NCCN 2016 V1. anorectal malignant melanoma ARMM 45 ~ 63 / % % 70% 3. National Comprehensive Cancer Network NCCN 21 NCCN NCCN T1NX T2NX

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1 NCCN 2016 V / / NCCN R R DOI: /j.cnki.syzlzz A anorectal malignant melanoma ARMM 45 ~ 63 / % % % 3 ARMM NCCN 4 National Comprehensive Cancer Network NCCN REC-2 REC-2 NCCN 2016 V1 NCCN NCCN NCCN 1. 3 REC-3 REC-3 T1N0 T1NX 1. 1 REC-1 T2NX REC-1 b NCCN 5-FU 5-FU 5-FU + NCCN

2 292 Journal of Practical Oncology Vol. 31 No / NCCN T2 / REC-4 REC-D REC-4 REC-D < 3 cm T3 N0 T N1 ~ 2 25 Gy / 5 f 2 1 T4 2 multidisciplinary MDT team MDT ct3 ~ 4 BRAF T N + long-course radiochemotherapy LCRT + metastatic colorectal cancer mcrc RAS KRAS /NRAS pathological complete response pcr 2016 RAS NCCN 5 5 Gy BRAF short-course preoperative radiotherapy SCRT BRAF V600E EGFR 2016 BRAF V600E Ngan 8 Trial / ct3 < 12 cm Bokemeyer Crystal OPUS KRAS mcrc 5 relapse-free survival RFS overall survival OS BRAF + BRAF BRAF + 2 P = BRAF mcrc BRAF EG- FR Pietrantonio SCRT pcr LCRT BRAF /RAS EGFR SCRT BRAF EGFR SCRT mcrc RAS BRAF BRAF 1. 5 REC-6 REC-10 REC-6 REC-10 / / BRAF BRAF REC-A 5 /6 1 REC-A 5 / EGFR stereotactic body radiation therapy SBRT EGFR BRAF 1. 7 REC-A 5 /6 2 REC-A 5 /6

3 * immunohistochemistry IHC mismatch repair MMR PCR microsatellite 1. 8 REC-8 REC-8 CT instability MSI 2015 MSI /MMR 5 1 CT Lynch CT Be CT 5 thesda MMR /MSI 2015 MMR / MSI 2 MLH1 BRAF V600E endoscopic ultrasonogra- Lynch phy EUS MRI 6 3 MSI-H Ⅱ 5 5-FU NCCN 4 mcrc MMR / MSI MMR MSI * NCCN Moreira 12 JAMA MSI-H dmmr Lynch REC-11 REC > 70 jj Bethesda MMR /MSI MMR /MSI Lynch pt3n0m0 MMR /MSI MSI-H overall response rate ORR 40% progression free survival PFS 78% pmmr ORR 0% PFS 11% dmmr ORR 71% PFS 67% 2016 NCCN mcrc MMR /MSI Ⅱ MMR /MSI dmmr 5-FU Ⅱ MMR /MSI REC-B 1 /3 REC-B 1 /3 pt3n0m0 Ⅱ NCCN Ⅱ MMR /MSI Le vs dmmr PD-1 MMR PD-1 circumferential resection margin CRM

4 294 Journal of Practical Oncology Vol. 31 No R TAS CRM OS PFS P < TAS-102 performance status PS Eastern Cooperative Oncology Group ECOG P < REC-C 2 /2 REC-E 6 /9 REC-C FDA mcrc 2 /2 REC-E 6 /9 * 2016 TAS-102 > 2 1 mg / m 2 min mcrc TAS-102 mcrc FOLFOX NCCN 2A 85 mg /m 2 > 2 1 XELOX + 2 ~ mg /m Cercek 19 J Oncol Pract 1 mg / m 2 min NCCN NCCN 1 Siegel R Ward E Brawley O et al. Cancer statistics 2011 the impact of eliminating socioeconomic and racial mg disparities on premature cancer deaths J. CA Cancer J REC-E /9 REC-E 1 2 Clin /9 2 Chen W Zheng R Baade PD et al. Cancer statistics in China 2015 J. CA Cancer J Clin TAS mg /m 2 3 Li M Gu J. Changing patterns of colorectal cancer in China over a period of 20 years J. World J 80 Gastroenterol Zhan TC Gu J Li M et al. Intermediate-fraction neoadjuvant radiotherapy for rectal cancer J. Dis Colon Rec- TAS-102 trifluridine FTD tum tipiracil hydrochloride TPI 5 National Comprehensive Cancer Network. NCCN clinical DNA practice guidelines in oncology Rectal cancer V1 Mayer EB /OL https / /www. Ⅲ RECOURSE nccn. org / professionals / physician_gls / pdf / rectal. pdf

5 Chae WY Lee JL Cho DH et al. Preliminary suggestion about staging of anorectal malignant melanoma may be used to predict prognosis J. Cancer Res Treat Miguel I Freire J Passos MJ et al. Anorectal malignant melanoma retrospective analysis of management and outcome in a single Portuguese institution J. Med Oncol Ngan SY Burmeister B Fisher RJ et al. Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer Trans-Tasman Radiation Oncology Group trial J. J Clin Oncol Abdalla EK Vauthey JN Ellis LM et al. Recurrence and outcomes following hepatic resection radiofrequency ablation and combined resection / ablation for colorectal liver metastases J. Ann Surg Bokemeyer C Van Cutsem E Rougier P et al. Addition of cetuximab to chemotherapy as first-line treatment for KRAS wild-type metastatic colorectal cancer pooled a- nalysis of the CRYSTAL and OPUS randomised clinical trials J. Eur J Cancer Pietrantonio F Petrelli F Coinu A et al. Predictive role of BRAF mutations in patients with advanced colorectal cancer receiving cetuximab and panitumumab a meta-analysis J. Eur J Cancer Moreira L Balaguer F Lindor N et al. Identification of Lynch syndrome among patients with colorectal cancer J. JAMA Sargent DJ Marsoni S Monges G et al. Defective mismatch repair as a predictive marker for lack of efficacy of fluorouracil-based adjuvant therapy in colon cancer J. J Clin Oncol Le DT Uram JN Wang H et al. PD-1 blockade in tumors with mismatch-repair deficiency J. N Engl J Med Bonjer HJ Deijen CL Haglind E. A randomized trial of laparoscopic versus open surgery for rectal cancer J. N Engl J Med Jeong SY Park JW Nam BH et al. Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy COREAN trial survival outcomes of an open-label non-inferiority randomised controlled trial J. Lancet Oncol Fleshman J Branda M Sargent DJ et al. Effect of laparoscopic-assisted resection vs open resection of stage Ⅱ or Ⅲ rectal cancer on pathologic outcomes The ACOSOG Z6051 randomized clinical trial J. JAMA Stevenson AR Solomon MJ Lumley JW et al. Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer The ALaCaRT randomized clinical trial J. JAMA Cercek A Park V Yaeger R et al. Faster FOLFOX Oxaliplatin can be safely infused at a rate of 1 mg /m 2 /min J. J Oncol Pract e Mayer RJ Van Cutsem E Falcone A et al. Randomized trial of TAS-102 for refractory metastatic colorectal cancer J. N Engl J Med 櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗櫗