Growing evidence has demonstrated that circulating tumor DNA (ctDNA) detection in colorectal cancer might be a promising approach to address current important clinical questions. During chemotherapy for metastatic colorectal cancer, tumor cells acquire potential resistance by generating additional somatic mutations related to therapeutic resistance. ctDNA can capture the tumor landscape, including heterogeneity, which might provide the opportunity for additional treatment options. Moreover, ctDNA detection is advantageous, because it can monitor tumor heterogeneity serially, in a non-invasive manner. ctDNA is considered valid for detecting minimal residual disease after a curable resection. By utilizing ctDNA detection, adjuvant chemotherapy for patients with stage II–III colorectal cancer might be omitted for patients at low risk of recurrence; or conversely, adjuvant chemotherapy might be highly recommended for patients at high risk, based on ctDNA findings. During multidisciplinary treatments for locally advanced rectal cancer, it is essential to monitor the responses to sequential treatments to make appropriate decisions. Currently, these decisions are mainly based on radiological or pathological findings. ctDNA can add value by providing the real-time status of locally advanced rectal cancer. In this review, we summarized the current evidence and discussed future strategies for using ctDNA in the treatment of colorectal cancer.

越来越多的证据表明，结直肠癌中的循环肿瘤 DNA (ctDNA) 检测可能是解决当前重要临床问题的一种有前途的方法。在转移性结直肠癌的化疗过程中，肿瘤细胞通过产生与治疗耐药相关的额外体细胞突变来获得潜在的耐药性。ctDNA 可以捕捉肿瘤情况，包括异质性，这可能为其他治疗选择提供机会。此外，ctDNA 检测是有利的，因为它可以以非侵入性的方式连续监测肿瘤异质性。ctDNA 被认为可有效检测可治愈切除术后的微小残留病灶。通过利用ctDNA检测，对于复发风险低的患者，可以省去II-III期结直肠癌患者的辅助化疗；或者相反，根据 ctDNA 发现，可能强烈建议高风险患者进行辅助化疗。在局部晚期直肠癌的多学科治疗过程中，必须监测对连续治疗的反应以做出适当的决定。目前，这些决定主要基于放射学或病理学发现。ctDNA 可以通过提供局部晚期直肠癌的实时状态来增加价值。在这篇综述中，我们总结了当前的证据并讨论了使用 ctDNA 治疗结直肠癌的未来策略。必须监测对连续治疗的反应以做出适当的决定。目前，这些决定主要基于放射学或病理学发现。ctDNA 可以通过提供局部晚期直肠癌的实时状态来增加价值。在这篇综述中，我们总结了当前的证据并讨论了使用 ctDNA 治疗结直肠癌的未来策略。必须监测对连续治疗的反应以做出适当的决定。目前，这些决定主要基于放射学或病理学发现。ctDNA 可以通过提供局部晚期直肠癌的实时状态来增加价值。在这篇综述中，我们总结了当前的证据并讨论了使用 ctDNA 治疗结直肠癌的未来策略。