{"id":17483,"date":"2025-12-19T13:14:55","date_gmt":"2025-12-19T13:14:55","guid":{"rendered":"https:\/\/www.colorectalcancercanada.com\/?p=17483"},"modified":"2026-01-08T23:33:10","modified_gmt":"2026-01-08T23:33:10","slug":"prise-en-charge-non-chirurgicale","status":"publish","type":"post","link":"https:\/\/www.colorectalcancercanada.com\/fr\/essais-cliniques\/prise-en-charge-non-chirurgicale\/","title":{"rendered":"Prise en charge non chirurgicale suite \u00e0 une th\u00e9rapie n\u00e9oadjuvante totale dans le cancer du rectum"},"content":{"rendered":"<p><span data-contrast=\"auto\">Un r\u00e9cent\u00a0<\/span><a href=\"https:\/\/www.thelancet.com\/journals\/lanonc\/article\/PIIS1470-2045(25)00542-X\/abstract\" target=\"_blank\" rel=\"noopener\"><span data-contrast=\"none\">essai clinique italien de phase II<\/span><\/a><span data-contrast=\"auto\">\u00a0(NO-CUT), publi\u00e9 dans\u00a0<\/span><i><span data-contrast=\"auto\">The Lancet\u00a0Oncology<\/span><\/i><span data-contrast=\"auto\">, a \u00e9valu\u00e9 si certains patients atteints d\u2019un cancer du rectum de stade II\u2013III peuvent \u00e9viter la chirurgie en toute s\u00e9curit\u00e9 apr\u00e8s une r\u00e9ponse compl\u00e8te au traitement initial. L\u2019\u00e9tude portait sur des patients pr\u00e9sentant un sous-type tumoral fr\u00e9quent appel\u00e9\u00a0<\/span><span data-contrast=\"auto\">pMMR\/MSS.<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><b><i><span data-contrast=\"auto\">pMMR\/MSS<\/span><\/i><\/b><span data-contrast=\"auto\">\u00a0: r\u00e9paration des m\u00e9sappariements efficace \/ microsatellite stable, d\u00e9crit un \u00e9tat \u00ab normal \u00bb des cellules canc\u00e9reuses, en particulier dans le cancer colorectal, o\u00f9 le syst\u00e8me de r\u00e9paration de l&rsquo;ADN appel\u00e9 \u00ab r\u00e9paration des m\u00e9sappariements \u00bb (MMR) fonctionne correctement, ce qui conduit \u00e0 un ADN stable (\u00ab microsatellite stable \u00bb) et \u00e0 moins de mutations par rapport aux tumeurs\u00a0dMMR\/MSI-H, qui entra\u00eenent souvent une mauvaise r\u00e9ponse \u00e0 l&rsquo;immunoth\u00e9rapie, mais un pronostic et une approche th\u00e9rapeutique diff\u00e9rents.<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><b><span data-contrast=\"auto\">L&rsquo;\u00e9tude<\/span><\/b><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Les 179 participants ont tous re\u00e7u une chimioth\u00e9rapie et une radioth\u00e9rapie avant toute intervention chirurgicale, dans le cadre d\u2019une th\u00e9rapie n\u00e9oadjuvante totale. Apr\u00e8s le traitement, deux approches ont \u00e9t\u00e9 adopt\u00e9es :<\/span><span data-ccp-props=\"{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;335551550&quot;:0,&quot;335551620&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240}\">\u00a0<\/span><\/p>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"9\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"auto\">Les patients chez qui le cancer semblait avoir compl\u00e8tement disparu ont fait l\u2019objet d\u2019une surveillance \u00e9troite sans chirurgie, selon une approche dite de \u00ab surveillance active \u00bb.<\/span><span data-ccp-props=\"{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;335551550&quot;:0,&quot;335551620&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240}\">\u00a0<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"9\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" data-aria-posinset=\"2\" data-aria-level=\"1\"><span data-contrast=\"auto\">Les patients pr\u00e9sentant une maladie r\u00e9siduelle ont, quant \u00e0 eux, subi une intervention chirurgicale.<\/span><span data-ccp-props=\"{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;335551550&quot;:0,&quot;335551620&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240}\">\u00a0<\/span><\/li>\n<\/ul>\n<p><span data-contrast=\"auto\">Les chercheurs cherchaient \u00e0 d\u00e9terminer si l\u2019absence de chirurgie augmentait le risque de propagation du cancer vers d\u2019autres parties du corps.<\/span><span data-ccp-props=\"{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;335551550&quot;:0,&quot;335551620&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240}\">\u00a0<\/span><\/p>\n<p><b><span data-contrast=\"auto\">Principales conclusions<\/span><\/b><span data-ccp-props=\"{&quot;335559685&quot;:0}\">\u00a0<\/span><\/p>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"6\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"auto\">26 % des patients ont obtenu une r\u00e9ponse compl\u00e8te, leur permettant d\u2019\u00e9viter une intervention chirurgicale.<\/span><span data-ccp-props=\"{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;335551550&quot;:0,&quot;335551620&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240}\">\u00a0<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"6\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}\" data-aria-posinset=\"2\" data-aria-level=\"1\"><span data-contrast=\"auto\">Apr\u00e8s environ trois ans de suivi, 95 % des patients n\u2019ayant pas subi de chirurgie ne pr\u00e9sentaient aucune propagation du cancer \u00e0 distance.<\/span><span data-ccp-props=\"{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;335551550&quot;:0,&quot;335551620&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240}\">\u00a0<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"6\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}\" data-aria-posinset=\"3\" data-aria-level=\"1\"><span data-contrast=\"auto\">Deux ans apr\u00e8s le traitement, 83 % des patients du groupe sans chirurgie demeuraient exempts d\u2019intervention chirurgicale.<\/span><span data-ccp-props=\"{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;335551550&quot;:0,&quot;335551620&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240}\">\u00a0<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"6\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;multilevel&quot;}\" data-aria-posinset=\"4\" data-aria-level=\"1\"><span data-contrast=\"auto\">Le contr\u00f4le global de la maladie \u00e9tait comparable \u00e0 celui observ\u00e9 chez les patients ayant subi une chirurgie.<\/span><span data-ccp-props=\"{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;335551550&quot;:0,&quot;335551620&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240}\">\u00a0<\/span><\/li>\n<\/ul>\n<p><b><span data-contrast=\"auto\">S\u00e9curit\u00e9<\/span><\/b><span data-ccp-props=\"{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;335551550&quot;:0,&quot;335551620&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240}\">\u00a0<\/span><\/p>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"11\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"auto\">Environ 31 % des patients ont pr\u00e9sent\u00e9 des effets ind\u00e9sirables graves, le plus souvent de nature intestinale ou li\u00e9s aux param\u00e8tres sanguins.<\/span><span data-ccp-props=\"{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;335551550&quot;:0,&quot;335551620&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240}\">\u00a0<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"11\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" data-aria-posinset=\"2\" data-aria-level=\"1\"><span data-contrast=\"auto\">Des complications graves ont \u00e9t\u00e9 observ\u00e9es chez 17 % des patients, et 7 % ont d\u00fb interrompre le traitement de fa\u00e7on pr\u00e9matur\u00e9e en raison des effets secondaires.<\/span><span data-ccp-props=\"{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;335551550&quot;:0,&quot;335551620&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240}\">\u00a0<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"11\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" data-aria-posinset=\"3\" data-aria-level=\"1\"><span data-contrast=\"auto\">Aucun d\u00e9c\u00e8s li\u00e9 au traitement n\u2019a \u00e9t\u00e9 rapport\u00e9.<\/span><span data-ccp-props=\"{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;335551550&quot;:0,&quot;335551620&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240}\">\u00a0<\/span><\/li>\n<\/ul>\n<p><b><span data-contrast=\"auto\">Conclusion<\/span><\/b><span data-ccp-props=\"{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;335551550&quot;:0,&quot;335551620&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Cette \u00e9tude s\u2019inscrit dans un corpus croissant de donn\u00e9es probantes sugg\u00e9rant que certains patients atteints d\u2019un cancer du rectum peuvent \u00e9viter une intervention chirurgicale en toute s\u00e9curit\u00e9 lorsqu\u2019ils pr\u00e9sentent une r\u00e9ponse compl\u00e8te au traitement initial. Cette approche pourrait :<\/span><span data-ccp-props=\"{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;335551550&quot;:0,&quot;335551620&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240}\">\u00a0<\/span><\/p>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"12\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"auto\">pr\u00e9server\u00a0la fonction intestinale normale ;<\/span><span data-ccp-props=\"{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;335551550&quot;:0,&quot;335551620&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240}\">\u00a0<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"12\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" data-aria-posinset=\"2\" data-aria-level=\"1\"><span data-contrast=\"auto\">r\u00e9duire\u00a0les effets secondaires \u00e0 long terme ;<\/span><span data-ccp-props=\"{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;335551550&quot;:0,&quot;335551620&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240}\">\u00a0<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"12\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" data-aria-posinset=\"3\" data-aria-level=\"1\"><span data-contrast=\"auto\">maintenir\u00a0un contr\u00f4le efficace de la maladie gr\u00e2ce \u00e0 une surveillance \u00e9troite et rigoureuse.<\/span><span data-ccp-props=\"{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;335551550&quot;:0,&quot;335551620&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240}\">\u00a0<\/span><\/li>\n<\/ul>\n<p><span data-contrast=\"auto\">Chez certains patients atteints d\u2019un cancer du rectum de stade II ou III, une prise en charge reposant sur la chimioth\u00e9rapie et la radioth\u00e9rapie, suivies d\u2019une surveillance attentive plut\u00f4t que d\u2019une chirurgie imm\u00e9diate, pourrait ainsi repr\u00e9senter une option th\u00e9rapeutique s\u00fbre et efficace, offrant la possibilit\u00e9 de pr\u00e9server la qualit\u00e9 de vie sans compromettre le contr\u00f4le du cancer.<\/span><span data-ccp-props=\"{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;335551550&quot;:0,&quot;335551620&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240}\">\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Un r\u00e9cent\u00a0essai clinique italien de phase II\u00a0(NO-CUT), publi\u00e9 dans\u00a0The Lancet\u00a0Oncology, a \u00e9valu\u00e9 si certains patients atteints d\u2019un cancer du rectum de stade II\u2013III peuvent \u00e9viter la chirurgie en toute s\u00e9curit\u00e9 apr\u00e8s une r\u00e9ponse compl\u00e8te au traitement initial. L\u2019\u00e9tude portait sur des patients pr\u00e9sentant un sous-type tumoral fr\u00e9quent appel\u00e9\u00a0pMMR\/MSS.\u00a0 pMMR\/MSS\u00a0: r\u00e9paration <a href=\"https:\/\/www.colorectalcancercanada.com\/fr\/essais-cliniques\/prise-en-charge-non-chirurgicale\/\">&#8230;<\/a><\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_price":"","_stock":"","_tribe_ticket_header":"","_tribe_default_ticket_provider":"","_tribe_ticket_capacity":"","_ticket_start_date":"","_ticket_end_date":"","_tribe_ticket_show_description":"","_tribe_ticket_show_not_going":false,"_tribe_ticket_use_global_stock":"","_tribe_ticket_global_stock_level":"","_global_stock_mode":"","_global_stock_cap":"","_tribe_rsvp_for_event":"","_tribe_ticket_going_count":"","_tribe_ticket_not_going_count":"","_tribe_tickets_list":"[]","_tribe_ticket_has_attendee_info_fields":false,"footnotes":""},"categories":[57,98],"tags":[],"class_list":["post-17483","post","type-post","status-publish","format-standard","hentry","category-essais-cliniques","category-research-updates-fr"],"_links":{"self":[{"href":"https:\/\/www.colorectalcancercanada.com\/fr\/wp-json\/wp\/v2\/posts\/17483","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.colorectalcancercanada.com\/fr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.colorectalcancercanada.com\/fr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.colorectalcancercanada.com\/fr\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/www.colorectalcancercanada.com\/fr\/wp-json\/wp\/v2\/comments?post=17483"}],"version-history":[{"count":0,"href":"https:\/\/www.colorectalcancercanada.com\/fr\/wp-json\/wp\/v2\/posts\/17483\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.colorectalcancercanada.com\/fr\/wp-json\/wp\/v2\/media?parent=17483"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.colorectalcancercanada.com\/fr\/wp-json\/wp\/v2\/categories?post=17483"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.colorectalcancercanada.com\/fr\/wp-json\/wp\/v2\/tags?post=17483"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}