oncotomskСибирский онкологический журналSiberian journal of oncology1814-48612312-3168Tomsk National Research Medical Сепtеr of the Russian Academy of Sciences10.21294/1814-4861-2025-24-2-126-132oncotomsk-3544Research ArticleОБЗОРЫREVIEWSСовременные принципы неоадъювантной терапии рака прямой кишкиModern principles of neoadjuvant therapy for rectal cancerhttps://orcid.org/0000-0001-6641-7229КарачунА. М.KarachunA. M.

Карачун Алексей Михайлович, доктор медицинских наук, профессор, заведующий отделением абдоминальной онкологии; профессор кафедры онкологии

Researcher ID (WOS): AAC-4011-2019. Author ID (Scopus): 6505903635

197758, г Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

191015, г Санкт-Петербург, ул. Кирочная, 41

Alexei M. Karachun, MD, DSc, Professor, Head of the Department of Abdominal Oncology; Professor, Department of Oncology

Researcher ID (WOS): AAC-4011-2019. Author ID (Scopus): 6505903635

68, Leningradskaya St., Pesochny, Saint Petersburg, 197758 

41, Kirochnaya St., Saint Petersburg, 191015 

https://orcid.org/0000-0002-2642-5440СамсоновД. В.SamsonovD. V.

Самсонов Денис Владимирович, кандидат медицинских наук, доцент; доцент 2 кафедры (хирургии усовершенствования врачей)

197758, г Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

191015, г Санкт-Петербург, ул. Кирочная, 41

Denis V. Samsonov, MD, PhD, Associate Professor; Associate Professor, 2nd Department (Surgery For Advanced Medical Studies)

68, Leningradskaya St., Pesochny, Saint Petersburg, 197758 

6, Akademika Lebedeva St., Saint Petersburg, 194044 

desavl@mail.ruhttps://orcid.org/0000-0002-7185-1967НовиковС. Н.NovikovS. N.

Новиков Сергей Николаевич, доктор медицинских наук, профессор, заведующий отделением радиотерапии 

Author ID (Scopus): 7202404433 

197758, г Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

Sergey N. Novikov, MD, DSc, Professor, Head of the Department of Radiotherapy 

Author ID (Scopus): 7202404433 

68, Leningradskaya St., Pesochny, Saint Petersburg, 197758 

ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Петрова» Минздрава России ; ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава РоссииРоссияN.N. Petrov National Medical Research Center of Oncology of the Ministry of Health of Russia ; I.I. Mechnikov North-Western State Medical University of the Ministry of Health of RussiaRussian FederationФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Петрова» Минздрава России ; ФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» МО РФРоссияN.N. Petrov National Medical Research Center of Oncology of the Ministry of Health of Russia ; S.M. Kirov Military Medical AcademyRussian FederationФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Петрова» Минздрава РоссииРоссияN.N. Petrov National Medical Research Center of Oncology of the Ministry of Health of RussiaRussian Federation202517052025242126132Copyright © Карачун А.М., Самсонов Д.В., Новиков С.Н., 20252025Карачун А.М., Самсонов Д.В., Новиков С.Н.Karachun A.M., Samsonov D.V., Novikov S.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.siboncoj.ru/jour/article/view/3544

Актуальность. Анатомические особенности локализации прямой кишки в пространстве, ограниченном жестким каркасом костей таза, обусловили приоритет комбинированного лечения местнораспространенного рака прямой кишки с существенной ролью предоперационного терапевтического компонента. В течение последних трех десятилетий лучевая терапия является важнейшим элементом неоадъювантного лечения рака прямой кишки. Весь указанный период времени продолжается исследовательская деятельность, направленная на повышение ее эффективности в профилактике местного рецидива. Материал и методы. Проведен обзор результатов актуальных исследований различных режимов неоадъювантной терапии местнораспространенного рака прямой кишки, а также перспективных вари­антов оптимизации предоперационного облучения. Поиск публикаций по тематике обзора произведен с использованием баз данных Web of Science и PubMed. В ходе проведенного анализа литературы изучены 202 источника, из которых для обзора отобрано 36. Результаты. Вопрос о преимуществе крупнофракционной лучевой терапии над пролонгированной химиолучевой остается открытым. Улучшение результатов неоадъювантного воздействия на опухоль прямой кишки связывают с различными вариантами увеличения дозы облучения. Кроме того, осуществляется изучение результатов предопе­рационной химиотерапии в качестве альтернативы облучению либо дополнительного фактора комбинированного влияния на первичную опухоль. Заключение. Предполагается, что стратегия тотальной неаодъювантной терапии не только улучшит локальный контроль заболевания, но и уменьшит риски системного рецидива. На современном этапе большое значение в оптимизации программы лечения больных раком прямой кишки придается мультидисицплинарному подходу.

Objective. The location of the rectum in the space limited by the rigid frame of the pelvic bones has determined the priority of combined modality treatment for locally advanced rectal cancer with a significant role of preoperative therapy. Over the past three decades, radiation therapy has become an increasingly integral component of neoadjuvant treatment of rectal cancer. Research activities aimed at increasing the effectiveness of perioperative radiotherapy in preventing local recurrence have been ongoing. Material and Methods. This article provides an overview of the results of current studies of various neoadjuvant therapy regimens for locally advanced rectal cancer, as well as promising options for optimizing preoperative irradiation. The search for publications on the topic of the review was performed using the Web of Science and PubMed databases. Out of 202 studies, 36 were selected for literature review. Results. The question of the advantage of large fraction radiotherapy over prolonged chemoradiotherapy still remains open. Improvements in neoadjuvant treatment outcomes in rectal cancer are associated with various options for increasing the radiation dose. In addition, the review examines the use of preoperative chemotherapy as an alternative to radiation therapy or as a component of combined modality treatment for rectal cancer. Conclusion. It is assumed that the strategy of total neoadjuvant therapy will not only improve local disease control, but also reduce the risks of systemic relapse. Currently, a multidisciplinary approach is of great importance in optimizing the treatment strategy for patients with rectal cancer.

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