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Côlon & Rectum

, Volume 10, Issue 1, pp 4–11 | Cite as

Recommandations pour la pratique clinique Cancer du rectum

Question 1 Comment choisir les thérapeutiques néo-adjuvantes ?
  • J. H. LefevreEmail author
  • P. Afchain
  • J. Cazejust
  • R. Coriat
  • F. Huguet
  • C. Lemanski
Dossier Thématique / Thematic File
  • 100 Downloads

Résumé

Les dernières RPC sur le traitement néoadjuvant du cancer du rectum dataient de 2005. Elles ont été mises à jour en intégrant les dernières publications. Pour les tumeurs T3 ou T4, une IRM est recommandée pour préciser la marge circonférentielle. Aucun des examens d’imagerie ne peut prédire avec précision le statut ganglionnaire.

La RT préopératoire diminue le taux de récidive locale mais altère le résultat fonctionnel digestif et la fonction sexuelle après chirurgie conservatrice.

Les cancers du haut rectum résécables d’emblée ne doivent pas bénéficier d’un traitement néoadjuvant.

Pour les tumeurs du tiers moyen et du tiers inférieur du rectum, l’indication dépend de l’évaluation en imagerie. Certaines tumeurs avec une bonne marge circonférentielle peuvent être traitées par chirurgie d’emblée. Les tumeurs mrT3d et T4 doivent bénéficier d’une radiochimiothérapie.

La CT associée à la RT repose sur le 5FU oral (capécitabine). L’utilisation du FU IV est une alternative possible. Il n’y a pas d’intérêt à ajouter une autre molécule de chimiothérapie. Après RT courte, la chirurgie doit être réalisée au maximum 7 jours suivants l’irradiation. Après CTRT, il ne semble pas nécessaire de prolonger le délai d’attente au delà de 6-8 semaines.

Mos clés

Cancer du rectum Traitement néo-adjuvant Radiothérapie Radiochimiothérapie Récidive locale 

Abstract

The previous guidelines for the neoadjuvant treatment of rectal cancer have been published in 2005. The present updates have taken into account all last scientific publications. For T4, T3 tumours, an MRI is mandatory to assess the circumferential margin. No radiological exam can predict with accurary the nodal status.

Neoadjuvant radiotherapy reduces the rate of local recurrence but alter the functionnal results as the sexual function after anterior resection. Resectable upper third rectal cancers don’t benefit from neoadjuvant treatment. For mid and lower third rectal cancers, indication for neoadjuvant treatment depends on the radiological explorations. Some tumours with a sufficient circumferential margin can be treated by immediate surgery. mrT3d or T4 tumours require neoadjuvant radiochemotherapy.

Concomitant chemotherapy should be based only on oral 5-FU (Capecitabine). Intravenous 5-FU is an alternative. Other chemotherapy regimens are not indicated. After short course radiotherapy, the waiting period shoud not exceed 7 days. After radiochemotherapy, it seems not usefull to extend the waiting period longer than 6-8 weeks.

Keywords

Rectal cancer Neoadjuvant treatment Radiotherapy Radiochemotherapy Local recurrence 

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Copyright information

© Springer-Verlag France 2015

Authors and Affiliations

  • J. H. Lefevre
    • 1
    Email author
  • P. Afchain
    • 2
  • J. Cazejust
    • 3
  • R. Coriat
    • 4
  • F. Huguet
    • 5
  • C. Lemanski
    • 6
  1. 1.Service de chirurgie générale et digestive, Hôpital Saint-AntoineAPHPParisFrance
  2. 2.Service d’oncologie, Hôpital Saint-AntoineAP-HPParisFrance
  3. 3.Service de radiologie, Hôpital Saint-AntoineAP-HPParisFrance
  4. 4.Service de radiothérapie, Hôpital TenonAP-HPParisFrance
  5. 5.Service de gastro-entérologie, Hôpital CochinAP-HPParisFrance
  6. 6.Service de radiothérapieInstitut du Cancer de MontpellierMontpellierFrance

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