Терморадиохимиотерапия в комбинированном лечении рака прямой кишки

Abstract

Currently, the treatment of rectal cancer requires a multidisciplinary approach. So the combined method of treatment, including chemoradiotherapy and the surgical stage, has proven itself reliably. However, the desired results that significantly increase the rates of relapse-free and metastatic survival have not yet been achieved. The use of radio modifiers makes it possible to enhance radiation exposure without increasing the total focal dose. One of the universal radio modifiers is local hyperthermia. Purpose: To develop a method of thermoradiochemotherapy in the combined treatment of distal rectal cancer and evaluate its effectiveness. Material and methods: This work is based on the analysis of the results of treatment of 141 patients with morphologically confirmed locally advanced distal rectal cancer. In accordance with the objectives of the study, all patients were divided into 2 groups. In the combined treatment of 75 patients, the first stage was performed chemoradiotherapy (CLT) in combination with local hyperthermia (LH). Local hyperthermia was not used in the treatment of 66 patients. Results: Long-term results of complex treatment of patients with an independent course of chemoradiotherapy/thermochemoradiotherapy (dynamic observation group) and after surgical treatment are presented. One – year relapse-free survival in the group with an independent course of TRHT was 96.7 %, in the CLT group – 79.3 % (p=0.024). There was a significant increase in three–year relapse-free survival – 93.3 % versus 76.7 % in the control (p=0.041). Among patients who underwent surgical treatment at the second stage, the study of one-year relapse-free survival did not reveal statistical significance. Three – year relapse-free survival in patients with TRHT compared with the CLT group was 96.2 % versus 86.0 % (p=0.038). The effectiveness of thermoradiochemotherapy in patients of this category was evaluated. The tolerability of treatment in all patients is satisfactory. Among all radiation reactions, the most frequently observed phenomena of radiation epidermitis I–II art. in the projection of irradiation fields (Table 1). Acute radiation reactions were reversible and did not have a negative effect on the subsequent stages of treatment. Treatment for all patients (n=141) was implemented in full.