How to Cite
Abstract
The objective is to study the treatment results of patients with low rectal cancer with complete tumor regression after neoadjuvant chemoradiation (CRT) and consolidating chemotherapy.
Materials and methods. The investigation involved 70 patients with adenocarcinoma of the low rectal cancer with the stage mrT2-3N0-1M0 who were treated from 2013 till 2018. All of these patients were given chemoradiation in the standard long-course fractionated radiation 2.0 Gy per day, total dose of 45 Gy and with Capecitabine in the daily dose of 825 mg / m2 in the days of radiation. If complete clinical and morphological regression of tumor was registered in 6 weeks after completion of CRT the patients were held 2 courses of consolidating chemotherapy with capecitabine in the daily dose of 3,500 mg / m2 for 14 days (the interval between chemotherapy courses was 7 days).
Results. Complete tumor regression was recorded in 22 (31.4 ± 5.5%) of 70 patients. The median follow-up was 26 months: any signs of progression weren’t detected in 20 (90.9 ± 6.1%) patients with detailed survey which was held every 3 months, and local recurrence was detected (R0) in 2 (9.1 ± 6.1%) patients in the first year of follow-up.
Conclusions. Neoadjuvant CLT and consolidating chemotherapy provide reliable local monitoring and prevention of hematogenous metastasis in patients with low rectal cancer. The preliminary results which were obtained in our research confirm the adequacy of the surviving approach after Complete tumor regression using the condition of active monitoring using a complex of clinical and instrumental methods. Final conclusions require further research.
References
Власов O.A., Барсуков Ю.А., Ткачев С.И. и др. Редукция стадии заболевания и показатели лечебного патоморфоза при различных вариантах программы полирадиомодификации в схемах комбинированного лечения больных раком прямой кишки // Онкологическая колопроктология. - 2018. - Т. 8. - № 2. - C. 63-72. - DOI: 10.17650/2220-3478-2018-8-2-63-72
Ерыгин Д.В., Бердов Б.А., Невольских A.A. и др. Неоадъювантная химиолучевая терапия местно-распространенного рака прямой кишки // Онкология. Журнал им. П.А. Герцена. - 2015. - Т. 4. - № 1. - С. 13-20. -. DOI: 10.17116/onkolog20154113-20
Карачун А.М., Синенченко Г.И., Самсонов Д.В., Алиев И.И. Полный патоморфологический ответ на неоадъювантную терапию и его роль в стратегии лечения рака прямой кишки // Онкологическая колопроктология. - 2013. - № 3. - С. 27-31. - DOI: 10.17650/2220-3478-2013-0-3-27-31
Кузьмичев Д.В., Мамедли З.З., Полыновский А.В. и др. Современные возможности применения неоадъ ювантной химиотерапии в комбинированном лечении местно-распространенного рака прямой кишки // Онкологическая колопроктология. - 2018. - Т. 8. - № 3. - С. 36-41. - DOI: 10.17650/2220-3478-2018-8-3-36-41
Расулов А.О., Мамедли З.З., Кузьмичев Д.В. и др. Органосохраняющее лечение рака прямой кишки // Онкологическая колопроктология. - 2016. - Т. 6. - № 4. - С. 13-17. - DOI: 10.17650/2220-3478-2016-6-4-13-17
Braendengen M., Tveit K.M., Berglund A. et al. Randomized phase III study comparing preoperative radiotherapy with chemoradiotherapy in nonresectable rectal cancer // J. Clin Oncol. - 2008. - Vol. 26 (22). - С. 3687-3694. - DOI: 10.1200/jco.2007.15.3858
Chen E.T., Mohiuddin M., Brodovsky H. et al. Downstaging of advanced rectal cancer following combined preoperative chemotherapy and high dose radiation // Int. J. Radiat. Oncol. Biol. Phys. - 1994. - № 30. - P. 169-175.
Ferrari L., Fichera A. Neoadjuvant chemoradiation therapy and pathological complete response in rectal cancer // Gastroenterol Rep. - 2015. - Vol. 3(4). - P 277-88. - DOI: 10.1093/gastro/gov039
Habr-Gama A., Perez R.O., Nadalin W. et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results // Ann Surg. - 2004. - Vol. 240(4). - P 711-717.
Habr-Gama A., Perez R.O., Proscurshim I. et al. Patterns of failure and survival for non-operative treatment of stage c0 distal rectal cancer following neoadjuvant chemoradiation therapy // J. Gastrointest. Surg. - 2006. - Vol.10. - P. 1319-1329.
Habr-Gama A., Gama-Rodrigues J., Sao Juliano G.P et al. Local recurrence after complete clinical response and watch and wait in rectal cancer after neoadjuvant chemoradiation: impact of salvage therapy on local disease control // Int. J. Radiat. Oncol. Biol. Phys. - 2014. - Vol. 88(4). - P 822-8. - DOI: 10.1016/j.ijrobp.2013.12.012
Perez K., Safran H., Sikov W. et al. Complete Neoadjuvant Treatment for Rectal Cancer: The Brown University Oncology Group CONTRE Study // Am J. Clin. Oncol. - 2017. - Vol. 40(3). - P 283-287. - DOI: 10.1097/COC.0000000000000149
Renehan A.G., Malcomson L., Emsley R. et al. Watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer (the OnCoRe project): a propensity-score matched cohort analysis // Lancet Oncol. - 2016. - Vol. 17(2). - P174-83. - DOI: 10.1016/S1470-2045(15)00467-2
Rödel C., Graeven U., Fietkau R. et al. German Rectal Cancer Study Group. Oxaliplatin added to fluorouracil-based preoperative chemoradiotherapy and postoperative chemotherapy of locally advanced rectal cancer (the German CAO/ARO/AIO-04 study): final results of the multicentre, open-label, randomised, phase 3 trial // Lancet Oncol. - 2015. - Vol.16(8). - P 979-989. - DOI: 10.1016/S1470-2045(15)00159
Sauer R., Liersch T., Merkel S. et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years // J. Clin Oncol. - 2012. - Vol. 30(16). - P. 1926-1933. - DOI: 10.1200/JCO.2011.40.1836
Sebag-Montefiore D., Stephens R.J., Steele R. et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial // Lancet. - 2009. - Vol. 373(9666). - P.811-820. - DOI: 10.1016/S0140-6736(09)60484-0
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
© АННМО «Вопросы онкологии», Copyright (c) 2019