肝脏是直肠癌最常见的转移部位，伴有可切除肝转移患者的生存较好。盆腔放疗已成为直肠癌伴肝转移多学科管理的组成部分。对于伴有不可切除肝转移患者，针对原发灶的姑息放疗能减少出血、梗阻等风险进而改善生活质量。对于伴有可切除肝转移患者，盆腔放疗可有效降低局部复发率、使部分患者免于手术而提高生活质量、甚至提高患者总生存率。目前，对于直肠癌伴肝转移患者盆腔放疗的标准化治疗模式没有达成共识，在如何筛选放疗获益人群、优化多学科协作以及放疗方案（长程放疗比短程放疗）、器官保留等方面成为研究热点。本文对近年来盆腔放疗在直肠癌伴肝转移中的研究进展作一综述，为直肠癌伴肝转移患者个体化盆腔放疗提供思路。 Hepatic metastasis is the most common in rectal cancer, and patients with resectable hepatic metastasis have better survival. Pelvic radiotherapy has become a key component of multidisciplinary management of rectal cancer with hepatic metastasis. For patients with unresectable hepatic metastasis, palliative radiotherapy to the primary lesion can reduce the risk of bleeding and obstruction and thus improve the quality of life. For patients with resectable hepatic metastasis, pelvic radiotherapy can effectively reduce the local recurrence rate, help some patients avoid surgery and improve their quality of life, and even improve the overall survival. At present, there is no consensus on the standardized treatment mode of pelvic radiotherapy for rectal cancer patients with hepatic metastasis, and it has become a hotspot for research on how to select the population benefiting from radiotherapy, how to optimize multidisciplinary collaboration and radiotherapy plans (long-course radiotherapy versus short-course radiotherapy) and how to preserve organs. This article reviews the research progress in pelvic radiotherapy for rectal cancer with hepatic metastasis in recent years, and provides ideas for individualized pelvic radiotherapy for rectal cancer with hepatic metastasis.
Pelvic radiotherapy strategy for rectal cancer with hepatic metastasis
Hepatic metastasis is the most common in rectal cancer, and patients with resectable hepatic metastasis have better survival. Pelvic radiotherapy has become a key component of multidisciplinary management of rectal cancer with hepatic metastasis. For patients with unresectable hepatic metastasis, palliative radiotherapy to the primary lesion can reduce the risk of bleeding and obstruction and thus improve the quality of life. For patients with resectable hepatic metastasis, pelvic radiotherapy can effectively reduce the local recurrence rate, help some patients avoid surgery and improve their quality of life, and even improve the overall survival. At present, there is no consensus on the standardized treatment mode of pelvic radiotherapy for rectal cancer patients with hepatic metastasis, and it has become a hotspot for research on how to select the population benefiting from radiotherapy, how to optimize multidisciplinary collaboration and radiotherapy plans (long-course radiotherapy versus short-course radiotherapy) and how to preserve organs. This article reviews the research progress in pelvic radiotherapy for rectal cancer with hepatic metastasis in recent years, and provides ideas for individualized pelvic radiotherapy for rectal cancer with hepatic metastasis.
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