I. What is neoadjuvant radiotherapy?
It is also called neoadjuvant therapy, that is, adjuvant radiotherapy and/or chemotherapy before surgery for malignant tumors.
Advantages and disadvantages of neoadjuvant radiotherapy
Advantages.
(1) It can improve the concentration of local chemotherapy drugs;
(2) Early treatment of clinical or subclinical micro-metastases and reduction of postoperative recurrence and metastasis;
(3) Reduces clinical staging, shrinks primary lesions, and increases the chance of surgery;
(4) To help understand the sensitivity of tumors to chemotherapeutic drugs, which can be used to guide the development of postoperative treatment plans;
(5) Reduce intraoperative cancer cell dissemination of medical origin.
Disadvantages.
(1) Chemotherapy-induced liver injury;
(2) Possible missed “window of opportunity for surgery” due to tumor progression
(3) Complete remission and may make it difficult to determine the extent of resection, and uncertainty of the extent of surgery may lead to residual tumor cells after surgery.
3. What kind of rectal cancer needs neoadjuvant radiotherapy?
Neoadjuvant radiotherapy is only applicable to rectal cancer <12cm from the anus, for
(1) patients with T3 and/or N+ resectable rectal cancer, preoperative neoadjuvant radiotherapy is recommended.
(2) Patients with T4 or locally advanced unresectable rectal cancer must be treated with neoadjuvant radiotherapy. After treatment, they must be re-evaluated and considered whether surgery is feasible
Most medical units in China adopt less standardized preoperative radiotherapy and chemotherapy for rectal cancer treatment, and even large hospitals do not reach the standardized preoperative treatment level, which urgently needs to be changed and requires doctors’ patience to explain and also patients to understand the treatment method.
Therefore, preoperative definitive evaluation is the key to specify the treatment plan and allow the patient to benefit the most. Do not save time and money by rushing the surgery, thinking that it is beneficial to the patient, without realizing that good intentions can do bad things. After completing the evaluation, be sure to communicate more with your doctor to decide on the most appropriate treatment plan.
IV. Methods of neoadjuvant treatment
The neoadjuvant treatment options for rectal cancer mainly include the following, and the first two methods have been more applied both at home and abroad.
(1) Long-range radiotherapy: 45.0~50.4 Gy/25~28 f/5 w program, mostly applied to patients in the United States and some European countries.
(2) Long-course radiotherapy: The radiotherapy regimen is the same as the 45.0-50.4 Gy/25-28 f/5 w regimen of long-course radiotherapy, supplemented with 5-fluorouracil-based chemotherapy.
(3) Short-course rapid fractionated radiotherapy: 25 Gy/5 f/1 w regimen, surgery within 1 week after radiotherapy, this regimen is mostly used in the Nordic countries.