新辅助治疗获得完全缓解后处理措施.pptxVIP

Is the wait and see policy justified to patients with rectal cancer achieving clinical complete response after adjuvant CRT?Back ground It is reported that preoperative chemoradiation treatment (CRT) may be associated with less acute toxicity, greater tumor response/sensitivity, and higher rates of sphincter-saving procedures when compared with postoperative course(Busse PM 1998). Preoperative (CRT) followed by total mesorectal excision (TME) is currently the standard of care in patients with locally advanced rectal cancer (ROBERT HUGHES 2010).Back ground A proportion of patients, who receive preoperative CRT for locally advanced (T3, T4, NX)rectal cancer achieve a clinical complete response and a pathologic complete response in the region of 15 to 30 percent(Mehta%20VK%202003Mehta VK 2003 ,Glynne-Jones%20R%202006Glynne-Jones R 2006). Support is growing in the United Kingdom for the concept of “waiting to see” and not proceeding to radical surgery when a complete clinical response is observed. The purpose of this speech was to discuss whether it is feasible to observe patients who achieve complete clinical response rather than proceed to surgery, which one will benefit patients.Current status of research60% of patients with local advanced rectal cancer who underwent neo-CRT obtained down-staging effect, in which 10%-50% reached CCR (Glynne-Jones R 2008). 27% patients who obtained CCR had the risk to relapse during 8 weeks to 14 months (Gollins S 2010)point of viewWait and see policyLocal radical surgeryProceeding to surgery1.Proceeding to surgery Most of the surgeons suggest patients who obtained CCR should undergo TME, reasons as follows: we can’t rule our the possibility of lymph node metastasis of patients obtained CCR, especially for lymph node beyond radiation area; CCR isn’t equivalent to PCR, we can’t make sure patients with CCR also obtained PCR, once colorectal cancer relapse, it shows diffuse and invasive growth, compared with primary carcinoma,