摘要化疗是结直肠癌多学科综合诊疗的主要治疗措施之一,在可切除的结直肠癌中,系统性化疗的地位越来越重要.在可切除的结肠癌中,对于局部晚期的高危T3或者T4期患者,围手术期化疗可降低肿瘤分期、提高病理完全缓解率(pCR)和术后病理肿瘤退缩,远期疗效还需长期随访证实,也需要三期随机对照研究证实.对于局部晚期直肠癌,在标准治疗策略?术前同步放化疗联合手术的基础上,放化疗前诱导化疗或放化疗后间隔期化疗构成的全程新辅助治疗模式,显示出化疗完成率更高、剂量给予更充分、患者依从性更好、毒性更易耐受,且有提高pCR率的趋势.而去放化疗的围手术期化疗也显示出长期生存结果与放化疗类似,且可避免放疗带来的功能受损和远期继发第二肿瘤.因此,在结直肠癌多学科诊疗中,围手术期化疗扮演着重要的角色.

abstractsPerioperative chemotherapy is the major component of therapeutic approaches in multidisciplinary team (MDT) of colorectal cancer. In resectable colorectal cancer, the role of systemic chemotherapy is more important. In resectable colon cancer, especially locally advanced high?risk T3 or T4 tumor, perioperative chemotherapy can confer downstaging of primary tumor, improve pathologic complete response (pCR) rate and postoperative tumor regression. However, long?term oncological outcomes need prolonging follow?up period and phase III randomized controlled trials to confirm. On the basis of standard of care with chemoradiation followed by surgery, total neoadjuvant threapy (TNT) strategy is suggested in locally advanced rectal cancer. Addition of systemic chemotherapy before or after chemoradiation showed advantages of more completion of neoadjuvant chemotherapy, high percentage of delivering drugs dosage, good compliance and tolerance. The trend toward higher pCR rate was also observed in TNT strategy. Neoadjuvant chemotherapy without chemoradiation had similar long?term efficacies compared with concurrent chemoradiation, with avoiding functional impairment and secondary cancers. In brief, perioperative chemotherapy plays a very important role in MDT of colorectal cancer.