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局部进展期直肠癌的全程新辅助治疗模式

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局部进展期直肠癌(LARC)目前公认的治疗模式为多学科综合治疗。标准术前同步放化疗可明显降低LARC的局部复发率,但不影响其远处转移发生率和总生存率,而全程新辅助治疗(TNT)通过提高化疗强度、延长放疗至手术的时间,从而提高肿瘤缓解率,可明显改善无病生存率和无转移生存率。TNT模式可明显提高患者的依从性,使全身化疗完成度更高,能带来最大程度的肿瘤退缩,不但能改善远期生存,也能增加器官功能保留的机会。对于远处转移风险高或器官功能保留意愿强的LARC患者,TNT是一种极具潜力的治疗模式。随着免疫治疗在TNT领域的应用,TNT模式不断拓展;同时,疗效预测标志物的探索将为个体化治疗奠定基础。
Total neoadjuvant therapy for locally advanced rectal cancer
Diagnosis and treatment of locally advanced rectal cancer(LARC)must be completed by a collaborative model of a multi-disciplinary team.The neoadjuvant chemoradiotherapy significantly reduced the local recurrence rate of LARC,but did not affect the occurrence of distant metastases and overall survival.Total neoadjuvant therapy(TNT),by strengthening the intensity of chemotherapy and extending the time from radiotherapy to surgery,can improve the tumor response rate as well as disease-free survival rate and metastasis-free survival rate.It offers advantages such as enhancing the compliance with chemotherapy,maximizing tumor regression,improving survival and increasing the chance of organ preservation.TNT is a promising treatment model for LARC patients with high risk of distant metastasis or strong desire for organ preservation.With the application of immunotherapy in the field of TNT,the mode of TNT continues to expand.And the exploration of therapeutic predictive markers will help to provide a personalized treatment for patients.

locally advanced rectal cancertotal neoadjuvant therapyneoadjuvant chemoradiotherapydisease-free survivalorgan preservation

周荻、周珺珺、胡斌、陈海燕

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上海交通大学医学院附属仁济医院放射诊疗科,上海 200127

局部进展期直肠癌 全程新辅助治疗 新辅助放化疗 无病生存 器官保留

2024

解放军医学杂志
人民军医出版社

解放军医学杂志

CSTPCD北大核心
影响因子:1.644
ISSN:0577-7402
年,卷(期):2024.49(1)
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