关键词: 大肠癌, 治疗指南, 精准医疗, 个体化治疗, 靶向治疗, 免疫治疗, 放射治疗, 微卫星不稳定性

Abstract: Japanese Guidelines for Colorectal Cancer Treatment (2024 Edition) were officially released in July 2024. Building upon the core content of the 2022 edition, the new guidelines incorporate necessary revisions and optimizations across multiple areas, including endoscopic treatment, surgical procedures, pharmacotherapy, and radiotherapy. The guidelines notably update the staging and treatment strategies for colorectal cancer and adjust novel therapeutic approaches for colorectal cancer with high microsatellite instability and BRAF gene mutations to better reflect the latest research advancements. In terms of treatment strategy, the guidelines encompass the most recent recommendations for both early colorectal cancer (Stage 0-Ⅲ) and advanced colorectal cancer (Stage Ⅳ), emphasizing precision and individualized therapy. In addition, the guidelines have updated the indications for total neoadjuvant therapy and non-operative management in rectal cancer, and have introduced particle radiotherapy as a treatment option for refractory recurrent rectal cancer. Regarding the treatment of Stage Ⅳ colorectal cancer, the guidelines revise the treatment strategies for hematogenous metastases, recommending radical resection when feasible, and incorporating radiotherapy ablation and stereotactic body radiotherapy as treatment options. The pharmacotherapy section updates targeted therapy regimens for unresectable or recurrent colorectal cancer.  Furthermore, the guidelines adjust immunotherapy indications for colorectal cancer with mismatch repair deficiency and high tumor mutation burden, recommending pembrolizumab as the primary treatment option. In the radiotherapy section, a comparison between preoperative and postoperative chemoradiotherapy is introduced, and indications for preoperative radiotherapy are optimized to reduce the risk of local recurrence. Additionally, for recurrent colorectal cancer, the guidelines update strategies for combining local and systemic treatments, offering more detailed recommendations for managing local recurrence of rectal cancer and distant metastatic lesions. 

Key words: colorectal cancer, treatment guidelines, precision medicine, personalized treatment, targeted therapy, immunotherapy, radiation therapy, microsatellite instability