Neoadjuvant capecitabine-based chemoradiotherapy followed by total mesorectal excision for locally advanced resectable rectal cancer

Twenty three patients with respectable clinical stages II and III cancer rectum entered the study. All patients received concurrent chemoradiotherapy [CRT] based on capecitabine orally at a dose of 825 mg/m2 twice a day throughout the concurrent radiotherapy [RT] course. A radiation dose of 45 Gy was given to the posterior part of the pelvis to include the tumor, the mesorectum, followed by a boost of 5.4 Gy limited to the tumor and corresponding mesorectum with a 2 cm margin. A total mesorectal excision [TME] surgery was performed after a rest period of 6-7 weeks from completion of the preoperative chemo-irradiation. Acute toxicities of concurrent chemo-radiotherapy were reversible and controllable. Grade 3 leucopenia was noted in one patient only. Acute cystitis, moderate grade, was developed in 3 patients. Neurological symptoms were noted in 3 patients. Bleeding during operation occurred in 8.7% of patients. One patient who showed clinical leakage failed conservative management and required surgical re-intervention. Downstaging rate for T-stage was 69.5% [16/23 patients]. This rate was higher for N-stage constituting 84.2% [16/ 19 patients as 4 patients were NO]. There was no increase in T- and/or N-stage [upstaging] recorded in this study. Complete pathological response was recorded in 2 patients only [8.7%]. Sphincter-conserving surgery was successfully performed in 2 of 7 patients who were considered for abdomino-perineal resection before chemo-irradiation [28.6%]. After a median follow up period of 24 months, overall survival rate was 90.9% [20/22]. Distant failure was higher than local recurrence [13.6% Vs 9.1% respectively]. In conclusion; preoperative concurrent capecitabine and radiotherapy is considered to be a safe procedure and well-tolerated in patients with clinical stages II and III resectable rectal cancer treated with TME surgery. Successful high rate of sphincter-sparing procedure to some patients with low cancer rectum is possible after preoperative concurrent capecitabine and radiotherapy. Preoperative concurrent capecitabine and radiotherapy may reduce recurrence and improve survival rates

Functinal and aesthetic outcome of reconstruction of large oro-facial defects involving the lip after tumor resection

Squamous cell carcinoma of the head and neck is a challenging disease to both surgeons and radiation oncologists due to proximity of many important anatomical structures. Surgery could be curative as these cancers usually metastasize very late by blood stream. This work addresses the oncologic, functional and aesthetic factors affecting reconstruction of large orofacial defects involving the lip following tumor resection. The study reviews the surgical outcome of one hundred and twelve patients with invasive tumors at, or extending to, the lip[s], treated at the Mansoura University-Surgical Oncology Department, from January 2000 to January 2005. Tumor stage were T2 [43], T3 [56] and T4 [13]. Nodal state was N0 in 80, N1 in 29 and N2 in three cases. AJCC stage grouping was II [T2N0] in 33 patients, stage III [T3N0 or T13N1] in 64 cases and stage IV [T4 due to bone erosion or N2] in 15 cases. The technique used for lip reconstruction was: Unilateral or bilateral myocutaneous depressor anguli oris flap [MCDAOF] for isolated lip defect [n=63]. Bilateral myocutaneous depressor anguli oris [MCDAOF] plus local cervical rotational flap chin defects [n=3]. Pectoralis major myocutaneous pedicled flap for cheek defects involving the lip together with a tongue flap for mucosal reconstruction [n=35]. Sternocleidomastoid clavicular myo-osseous flap for concomitant mandibular defects [n=i2]. Aesthetic and functional results are evaluated regarding appearance, oral incompetence, disabling microstomia and eating difficulties. Depressor anguli oris reconstruction allowed functioning static and dynamic oral function in all cases in contrast to the Pectorails major flap. There were 18 cases of oral incompetence [46.1%], nine cases of speech difficulty [23%] and five patients with poor cosmetic appearance within the second group. Total flap loss was not encountered, Partial flap loss affected thirteen depressor anguli oris flaps [21.3%] and six pectoral flaps [15.3%]