ABSTRACT
The total of 296 T3-4NO-2 Federal Coloproctology Science Center colon cancer patients received treatment since 2004 to 2011, 165 patients (main group) also received treatment (pre- and postoperative irradiation, surgery, adjuvant chemotherapy) in P.A.Herzen State Clinical Research Center for Oncology. The control group (131 patients) received only surgery with adjuvant chemotherapy. Based on our results, prolonged chemoradiotherapy leads to statistically significant decrease of regional mesorectal lymph nodes metastases, the decrease is most evident in N1 stage patients group (1-3 lymph nodes metastases). However, the number of diagnosed involved lymph nodes also depends on the depth of tumor penetration and the timing between chemoradiotherapy and surgery. The most important prognostic criterion is not the state of involved lymph nodes, but their number.
Subject(s)
Chemoradiotherapy, Adjuvant , Lymph Nodes/pathology , Neoadjuvant Therapy/methods , Rectal Neoplasms/therapy , Adult , Aged , Female , Humans , Lymph Nodes/drug effects , Lymph Nodes/radiation effects , Lymphatic Metastasis/radiotherapy , Male , Middle Aged , Neoplasm Staging , Rectal Neoplasms/drug therapy , Rectal Neoplasms/pathology , Rectal Neoplasms/radiotherapy , Rectal Neoplasms/surgery , Survival Analysis , Treatment OutcomeABSTRACT
An analysis of complex treatment of 154 patients with T2-4N0-2 stage rectal cancer is presented who were given preoperative chemoradiotherapy in regimen of dynamic functioning with total focal dose 39.5 Gy (71 patients of the first group) and 47 Gy (83 patients of the second group) using 5-fluororacil and cisplatin. A multivariant analysis has demonstrated a reliably increased frequency of total and close to total regressions of rectal cancer (1-2 stage by Mandard) in the second group as compared with reduced duration of the operative intervention the 1st group (43.2% and 23.9). Frequency of postoperative complications did not have reliable difference in both groups as well as the number of sphinctersaving surgical procedures.
Subject(s)
Adenocarcinoma/secondary , Chemoradiotherapy , Dose-Response Relationship, Radiation , Neoplasm Recurrence, Local/prevention & control , Preoperative Care/methods , Rectal Neoplasms , Rectum/surgery , Adult , Aged , Colectomy , Combined Modality Therapy , Female , Humans , Male , Middle Aged , Neoplasm Grading , Neoplasm Staging , Rectal Neoplasms/pathology , Rectal Neoplasms/therapy , Rectum/pathology , Treatment OutcomeABSTRACT
Complex treatment included preoperative radiochemotherapy (fractionated TTD of 47 Gy), 5-FU 2.75-3.5 g, cisplatin 90 mg, surgery and postoperative adjuvant chemotherapy (XELOX). The radiochemotherapy/ surgery interval ranged 21-72 days (average--40; median--41.2 +/- 7.9). Patients were divided into two groups: those operated on within days 21-40 (1) and days 41-72 (2) to evaluate the impact of the interval between surgery and completion of radiochemotherapy. The intervals longer than 40 days were not followed by longer sphincter-saving operations, higher intraoperative blood loss or postoperative complication incidence, as compared with the 21-40 day interval. Besides, radiochemotherapy-related alterations in tumor tissues arising more than 40 days after exposure were more pronounced, yet unaccompanied by significantly better end results.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Neoadjuvant Therapy/methods , Rectal Neoplasms/therapy , Adult , Aged , Anal Canal/surgery , Chemotherapy, Adjuvant , Cisplatin/administration & dosage , Dose Fractionation, Radiation , Drug Administration Schedule , Female , Fluorouracil/administration & dosage , Humans , Male , Middle Aged , Neoplasm Staging , Radiotherapy, Adjuvant , Rectal Neoplasms/drug therapy , Rectal Neoplasms/pathology , Rectal Neoplasms/radiotherapy , Rectal Neoplasms/surgery , Time Factors , Treatment OutcomeABSTRACT
Despite the international experience enriched in the number of observations of combination treatment in patients with rectal cancer, many issues remain to be the subject-matter of the discussion. This also applies to the estimation of the value of tumor regression after neoadjuvant chemoradiation therapy in order to develop indications for sphincter-sparing operations depending on the site of a tumor in the organ and their impact on long-term treatment results. The authors have gained experience with combination treatment in 157 patients with rectal cancer (T2-4 N0-2 M0) receiving neoadjuvant chemoradiation therapy in a cumulative radiation dose of 39.5-47 Gy and radical surgery 4-6 weeks after radiation. The direct effect of chemoradiation therapy has been investigated using a set of studies involving ultrasonography, magnetic resonance imaging, endoscopic diagnosis, as well as the data of a postoperative morphological study of primary tumor and lymph nodes. The authors have evaluated the impact of preoperative chemoradiation therapy on the rate and degree of resorption of a primary tumor, including the depth of its invasion through the intestinal wall and exit into the cellular tissue, its localization in the organ and the distance to the anus, a difference in the preoperative estimation of stages and according to the data of pathomorphological studies of intraoperative specimens, etc. The degree of tumor resorption was comparatively analyzed with the long-term results and the rate of sphincter-sparing operations.