结直肠癌诊疗指南及规范(10)

b 长程放化疗后等待5-12周的间歇期再行手术治疗，以便患者能从术前放化疗毒性中恢复。 c 术后辅助化疗可参考结肠癌“3.1.1.3辅助化疗”。

d 建议行多学科讨论是否采用短程放疗[14-17]，主要考虑其降期的必要性和可能的长期毒性反应。短程放疗具体方案为5*5Gy，每天一次，每次5Gy，共5天，连续照射，建议行3D-CRT或IMRT技术。放疗后1周内进行根治手术，不推荐同期应用化疗药物，包括靶向治疗药物。

e 辅助治疗根据术后病理判断，如果为T1N0或T2N0，则无需辅助化疗。所有接受术前辅助治疗的患者，均应接受术后辅助治疗，总的辅助治疗的疗程推荐为6个月[18]。 f 考虑到放化疗带来的毒性，对于局部复发低风险的直肠癌患者可采用手术+辅助化疗的治疗方案。 g 术前化疗+放化疗+手术的治疗策略来自少数II期或回顾性研究[19-20]，可以作为一种治疗选择，目前首选治疗仍是术前同期放化疗+手术+辅助化疗的治疗策略。术前化疗方

案同辅助化疗。

h 如存在手术禁忌，推荐行有效的化疗方案进行化疗，但是不推荐使用FOLFOXIRI 方案。而术后总的辅助治疗的疗程推荐为6个月[18]。 i 再次评估，如果可以接受综合治疗，则进行辅助治疗，总的辅助治疗的疗程包括化疗和 放疗不超过6个月[18]。术后辅助治疗建议8周内进行，而术后辅助放疗开始时间建议不超过12周。

参考文献

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2.Sauer R, Liersch T, Merkel S, et al.Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol.2012;30:1926-33.

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14.Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med.1997;336:980-7.

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16.Bujko K, Nowacki MP, Nasierowska-Guttmejer A, et al. Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg.2006;93:1215-23.

17.Ngan SY, Burmeister B, Fisher RJ, et al.Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: Trans-Tasman Radiation Oncology Group trial 01.04. J Clin Oncol.2012;30:3827-33. 18.Andre T, Boni C, Mounedji-Boudiaf L, et al.Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med.2004;350:2343-51.

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20.Marechal R, Vos B, Polus M, et al.Short course chemotherapy followed by concomitant chemoradiotherapy and surgery in locally advanced rectal cancer: a randomized multicentric phase II study.Ann Oncol.2005;23:1525-30. 4.1.4 附录

一．放射治疗的原则

放射野应包括肿瘤或者瘤床及2-5cm的安全边缘、骶前淋巴结、髂内淋巴结。T4肿瘤侵犯 …… 此处隐藏：5312字，全部文档内容请下载后查看。喜欢就下载吧 ……