tumorsMalignant tumoursMalignant tumours2224-50572587-6813Rosoncoweb10.18027/2224-5057-2024-004tumors-1328Research ArticleОБЗОРЫ И АНАЛИТИКАREVIEWS AND ANALYSISТотальная неоадъюватная терапия при местнораспространенном раке прямой кишки: обзор литературыTotal neoadjuvant therapy for locally advanced rectal cancer: a literature reviewhttps://orcid.org/0000-0002-1148-8051ПолыновскийА. В.PolynovskiyA. V.

Андрей Владимирович Полыновский

115478; Каширское шоссе, 23; Москва

Andrei Vladimirovich Polynovskiy

115478; 23 Kashirskoe Shosse; Moscow

polynovskiy@gmail.comhttps://orcid.org/0000-0002-9289-1247МамедлиЗ. З.MamedliZ. Z.

Заман Заурович Мамедли

115478; Каширское шоссе, 23; Москва

Zaman Zaurovich Mamedli

115478; 23 Kashirskoe Shosse; Moscow

https://orcid.org/0000-0002-8129-5394КузьмичевД. В.KuzmichevD. V.

Дмитрий Владимирович Кузьмичев

115478; Каширское шоссе, 23; Москва

Dmitrii Vladimirovich Kuzmichev

115478; 23 Kashirskoe Shosse; Moscow

https://orcid.org/0000-0003-2245-214XТрякинА. А.TryakinA. A.

Алексей Александрович Трякин

115478; Каширское шоссе, 23; Москва

Aleksei Aleksandrovich Tryakin

115478; 23 Kashirskoe Shosse; Moscow

https://orcid.org/0000-0001-7753-3081КузнецоваО. А.KuznetsovaO. A.

Олеся Алексеевна Кузнецова

115478; Каширское шоссе, 23; Москва

Olesya Alekseevna Kuznetsova

115478; 23 Kashirskoe Shosse; Moscow

https://orcid.org/0000-0002-9042-942XКочкинаС. О.KochkinaS. O.

Софья Олеговна Кочкина

115478; Каширское шоссе, 23; Москва

Sofya Olegovna Kochkina

115478; 23 Kashirskoe Shosse; Moscow

https://orcid.org/0000-0002-6123-3903АнискинА. А.AniskinA. A.

Александр Александрович Анискин

115478; Каширское шоссе, 23; Москва

Aleksandr Aleksandrovich Aniskin

115478; 23 Kashirskoe Shosse; Moscow

https://orcid.org/0009-0008-4143-2615ГорбуноваА. С.GorbunovaA. S.

Арина Сергеевна Горбунова

115478; Каширское шоссе, 23; Москва

Arina Sergeevna Gorbunova

115478; 23 Kashirskoe Shosse; Moscow

https://orcid.org/0000-0002-6478-0005АлексанцевД. В.AleksancevD. V.

Денис Викторович Алексанцев

115478; Каширское шоссе, 23; Москва

Denis Viktorovich Aleksantsev

115478; 23 Kashirskoe Shosse; Moscow

https://orcid.org/0000-0003-0566-1302ТемирсултановаХ. Р.TemirsultanovaH. R.

Хава Рамазановна Темирсултанова

115478; Каширское шоссе, 23; Москва

Hava Ramazanovna Temirsultanova

115478; 23 Kashirskoe Shosse; Moscow

ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н. Н. Блохина» Минздрава РоссииРоссияN. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of RussiaRussian Federation2024220720241426574Copyright © Полыновский А.В., Мамедли З.З., Кузьмичев Д.В., Трякин А.А., Кузнецова О.А., Кочкина С.О., Анискин А.А., Горбунова А.С., Алексанцев Д.В., Темирсултанова Х.Р., 20242024Полыновский А.В., Мамедли З.З., Кузьмичев Д.В., Трякин А.А., Кузнецова О.А., Кочкина С.О., Анискин А.А., Горбунова А.С., Алексанцев Д.В., Темирсултанова Х.Р.Polynovskiy A.V., Mamedli Z.Z., Kuzmichev D.V., Tryakin A.A., Kuznetsova O.A., Kochkina S.O., Aniskin A.A., Gorbunova A.S., Aleksancev D.V., Temirsultanova H.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.malignanttumors.org/jour/article/view/1328

   Проблема лечения местно-распространенного рака прямой кишки (МРРПК) за последние десятилетия не теряет своей важности и актуальности в связи с неуклонным ростом заболеваемости. Длительное время стандартом лечения МРРПК является проведение пролонгированного курса химиолучевой терапии (ХЛТ) на фоне приема фторпиримидинов с последующим хирургическим лечением в объеме тотальной мезоректумэктомии (ТМЕ) и проведением адъювантной химиотерапии. Несмотря на достигнутые успехи лечения, частота рецидивов составляет 5–10 %. При этом не менее важной остается проблема отдаленного метастазирования, частота которого достигает 30 % и более и является основной причиной гибели данной категории пациентов. Следует также отметить, что полный курс адъювантной химиотерапии завершают около 50 % пациентов. Причинами этого могут быть послеоперационные осложнения, длительное восстановление после обширных хирургических вмешательств и др. Перспективным направлением в интенсификации предоперационного лечения и, в свою очередь, профилактикой отдаленного метастазирования явилось появление концепции тотальной неоадъювантной терапии (TNT — total neoadjuvant therapy). В данном обзоре будут рассмотрены основные этапы в эволюции лечения МРРПК и становление этапов тотальной неоадъювантной терапии.

   The problem of locally advanced rectal cancer (LARC) treatment has not lost its importance and relevance over the past decades, due to the steady increase in the incidence. For a long time, neoadjuvant chemoradiotherapy (nCRT) before total mesorectal excision (TME) and followed systemic chemotherapy was widely accepted as the standard therapy for locally advanced rectal cancer. Although local control is more than satisfactory using this approach, the same cannot be said of distant metastases, which rate reaches 30 % or more and is mainly the cause of death of this category of patients. One of the reasons for this lack of improvement may be the rate of patients who complete the planned adjuvant chemotherapy, which is approximately 50 %. The reasons for that may be postoperative complications, long-term recovery after extensive surgical procedures, etc. Total Neoadjuvant Therapy (TNT) is an emerging approach for the treatment of LARC aimed at improving distant metastasis. This review will outline the main steps in the evolution of LARC treatment and the formation of the stages of total neoadjuvant therapy.

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The authors declare that there are no conflicts of interest present.