Сибирский онкологический журнал (Apr 2016)

IMMEDIATE RESULTS OF RADICAL SURGERY UNDER CONDITIONS OF COMBINED MODALITY TREATMENT OF RECTAL CANCE

  • S. G. Afanasyev,
  • Zh. A. Startseva,
  • A. Yu. Dobrodeev,
  • A. S. Tarasova,
  • S. I. Savosina,
  • A. V. Usova,
  • I. S. Polezhaeva

DOI
https://doi.org/10.21294/1814-4861-2016-15-1-5-10
Journal volume & issue
Vol. 15, no. 1
pp. 5 – 10

Abstract

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The purpose of the study was to assess the immediate response to combination therapy including prolonged preoperative concurrent chemoradiotherapy with capecitabine as a radiosensitizer and local hyperthermia for patients with rectal cancer.Materials and methods. A total of 25 patients received combined modality treatment. The proportions of patients with stages II (T3–4N0 M0 ), III (T1–4N1–2M0 ) and IVa (T1–4N0–2M1 ) were 3 (12 %), 13 (52 %) and 9 (36 %), respectively. The rectal ampulla was diagnosed most frequently (68 %). The patients received preoperative radiation therapy (1.3 Gy twice daily for 5 days per week to a total dose of 54 Gy) concurrently with capecitabine (825 мg/m2 , twice a day for 5 days a week) and local hyperthermia (3 times a week, 3 hours before irradiation session, at temperatures between 42–44°С, for 45–60 minutes, to a maximum of 10 sessions).Results. Grade 1-2 radiation-induced skin reactions were observed in 3 (12 %) patients. By assessing immediate tumor response 6 months after completing radiotherapy, histologically confirmed complete regression was registered in 2 (8%) patients and partial regression in 23 (92%) patients. Rectal extirpation was performed on 8 (32%) patients and sphincter-preserving surgeries on 15 (68%) patients. Patients with complete regression were followed up. Postoperative complications were observed in 3(12%) patients. None of the patients died. No local recurrence and distant metastases were registered at the 12–18 month follow-up.Conclusion. Short-and long-term outcomes of combined modality treatment including preoperative concurrent chemoradiotherapy with capecitabine as a radiosensitizer and local hyperthermia indicate that this treatment protocol is effective and safe for patients with stage II–IVа rectal cancer. Concurrent chemoradiotherapy results in a significant tumor regression, thus extending the indications for sphincter-preserving surgery.

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