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1、直肠癌新辅助治疗进展广西医科大学附属肿瘤医院覃宇周II-III期直肠癌术前放疗和放化疗术前放疗和单纯手术比较，降低了局部区域复发率，提高了无病生存率和总生存率(I类)术前放化疗和术前放疗比较，进一步降低了局部区域复发率，但两组生存率相同(I类)术前放化疗和术后放化疗比较，毒副作用低，显著降低了局部区域复发率，生存率相似(I类)术前放化疗之新辅助化疗，未提高近期疗效，生存率有待长期随诊(III类)辅助化疗-NCCN指南EORTC22921Long-termresults：术后辅助化疗不改善无病生存和总生存无病生存时间Bosset,Jean-Fr
2、ançois,etal."Fluorouracil-basedadjuvantchemotherapyafterpreoperativechemoradiotherapyinrectalcancer:long-termresultsoftheEORTC22921randomisedstudy."Thelancetoncology15.2(2014):184-190.EORTC22921Long-termresults：术后辅助化疗不改善无病生存和总生存总生存时间Bosset,Jean-François,etal."Fluorouracil-b
3、asedadjuvantchemotherapyafterpreoperativechemoradiotherapyinrectalcancer:long-termresultsoftheEORTC22921randomisedstudy."Thelancetoncology15.2(2014):184-190.EORTC22921Long-termresults：术后辅助化疗不改善无病生存和总生存1、化疗依从性非常差：术前依从率为82%术后依从率为42.9%2、化疗方案中不包括奥沙利铂Bosset,Jean-François,etal."C
4、hemotherapywithpreoperativeradiotherapyinrectalcancer."NewEnglandJournalofMedicine355.11(2006):1114-1123.CAO/ARO/AIO-94Trial术后放化疗增加短期和长期的毒副作用Sauer,Rolf,etal."Preoperativeversuspostoperativechemoradiotherapyforrectalcancer."NewEnglandJournalofMedicine351.17(2004):1731-1740.C
5、AO/ARO/AIO-94Trial术后的辅助放疗和化疗多数无法按疗程完成Sauer,Rolf,etal."Preoperativeversuspostoperativechemoradiotherapyforrectalcancer."NewEnglandJournalofMedicine351.17(2004):1731-1740.SEERData超过1/3的患者因为各种原因未能接受辅助化疗Cancer.2014Apr15;120(8):1162-70.doi:10.1002/cncr.28545.Epub2014Jan28.Postop
6、erativechemotherapyuseafterneoadjuvantchemoradiotherapyforrectalcancer:AnalysisofSurveillance,Epidemiology,andEndResults-Medicaredata,1998-2007.HaynesAB1,YouYN,HuCY,EngC,KopetzES,Rodriguez-BigasMA,SkibberJM,CantorSB,ChangGJ.手术并发症的影响手术并发症导致化疗推迟及预后不良Tevis,SarahE.,etal."Postop
7、erativeComplicationsinPatientsWithRectalCancerAreAssociatedWithDelaysinChemotherapyThatLeadtoWorseDisease-freeandOverallSurvival."DiseasesoftheColon&Rectum56.12(2013):1339-1348.手术并发症的影响手术并发症导致化疗推迟及预后不良Tevis,SarahE.,etal."PostoperativeComplicationsinPatientsWithRectalCancerA
8、reAssociatedWithDelaysinChemotherapyThatLeadtoWorseDisease-freeandOverallSurvival.
