Abstract
<p>Neoadjuvant approach or preoperative use of radiotherapy and chemotherapy in the treatment of locally advanced rectal cancer has led to a significant improvement in local control of the disease by reducing the percentage of local recidives. Furthermore, it has improved the quality of life since the number of sphincter sparing resections has been increased, while it has not affected the overall survival of patients. In the treatment of locally advanced rectal cancer, recommendations for selecting appropriate patients for this kind of treatment are based on independent prognostic factors: the stage of disease (tumor size, lymph nodes, infiltration of the mesorectal fasciae) and localization of the tumor in relation to anal verge. These prognostic factors indicate the risk of local recidive the likelihood of which is reduced by neoadjuvant treatment with sfincter sparing resection with the aim of improving the quality of life. The success of neoadjuvant treatment depends on: modality and radiotherapy treatment technique, the time at which primary tumor resection occurs, as well as tumor biology. The findings of colorectal carcinogenesis mechanisms have raised hope that molecular therapy together with new radiation techniques will provide a better response to preoperative treatment, thereby determining the choice of adjuvant therapy in order to achieve better overall survival of patients. The ongoing clinical studies will provide answers to these questions.</p>
Highlights
Neoadjuvantni pristup u lečenju lokalno uznapredovalog karcinoma rektuma doveo je do značajnog poboljšanja lokalne kontrole bolesti smanjenjem procenta lokalnih recidiva i poboljšanja kvaliteta života jer je povećan broj sfinkter poštednih resekcija, ali nije uticao na promenu ukupnog preživljavanja bolesnika
Navedeni prognostički faktori ukazuju na rizik od razvoja lokalnog recidiva čiju verovatnoću smanjuje neoadjuvantno lečenje uz sfinkter poštednu resekciju sa ciljem poboljšanja kvaliteta života
It has improved the quality of life since the number of sphincter sparing resections has been increased, while it has not affected the overall survival of patients
Summary
Neoadjuvantni pristup (preoperativna primena terapije zračenjem i hemioterapije) u lečenju lokalno uznapredovalog karcinoma rektuma doveo je do značajnog poboljšanja lokalne kontrole bolesti smanjenjem procenta lokalnih recidiva i poboljšanja kvaliteta života jer je povećan broj sfinkter poštednih resekcija, ali nije uticao na promenu ukupnog preživljavanja bolesnika. U lečenju lokalno uznapredovalog karcinoma rektuma preporuke u izboru bolesnika za ovaj vid lečenja zasnivaju se na nezavisnim prognostičkim faktorima: stadijum bolesti (veličina tumora, limfni nodusi, inflitracija mezorektalne fascije) i lokalizacija tumora u odnosu na anokutanu liniju. Prema TNM klasifikaciji, karcinom rektuma je podeljen u četiri stadijuma: lokalno ograničena bolest (I i II stadijum), lokalno uznapredovala bolest (III stadijum) i udaljene metastaze bez obzira na stadijum lokalne bolesti (IV stadijum). Glavni ciljevi lečenja bolesnika sa lokalno uznapredovalim karcinomom rektuma su: (1) optimalna lokoregionalna kontrola bolesti, (2) poboljšavanje preživljavanja i (3) očuvanje kvaliteta života. Na ovaj način je procenat lokalnih recidiva smanjen sa 15-65% na oko 8% [6]
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