Radiotherapy in the comprehensive treatment of rectal cancer
DOI:
https://doi.org/10.12775/JEHS.2022.12.05.031Keywords
neoadjuvant chemoradiotherapy, tumor process, rectal cancer, recurrence-free survival, localregional recurrences, radiotherapyAbstract
Introduction. A favorable outcome of the treatment of patients with rectal cancer in the early stages is not a difficult task, as it is easily solved thanks to only surgical intervention. The biggest problem is the treatment of patients with late-stage (III and IV) rectal cancer. The use of radiation therapy is an integral niche in the complex treatment of rectal cancer. Complete or partial clinical response of the tumor to neoadjuvant therapy is a favorable factor that correlates with an increase in overall and recurrence-free survival of patients with rectal cancer.
Aim. To conduct an analysis of the effectiveness of radiotherapy and neoadjuvant chemoradiotherapy in the complex treatment of rectal cancer based on the results of the tumor's clinical response to the treatment.
Research results. In both groups of patients, the tumor was localized in the middle ampullary part of the rectum in 52.6% of the main group and 55.4% of the control group. In the lower ampullary section of the rectum in 22 patients of the main group (38.6%) and in 22 (39.3%) of the control group, respectively. The number of patients with tumor localization in the upper ampullary region was 5 (8.8%) and 35 (5.3%), respectively. Positive dynamics in the form of replacement of tumor tissue by fibrosis was observed in 89 (78.7%) patients in the compared groups. A complete clinical response was noted in 2 (3.5%) patients in the main group and in 1 (1.8%) in the control group. In 86 patients in the compared groups, II and III degrees of tumor regression according to TRG grading were recorded in 43 (75.4%) patients in the main group and 43 (76.8%) in the control group.
Conclusions. In both groups, the tumor was most often localized in the middle ampullary part of the rectum, 52.6% in the main group and 55.4% of the control group. Positive dynamics in the form of replacement of tumor tissue by fibrosis was observed in 89 (78.7%) patients in the compared groups. A complete clinical response was noted in 2 (3.5%) patients in the main group and in 1 (1.8%) in the control group. Unsatisfactory dynamics in the form of IV and V degrees of tumor regression according to the TRG grading were noted in 12 (21.05%) patients of the main group and in 12 (21.4%) - in the control group.
References
Bujko, K., Wyrwicz, L., Rutkowski, A., Malinowska, M., Pietrzak, L., Kryński, J., ... & Polish Colorectal Study Group. (2016). Long-course oxaliplatin-based preoperative chemoradiation versus 5× 5 Gy and consolidation chemotherapy for cT4 or fixed cT3 rectal cancer: results of a randomized phase III study. Annals of oncology, 27(5), 834-842.
Lee, S. U., Kim, D. Y., Kim, S. Y., Baek, J. Y., Chang, H. J., Kim, M. J., ... & Oh, J. H. (2013). Comparison of two preoperative chemoradiotherapy regimens for locally advanced rectal cancer: capecitabine alone versus capecitabine plus irinotecan. Radiation Oncology, 8(1), 1-7.
Jiao, D., Zhang, R., Gong, Z., Liu, F., Chen, Y., Yu, Q., ... & Jia, J. (2015). Fluorouracil-based preoperative chemoradiotherapy with or without oxaliplatin for stage II/III rectal cancer: a 3-year follow-up study. Chinese Journal of Cancer Research, 27(6), 588.
Golo, D., But-Hadzic, J., Anderluh, F., Brecelj, E., Edhemovic, I., Jeromen, A., ... & Velenik, V. (2018). Induction chemotherapy, chemoradiotherapy and consolidation chemotherapy in preoperative treatment of rectal cancer-long-term results of phase II OIGIT-01 Trial. Radiology and oncology, 52(3), 267-274.
Bahadoer, R. R., Dijkstra, E. A., van Etten, B., Marijnen, C. A., Putter, H., Kranenbarg, E. M. K., ... & Silviera, M. L. (2021). Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. The Lancet Oncology, 22(1), 29-42.
Simson, D. K., Mitra, S., Ahlawat, P., Saxena, U., Sharma, M. K., Rawat, S., ... & Tanwar, A. (2018). Prospective study of neoadjuvant chemoradiotherapy using intensity-modulated radiotherapy and 5 fluorouracil for locally advanced rectal cancer–toxicities and response assessment. Cancer Management and Research, 10, 519.
Liu, S. X., Zhou, Z. R., Chen, L. X., Yang, Y. J., Hu, Z. D., & Zhang, T. S. (2015). Short-course versus long-course preoperative radiotherapy plus delayed surgery in the treatment of rectal cancer: a meta-analysis. Asian Pacific Journal of Cancer Prevention, 16(14), 5755-5762.
Van der Valk, M. J., Hilling, D. E., Bastiaannet, E., Kranenbarg, E. M. K., Beets, G. L., Figueiredo, N. L., ... & Zimmerman, D. D. (2018). Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in the International Watch & Wait Database (IWWD): an international multicentre registry study. The Lancet, 391(10139), 2537-2545.
Patel, U. B., Brown, G., Machado, I., Santos-Cores, J., Pericay, C., Ballesteros, E., ... & Fernandez-Martos, C. (2017). MRI assessment and outcomes in patients receiving neoadjuvant chemotherapy only for primary rectal cancer: long-term results from the GEMCAD 0801 trial. Annals of Oncology, 28(2), 344-353.
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