously eminence before the test. Re-evaluation after radiotherapy, and strive for surgery.
At present, most of the international guides recommend that patients preoperative radiotherapy or altering treatment, and then carry out radical surgery, follow-up auxiliary treatment according to the patient's pathological results. At present, for patients with local progress period, a single treatment model has gradually becomes difficult to adapt to all patient needs, so the overall treatment model is constantly optimized.
For radiotherapy, the optimization direction may focus mainly in two aspects: one aspect is to do addition, with higher strength new adjuvant treatment, to exchange tumors better retreat, thereby increasing the overall prognosis of patients.
In another aspect, it is necessary to subtract, such as the use of short-range treatments, such as the radiotherapy, which will better saving health resources. Nowadays, there are many research, including 5 x 5 short-range radiotherapy, immediately do surgery, or like long-range chemotherapy, after short-range radiotherapy, in the interval, some consolidation of chemotherapy, and get a satisfaction Tumor retreat.
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