中国实用外科杂志

中国实用外科杂志 ›› 2009, Vol. 29 ›› Issue (09): 717-721.

• 专家论坛 • 上一篇    下一篇

直肠癌治疗理念更新——强调术前多学科评估

姚宏伟1， 刘荫华2   

  1. 1 北京大学第三医院，北京100191 ；2 北京大学第一医院，北京100034
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2009-09-01 发布日期:2009-09-01

  • Received:1900-01-01 Revised:1900-01-01 Online:2009-09-01 Published:2009-09-01

PDF

摘要：

2009版NCCN直肠癌临床实践指南本年度共涉及14项更新，包括诊断、多学科评估、辅助化放疗、新辅助化放疗、晚期解救及靶向药物治疗等内容。其重点更新包括：直肠癌术前可切除性评估首次在正文中强调了应选择“硬性直肠镜”而非“直肠镜”；明确K?ras基因野生型结直肠癌病人是靶向药物西妥昔单抗临床应用适应证人群；提出了微卫星不稳定性与预后和化疗敏感性的关系等。而2009年美国临床肿瘤学会年会主题所提出的“癌症医疗个体化（personalizing cancer care）”理念也在肿瘤领域引起重大反响，这一理念明确了除个体化治疗计划（personalized therapy）外，“癌症医疗个体化”还包括了个体化癌症风险评估、个体化生存规划以及终末期病人姑息治疗和护理的个体化等内容。正确理解肿瘤诊治理念更新变化，强调科学客观的临床多学科评估，将成为推动直肠癌诊治水平的基础和保障。

关键词: K?ras基因, 直肠癌, 美国国家癌症综合网, 循证医学, 多学科评估

Abstract:

Multidisciplinary assessment: a new concept for treatment of rectal cancer YAO Hong-wei*, LIU Yin-hua. *Peking University Third Hospital, Beijing 100191, China Corresponding author: LIU Yin-hua, E-mail: liuyinhua@medmail.com.cn Abstract NCCN Clinical Practice Guideline in Rectal Cancer (Version 2009) covers 14 updates, ranging from diagnosis, multidisciplinary assessment, adjuvant chemoradiotherapy, neoadjuvant chemoradiotherapy, late-stage salvage treatment and targeted drugs, etc. It emphasizes the fact for the first time that the preoperative assessment of resectability for rectal cancer should choose rigid proctoscopy instead of proctoscopy, and ascertains that wide type KRAS gene is the only clinical indication of the targeted drug cetuximab for patients with rectal cancer, and proposes the relation between microsatellite instability (MSI) and prognosis and sensitivity of chemotherapy. The annual meeting of American Society of Clinical Oncology (ASCO) 2009 took the concept of “personalizing cancer care”as the subject, which evokes great resonance in oncological field. Besides personalized therapy, it includes personalized cancer risk evaluation, survival planning, palliative treatment for late-stage patients and personalized nursing, as well. Understanding the updates in oncology exactly and emphasizing a scientific multidisciplinary assessment will provide a solid foundation for promoting the level of clinical practice in rectal cancer.

Key words: rectal cancer, National Comprehensive Cancer Network（NCCN）, evidence-based medicine（EBM）, multidisciplinary assessment, K?ras gene