[Combined treatment of rectal cancer with moderate risk of tumor progression]. / Rezul'taty primeneniya kombinirovannogo metoda lecheniya bol'nykh rakom pryamoi kishki so srednim riskom progressirovaniya opukholevogo protsessa.

OBJECTIVE: To increase the effectiveness of combined treatment in patients with rectal cancer and moderate risk of progression based on the concept of polyradiomodification (PRM). MATERIAL AND METHODS: The study included 337 patients with rectal cancer and moderate risk of tumor progression. A short course of radiotherapy (cRT) (5x5 Gy) combined with several radiomodifiers (cRT+PRM) was performed in 147 (43.6%) patients. Other 190 (56.4%) patients underwent cRT. The following radio modifiers were used: three-time application of local microwave hyperthermia (Yacht-3 or Yacht-4 devices), two-time intrarectal delivery of a biopolymer composition with Metronidazole before the 3rd and 5th irradiation sessions and two-week oral administration of Capecitabine (Xeloda) at a daily dose of 2.0 g/m2. Surgery was performed in 4-6 weeks after radiotherapy. RESULTS: CRT+PRM program increased 5-year relapse-free survival up to 81.3% compared to 60.3% after cRT alone (p=0.0003) due to significant reduction of the incidence of cancer recurrence from 8.4% to 0.7% (p=0.0013). More effective local growth control expanded the indications for sphincter-sparing surgery. These procedures were performed in 89.1% and 70.5% of patients, respectively (p=0.00001). In the cRT+PRM group, sphincter-sparing surgery reduced incidence of cancer recurrence from 13.7% to 0.8% (p=0.0110), distant metastases - from 23.9% to 13.7% (p=0.00349). CONCLUSION: Radiomodification in neoadjuvant radiotherapy is justified in patients with moderate risk of tumor progression, improves long-term results and increases the incidence of sphincter-sparing surgery.

[Current state of the problem of treatment and prognosis of colorectal cancer].

The article presents an overview of the current state of the problem of colorectal cancer based on the features of its various clinical forms. It was shown that despite the fact that the surgical method was the leading cancer treatment for colon and rectum cancer the preference should be given to the combined and complex methods and in the treatment of squamous cell carcinoma of the anal canal, the emphasis was on conservative treatment with chemoradiation, leading to stable remission that avoided traumatic surgery in most cases. Also current data are presented on the necessity to identify circulating and disseminated tumor cells to refine prognosis and further explore ways to improve long-term results.

[Long-term results of surgery and preoperative hypoxyradiotherapy for colorectal cancer].

Combined treatment for colorectal cancer involving preoperative hypooxyradiotherapy was used to boost targeted irradiation of tumor cells. End results were significantly improved due to the decrease in the number of distant metastases even in cases of poor prognosis because of lymph node involvement.

[The long-term follow-up results of the colon cancer treatment].

Results of treatment of 298 patients with colon cancer in the absence of distant metastases were analyzed. The long-term follow-up results were obtained after up to 20 years; 10 years follow-up results were obtained in 95% of the operated patients. The survival rate was significantly dependant on the stage of the disease, i.e., on the presence of regional lymph nodes invasion. Authors conclude, that possibilities of surgical treatment in further improvement of survival rates are to certain limited and exhausted. Therefore, further workout of perioperative combined chemo- and radiotherapy of patients with colon cancer is expected to improve the results.

[Combined treatment for rectal cancer using different radiomodification means].

The paper presents an evaluation of the results of surgical and combined treatment received by 961 patients at the Center's Clinics within 28 years. The analysis was based on 3 protocols of prospective randomized study. It dealt with assessment of the end results of surgical and combined treatment for operable rectal cancer using one preoperative hyperfractonated STD of 5-25 Gy. That was combined with local microwave hyperthermia and two radio modifiers--local microwave hyperthermia+intrarectal administration of a preparation containing metronidazolum. Due to the latter factor, the rate of 3-year relapse-free survival rose considerably. Also, loco-regional and distant metastasis incidence was cut down due to superior ablasticity of surgery.

[Use of combined treatment of rectal cancer involving metastases to regional lymph nodes].

Use of combined pre- and intraoperative radiotherapy for rectal cancer involving metastases to regional lymph nodes failed to lower incidence of loco-regional recurrences or improve 5-year results, as compared with pre-operative radiotherapy alone. Besides, distant metastasis rates remained rather high (ca.30%). However, pre-operative radiotherapy plus local SHF-hyperthermia were followed by a significant drop in loco-regional recurrence incidence (to 2.3%), as compared with surgery alone and combined treatment using pre-operative hyper-fractionated-radiotherapy (TTD 25 Gy). Distant metastasis rates dropped to 25%. Also, 5-year survival increased significantly.

[Preoperative thermoradiotherapy in the combined treatment of rectal tumors is the inferior ampullar segmento]. / Predoperatsionnaia termoluchevaia terapiia v kombinirovannom lechenii raka nizhneampuliarnogo otdela priamoi kishki.

Data on the examination of 260 radically-treated patients with rectal tumors in the inferior ampullar segment are presented. 107 patients received surgery alone, another 75--preoperative radiotherapy, while still another 78--preoperative thermoradiotherapy. Combined treatment of stage III tumors significantly reduced recurrence incidence and was followed by significant increase in recurrence-free survival rates. In cases of tumor disseminated to the regional lymph nodes, recurrence-free survival was observed after preoperative thermoradiation only.

[Adjuvant radiotherapy in the combined treatment of rectal cancer]. / Ad"iuvantnaia luchevaia terapiia v kombinirovannom lechenii raka priamoi kishki.

Radiotherapy was given postoperatively to 37 out of 81 patients with metastases into the regional lymph nodes (stage C after Dukes) to prevent relapse. All the patients had undergone radical surgery. No significant decrease in relapse incidence could be achieved unless an absorbed dose of 40 Gy was received postoperatively. However, combined treatment failed to produce a significant rise in five-year survival due to deaths from distant metastases.

[An assessment of the efficacy of preoperative radio- and thermoradiotherapy in treating rectal cancer]. / Otsenka éffektivnosti predoperatsionnoi luchevoi i termoradioterapii v lechenii raka priamoi kishki.

Immediate results of combined and surgical treatment of 415 patients with stage III rectal cancer were analysed. Combined treatment including intensive preoperative irradiation and preoperative thermoradiotherapy was not associated with higher postoperative lethality as compared to surgery alone, the indexes being 1.9 +/- 0.9%, 3.8 +/- 2.6% and 2.7 +/- 1.3%. Pyoinflammatory complications developed in 40.7 +/- 3.3% and 45.6 +/- 6.8% of cases in the two combined treatment groups, respectively, and in 33.2 +/- 3.8% in the control group. In patients subjected to preoperative irradiation in combination with microwave hyperthermia, no increase in the occurrence of pyoinflammatory complications was observed, but surgical wounds took longer to heal. The rate of complications following sphincter-sparing procedures, whether used alone or in combination treatment, was similar. It is concluded that the use of combined modality treatment should not bar sphincter-sparing surgery.