侧方淋巴结转移的中低位局部晚期直肠癌治疗现状  

Current status of treatment for locally advanced middle-low rectal cancer with lateral lymph nodemetastasis

作　　者：李春英 纪鑫 栾瑾微[1] 周洋[2] 李嘉琪[1] 李香兰[1] Li Chunying;Ji Xin;Luan Jinwei;Zhou Yang;Li Jiaqi;Li Xianglan(Department of Abdominal Radiotherapy,Harbin Medical University Cancer Hospital,Harbin 150000,China;Department of Radiology,Harbin Medical University Cancer Hospital,Harbin 150000,China)

机构地区：[1]哈尔滨医科大学附属肿瘤医院腹部放疗科,哈尔滨150000 [2]哈尔滨医科大学附属肿瘤医院放射科,哈尔滨150000

出　　处：《中华放射肿瘤学杂志》2023年第12期1104-1108,共5页Chinese Journal of Radiation Oncology

摘　　要：中低位局部晚期(Ⅱ-Ⅲ期)直肠癌侧方淋巴结转移(LLN)率高、预后差。目前,关于LLN治疗方案东西方争议较大:以日本为代表的东方学者认为LLN是区域性疾病,当肿瘤位于腹膜返折下且侵及肌层时无论有无LLN,均推荐预防性盆腔侧方淋巴结清扫(LPLND);而欧美学者认为LLN是全身性疾病,推荐新辅助放化疗(nCRT)联合全直肠系膜切除(TME)。然而,近年来有研究发现,nCRT或LPLND均不能显著降低LLN患者的局部复发率,而nCRT联合LPLND治疗的预后更好,也有研究发现增加转移淋巴结放疗剂量可以提高局部控制率。本文综述了该类人群的治疗现状,以期为临床治疗提供依据。The incidence of lateral lymph node metastases(LLN)of locally advanced middle-low rectal cancer(Ⅱ-Ⅲstage)is high and clinical prognosis is poor.At present,the treatment plan of LLN is controversial between the East and the West.Scholars from the East represented by Japan believe that LLN is a regional disease.Lateral pelvic lymph node dissection(LPLND)is recommended when the tumor is located under the peritoneal reflection and invades into the muscular layer,regardless of the presence or absence of LLN.However,European and American scholars believe that LLN is a systemic disease and recommend neoadjuvant chemoradiotherapy(nCRT)combined with total mesorectal excision(TME).Nevertheless,recent studies have found that neither nCRT nor LPLND can significantly reduce the locoregional recurrence(LR)rate in patients with LLN,while nCRT combined with LPLND yields better prognosis.Some studies have also demonstrated that increasing the radiotherapy dose of metastatic lymph nodes can improve the local control rate.In this article,current treatment status of this population was reviewed,aiming to provide a basis for clinical treatment.

关 键 词：直肠肿瘤 侧方淋巴结转移 新辅助放化疗法 盆腔侧方淋巴结清扫 全直肠系膜切除 

分 类 号：R735.37[医药卫生—肿瘤]