prikaz primera
Anja Meden (Author), Franc Anderluh (Author), Vaneja Velenik (Author)

Abstract

Sodobno standardizirano zdravljenje lokalno napredovalega raka danke (LNRD) je sestavljeno iz predoperativne kemoradioterapije (KTRT), resekcije s totalno mezorektalno ekscizijo (TME) in pri izbranih bolnikih iz pooperativne kemoterapije (KT). S stopnjevanjem intenzivnosti predoperativnega zdravljenja je prišlo do občutnega porasta patoloških (pCR) in kliničnih popolnih odgovorov (cCR). Pri skrbno izbranih bolnikih s cCR je namesto operativnega zdravljenja možno tudi skrbno spremljanje (angl. Watch & Wait – pristop W&W). Preživetje bolnikov, ki so samo sledeni, ni nič slabše od preživetja operiranih, ob tem pa se izognemo s kirurškim zdravljenjem povezano smrtnostjo in pooperativnim zapletom. V Sloveniji je pristop W&W vključen v zadnja nacionalna priporočila za zdravljenje raka debelega črevesa in danke. Kljub številnim prednostim pristopa W&W še vedno ostaja tveganje za ponovitev in napredovanje bolezni s sistemskim razsojem. Za ugoden izid zdravljenja je ključna skrbna selekcija bolnikov. Težava je predvsem subjektivnost ocene cCR. V prispevku je opisan primer bolnika z LNRD, ki je bil zdravljen s predoperativno KTRT, po čemer je prišlo do cCR. Nato je bil obravnavan s pristopom W&W. Po dveh letih od začetka zdravljenja je prišlo do razsoja bolezni, zaradi česar je bolnik pozneje umrl.

Keywords

rak danke;neoperativni pristop;neoadjuvantna terapija;

Data

Language: Slovenian
Year of publishing:
Typology: 1.04 - Professional Article
Organization: OI - Institute of Oncology
Publisher: Onkološki inštitut Ljubljana
UDC: 616.3
COBISS: 112159747 Link will open in a new window
ISSN: 1408-1741
Views: 99
Downloads: 49
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Other data

Secondary language: English
Secondary title: Watch & wait approach following total neoadjuvant therapy of rectal cancer
Secondary abstract: Modern standardized treatment of locally advanced rectal cancer (LARC) consists of preoperative chemoradiotherapy (CTRT), operative resection with total mesorectal excision (TME), followed by postoperative chemotherapy (CT) in selected patients. With escalated intensity of preoperative treatment, there was a significant increase in pathological (pCR) and clinical complete responses (cCR). In carefully selected patients with cCR, close monitoring – watch & wait approach (W&W) instead of surgical treatment is possible. Survival of only monitored patients is not worse in comparison with operated patients, but with the addition of avoiding surgical treatment-related mortality and postoperative complications. In Slovenia, the W&W approach is included in the latest national recommendations for the treatment of colon and rectal cancer. Despite the many benefits of the W&W approach, a risk of recurrence and distant metastasizing still remains. Careful selection of patients is crucial for a favourable treatment outcome. The main problem is cCR assessment subjectivity. This paper describes the case of a patient with LARC who was treated with preoperative CTRT after cCR. The patient was treated with a W&W approach. Two years after beginning treatment, the disease had progressed, and the patient later died.
Pages: str. 22-26
Volume: ǂLetn. ǂ26
Issue: ǂšt. ǂ1
Chronology: jun. 2022
ID: 15795599