Rectal cancer - French intergroup clinical practice guidelines for diagnosis, treatment, and follow-up (TNCD, SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, SFP, RENAPE, SNFCP, AFEF, SFR, and GRECCAR).
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Cotte Eddy, Arquilliere Justine, Artru Pascal, Bachet Jean Baptiste, Benhaim Leonor, Bibeau Frederic, Christou Niki, Conroy Thierry, Doyen Jérome, Hoeffel Christine, Meillan Nicolas, Mirabel Xavier, Pioche Mathieu, Rivin Del Campo Eleonor, Vendrely Véronique, Huguet Florence, Bouché Olivier, Thésaurus National de Cancérologie Digestive (TNCD) (Société Nationale Française de Gastroentérologie (SNFGE), Fédération Francophone de Cancérologie Digestive (FFCD), Groupe Coopérateur multidisciplinaire en Oncologie (GERCOR), Fédération Nationale des Centres de Lutte Contre le Cancer (UNICANCER), Société Française de Chirurgie Digestive (SFCD), Société Française d'Endoscopie Digestive (SFED), Société Française de Radiothérapie Oncologique (SFRO), Association de Chirurgie Hépato-Bilio-Pancréatique et Transplantation (ACHBT), Société́ Française de Pathologie (SFP), Réseau National de Référence des Tumeurs Rares du Péritoine (RENAPE), Société Nationale Française de Colo-Proctologie (SNFCP), Association Française pour l’Étude du Foie (AFEF), Société Française de Radiologie (SFR)), GRECCAR (Groupe de Recherche Chirurgical sur la Cancer du Rectum)
Аннотация
METHODS: This work was supervised by French medical and surgical societies involved in RA management. Recommendations were rated from A to C according to the literature until September 2023.
RESULTS: Based on the pretreatment work-up, RA treatment was divided into four groups. T1N0 can be treated by endoscopic or surgical excision alone if there is no risk factor for lymph node involvement. For T2N0, radical surgery with total mesorectal excision is recommended, but rectal conservation is possible for small tumors (<4cm) after complete/subcomplete response following chemoradiotherapy. For T12N+ or T3+any N, total neoadjuvant treatment (TNT) followed by radical surgery is the gold standard, but rectal conservation is possible for small tumors after complete/subcomplete response following TNT. T3N2 or T+any N are an indication for TNT followed by radical surgery. Immunotherapy shows promise for dMMR/MSI RA. For metastatic tumors, recommendations are based on less robust evidence and chemotherapy plays a major role.
CONCLUSION: These guidelines aim at providing a personalized therapeutic strategy and are constantly being optimized. Each case should be discussed by a multidisciplinary team.