Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_151_библиотеки_им_акад_М_И_Перельмана

An important advantage of TNT is the potential to avoid radical surgical inter­vention. Both the safety and feasibility of offering a strict surveillance strategy has been established in patients with a clinical complete response (cCR) after neoadjuvant therapy (van der Valk et al. 2018; Garcia-Aguilar et al. 2020, 2022). However, there remains hesitancy to offer organ preservation treatment to those aged under 50 owing to a potentially higher oncological risk. Recent data comparing young patients to their older counterparts following a watch-and-wait strategy after a cCR demonstrated no additional oncological risk, with comparable disease-specific survival, risk of local recurrence, and distant metastases (Bahadoer et al. 2022). While undergoing surgical resection provides greater oncological certainty owing to histological confirmation of tumour response, a watch-and-wait approach still should be discussed with patients when a cCR is demonstrated after treatment based on current evidence.

to one-third of patients (Andreyev 2015). Radiation-induced gastrointestinal symptoms affect as many patients each year as develop inflammatory bowel disease, and as cancer therapy continues to improve with increased survivorship, gastrointes­tinal radiation toxicity will become a more prevalent health issue (Andreyev 2015; Dalsania et al. 2021). Improvement techniques in radiation therapy in attempts to reduce the amoun t of exposure to adjacent normal tissue have led to reduction in acute toxicity; however, reduction of later toxicity is yet to be demonstrated (Klopp et al. 2018). Concurrent chemotherapy and prior abdominal surgery contribute to the development of longer-term complications (Dalsania et al. 2021). Toxic effects can be progressive, with the need for operative intervention to manage these complications increasing over time (Andreyev et al. 2011). Bowel dysfunction and unpredictability, due to radiotherapy in addition to surgical intervention, cause heightened anxiety and fear, exacerbating functional limitations and restrictions survivors place on themselves, for example, alternating diet to accommodate bowel function, staying at home, or near a toilet at all times (Lim et al. 2021).

doses of radiation, with a dose-dependent relationship between radiation and prema­ture menopause (Maltaris et al. 2007; Wo and Viswanathan 2009). In addition, the uterus is also the victim of radiation-included damage. If conception is achieved, pregnancy maintenance is impacted by the development of fibrosis and a reduction in uterine blood flow, uterine volume, and elasticity as a consequence of radiation exposure (Maltaris et al. 2007; Teh et al. 2014). Miscarriage, placental abnormalities, and premature labour are consequences (Spanos et al. 2008;Wo and Viswanathan 2009). In addition, radiation therapy can also lead to sterility in the male patient, due to effects on spermatogenesis (Vakalopoulos et al. 2015; Eng et al. 2022). The impact of treatment on fertility must be explored with patients, and options for fertility preservation discussed, particula rly in the era of increased access to assisted reproductive technology. Data on how to best manage these toxicities is lacking, with a limited evidence base for proposed treatments. This is true in the management of rectal tumours and also applies to other pelvic malignancies where radiotherapy forms part of the treatment plan (Dalsania et al. 2021). However, with the emerging increased understanding of the underlying aetiology and molecular mechanisms of radiation-induced toxicity, and ongoing efforts to focus the field of radiation delivery, one can hope this can shed a light on effective treatment mechanisms and reduce the burden of radiation-induced morbidity (Andreyev