While adjuvant chemotherapy is an established treatment for pathological stage II and especially stage III colon cancer, its role in the multimodal management of rectal cancer remains controversial. As a result, there is substantial variation in the use of this treatment in clinical practice. Even among centres and physicians who consider adjuvant chemotherapy as a standard treatment, notable heterogeneity exists with regard to patient selection criteria and chemotherapy regimens. The controversy around this topic is confirmed by the lack of full consensus among national and international clinical guidelines. While most of the clinical trials do not support the contention that adjuvant chemotherapy may improve survival outcomes if pre-operative (chemo)radiotherapy is also given, these suffer from many limitations that preclude drawing definitive conclusions. Nevertheless, in the era of evidence-based medicine, physicians should be guided by the available data and refrain from extrapolating results of adjuvant colon cancer trials to inform treatment decisions for rectal cancer. Patients should be informed of the evidence gap, be given the opportunity to carefully discuss pros and cons of all the possible management options and be empowered in the decision making. In this article we review the available evidence on adjuvant chemotherapy for rectal cancer and propose a risk-adapted decisional algorithm that largely relies on informed patient preferences.

中文翻译：

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直肠癌的辅助化疗：目前的临床证据和建议。

虽然辅助化疗是病理性II期尤其是III期结肠癌的既定治疗方法，但其在直肠癌多式联运管理中的作用仍存在争议。结果，在临床实践中该治疗方法的使用存在很大差异。即使在将辅助化疗视为标准治疗的中心和医生中，在患者选择标准和化疗方案方面也存在明显的异质性。围绕该主题的争议已被国内和国际临床指南之间缺乏完全共识所证实。尽管大多数临床试验不支持以下观点：如果还进行术前（化学）放疗，辅助化疗可能会改善生存结果，这些受到许多限制，无法得出明确的结论。然而，在循证医学时代，医生应以可用数据为指导，不要外推辅助结肠癌试验的结果以告知直肠癌的治疗决策。应该告知患者证据不足，让他们有机会仔细讨论所有可能的管理选择的利弊，并在决策中赋权。在本文中，我们回顾了直肠癌辅助化疗的可用证据，并提出了一种风险适应性决策算法，该算法主要依赖于知情的患者偏好。医师应以可用数据为指导，避免推断辅助性结肠癌试验的结果，以为直肠癌的治疗决策提供依据。应该告知患者证据不足，让他们有机会仔细讨论所有可能的管理选择的利弊，并在决策中赋权。在本文中，我们回顾了直肠癌辅助化疗的可用证据，并提出了一种风险适应性决策算法，该算法主要依赖于知情的患者偏好。医师应以可用数据为指导，避免推断辅助性结肠癌试验的结果，以为直肠癌的治疗决策提供依据。应该告知患者证据不足，让他们有机会仔细讨论所有可能的管理选择的利弊，并在决策中赋权。在本文中，我们回顾了直肠癌辅助化疗的可用证据，并提出了一种风险适应性决策算法，该算法主要依赖于知情的患者偏好。