1、胡华斌以治疗目的为导向的结 直肠癌围 手术期内科治疗Supported by an educational grant from Bayer Healthcare Pharmaceuticals Inc.2 结肠癌的新 辅助 治疗3局部进展期直肠癌的围手术期治疗1主要内容非 TME年代：术前放疗地位的确立Swedish Rectal Cancer Trial（ 1997）1168 patients randomised to 25 Gy (5x5) PRT or no RTSurgery alone Preop. RT PRate of Local Recurrence 27% 11% 0.0
2、015yrs OS 48% 58% 0.004N Engl J Med 1997;336:980-987n 术前放疗 +手术 优于 单纯手术231TME年代：围手术期治疗模式的变化EORTC 22921 345: 63846. N Engl J Med 2004;351:173140.J Clin Oncol 2009;27:512430. N Engl J Med 2006;355:111423.J Clin Oncol 2006;24:46205.231既往研究设计的局限性Trial Year Inclusioncriteria Loco-regionalStagingPreo. FU r
3、egimen Surgery End pointsNSABPR-03 1997cT3-4 or N+ rectal cancer EUS optionalFU 500 mg/m2 once per week for 6 weeks No TMELR nsDFS 64.7 vs. 53.4%OS nsCAO/ARO/AIO-94 2004cT3-4 or N+ rectal cancerEUS and Abdomino-pelvic CT scanFU 120-hour continuous infusion (during the first and fifth weeks of radiot
4、herapy)TMELR 7.1 vs. 10.1%DFS nsOS nsEORTC22921 2005T3 or T4 rectal cancer EUS (64.8%)FU 350 mg/m2/d for 5 days(two courses were combined with preoperative)NALR 11.8 vs. 22.4%DFS nsOS nsFFCD9203 2006cT3-4rectal cancer EUS, pelvic CT350 mg/m2/d during 5 days (during the first and fifth weeks of radio
5、therapy)TMErecommendedLR 8.1 vs. 16.5%DFS 59.4 vs. 55.5%OS ns231局部进展期 直肠癌（ LARC）治疗 标准术前同步放化疗（联合氟尿嘧啶）TME 手术 辅助化疗231远期疗效并未提高： CAO/ARO/AIO-94 11年随访结果J Clin Oncol 2012;30:192633.231远期疗效并未提高： EORTC 22921研究 10年随访结果 局部复发率显著降低（ 25%下降至 5-10%） 远处转移率仍高达 30% OS和 DFS未能得到改善Lancet Oncol 2014;15:18490.231放疗引起相关毒性J Clin Oncol. 2005 Sep 1;23（ 25） :6199-206.Lancet. 2009 Mar 7;373（ 9666） :821-8. J Clin Oncol. 2014 Feb 20;32（ 6） :513-8. 231后 TME时代， LARC治疗需求的改变手术 化疗放疗降低局部复发减少远处转移降低治疗相关毒性器官保留
