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Radiothérapie seule ou associée aux traitements médicaux dans les cancers du rectum

Radiotherapy alone and chemoradiotherapy in rectal cancer treatment

  • Synthèse / Review Article
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Oncologie

Abstract

Rectal cancer requires a multidisciplinary specialist approach for optimal results. Contact radiotherapy has shown excellent results in T1 N0 disease. A new machine (Papillon 50) should be soon available. Preoperative chemoradiotherapy is the new standard treatment for CT3–CT4 resectable cancer. The local failure rate has dramatically decreased from 30% (20 years ago) down to about 5%. When local failures are disappearing, distant metastases are emerging. The current questions are as follows: 1) How to predict response to chemoradiation to modify the surgical strategy? 2) How to identify patients with high risk of distant metastases to explore more intensive upfront treatments? 3) How to identify the low-risk patient group for which less aggressive treatments may be sufficient?

Résumé

La prise en charge du cancer rectal doit être multidisciplinaire. La radiothérapie de contact, endorectale, a montré une grande efficacité dans les cancers T1 N0. La mise sur le marché d’une nouvelle machine (Papillon 50) qui remplacera l’appareil Philips devrait réhabiliter cette technique peu coûteuse. La radiochimiothérapie (RCT) préopératoire est le nouveau standard des cancers CT3–T4 résécables, pour lesquels le taux de récidives locales (RL) a chuté de 30 à 5 % au cours des 20 dernières années. L’éradication des RL est quasi atteinte, alors qu’émerge le risque métastatique. Les questions soulevées actuellement sont: 1) l’identification des patients « répondeurs » à l’issue de la RCT pour réduire l’importance du geste chirurgical; 2) l’identification des patients à très haut risque de métastases pour explorer des stratégies de traitement d’induction plus intensifiées; 3) l’identification de sous-groupes pour lesquels un allègement des traitements d’induction peut être envisagé.

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Authors and Affiliations

  1. Service d’oncologie-radiothérapie, CHU Jean-Minjoz, 2, boulevard Fleming, F-25030, Besançon cedex, France

    B. Schipman, E. Bonnet, L. Aherfi, A. Sedrati & J. -F. Bosset

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  1. B. Schipman
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  2. E. Bonnet
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  3. L. Aherfi
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  4. A. Sedrati
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  5. J. -F. Bosset
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Correspondence to J. -F. Bosset.

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Schipman, B., Bonnet, E., Aherfi, L. et al. Radiothérapie seule ou associée aux traitements médicaux dans les cancers du rectum. Oncologie 12, 37–40 (2010). https://doi.org/10.1007/s10269-009-1832-8

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  • DOI: https://doi.org/10.1007/s10269-009-1832-8

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