ABSTRACT
INTRODUCTION: Preoperative radiotherapy is considered to be the standard approach in the treatment of the rectal carcinoma. Acute hypoxia decreases partial pressure of oxygen in healthy tissues immediately, but in the tumor after 30 min of duration. There is a higher radioresistance of healthy tissues in this interval because of lower oxygenation compared with normooxic status and the tumor is still relatively good oxygenated. This fact theoretically enables higher doses of radiotherapy and lower adverse effects. The aim of this study was to evaluate short and long term complications after preoperative radiotherapy of rectal carcinoma in hypoxia. PATIENTS AND METHODS: Between April 1991 and October 2000, 127 patients with the rectal carcinoma were treated preoperatively with locoregional accelerated hypofractionated radiotherapy in hypoxic conditions in Masaryk Memorial Cancer Institute. The dosis was up to 8 x 4 Gy. Acute hypoxia was induced during irradiation by ventilation of a hypoxic gas mixture containing 7.8-8.0% oxygen for totally 7-8 min. Operation was performed till 24 hours. RESULTS: There was no complication concerning with breathing of hypoxic gas mixture. A 30 day postoperative mortality was 0.8%. A 30 day postoperative morbidity was 31.7%. An anastomotic leakage occurred in 6.5%. Chronic gastrointestinal disorders occurred in 16.1% patients. CONCLUSION: Preoperative irradiation in hypoxic conditions is safe and efficient procedure. It permits safe administration of doses higher than those tolerated by normooxic conditions. Type and frequency of complications are comparable with other preoperative regimens.
Subject(s)
Carcinoma/radiotherapy , Hypoxia , Rectal Neoplasms/radiotherapy , Adult , Aged , Carcinoma/surgery , Dose Fractionation, Radiation , Female , Humans , Male , Middle Aged , Postoperative Complications , Radiation Injuries , Radiotherapy Dosage , Radiotherapy, Adjuvant , Rectal Neoplasms/surgeryABSTRACT
INTRODUCTION: The aim of this study was to evaluate long term results of patients with rectal carcinoma which were irradiated in hypoxic conditions. PATIENTS AND METHODS: Of all patients which were irradiated in hypoxic conditions in Masaryk Memorial institute, 93 patients were followed up longer time than five year. RESULTS: The most common surgical procedure was resection in 60%, overall five year survival was 73.1%, systemic relapse of disease occurred in 33.3% and local recurrence rate was 13.9%. CONCLUSION: Preoperative irradiation in hypoxic conditions permits safe administration of doses higher than those tolerated by normooxic conditions, without increase of complication. Long term results are comparable with crucial trials.
Subject(s)
Hypoxia , Neoadjuvant Therapy , Radiotherapy/methods , Rectal Neoplasms/radiotherapy , Humans , Neoplasm Recurrence, Local , Rectal Neoplasms/mortality , Rectal Neoplasms/surgery , Survival RateABSTRACT
In three surgical centres in the Czech Republik three modern two-piece colostomic systems where compared which are at present available in the Czech republik, incl. an attempt to assess how they influence the quality of life of the patients. The investigation comprised 117 patients mean age 59 years-93 after colostomy, 13 with ileostomy. The investigated systems were ConvaTec Combihesive Flexible, Coloplast 2002, Hollister Guardian two-piece ostomy systems with a closed sac and inner filter. The main investigated parameters were: tolerance of the products, preference expressed by the patient, the state of the skin beneath the plaster and the index of general health (GWBI). From the investigation ensued that in the Czech Republic the system ConvaTec Combihesive proved very useful and there probably will not be a demand for a change to another system offered by distinguished producers, as such a change would not entail any advantages. It was revealed that when the ConvaTec Combihesive system is used, the skin is maintained in a good condition which has a favourable impact on the feeling of wellbeing and improves the quality of life.