КОНСОЛИДИРУЮЩАЯ ХИМИОТЕРАПИЯ В РЕЖИМЕ CapOx ПОСЛЕ ХИМИОЛУЧЕВОЙ ТЕРАПИИ УЛУЧШАЕТ ВЫЖИВАЕМОСТЬ ПАЦИЕНТОВ С МЕСТНОРАСПРОСТРАНЕННЫМ РАКОМ ПРЯМОЙ КИШКИ

Abstract

Purpose: Consideration of the long-term three-year results of combined treatment of patients with locally advanced rectal cancer using preoperative chemoradiotherapy and consolidating chemotherapy. Material and methods: Patients aged >18 with histologycally verified MRI-staged low and medium T3(CRM+)‒4N0‒2M0 rectal cancer were included. In the study group patients received neoadjuvant chemoradiotherapy 52‒56 Gy in 2 Gy fractions with capecitabine 850 mg/m2 per os two times a day and followed by 4 cycles in СapOx regimen. In the control group, similar chemoradiotherapy was performed without consolidating chemotherapy. The study group consisted of 105 patients, and the control group consisted of 99 patients. The median follow-up was 42.4 months. Results: The full planned course of preoperative treatment was carried out in 201 (98.5 %) patients. Progression of the disease after the neoadjuvant therapy was not detected in any patient. A complete pathological response in the tumor was registered in 29 (15.1 %) patients, and a complete clinical response in 12 (6 %) patients. In the study and control groups, these indicators were (20 % vs. 10.3 %, p=0.04) and (9.5 % vs. 2 %, p=0.01), respectively. Local relapses in the study were registered in 18 (8.8 %) patients, and distant metastases in 53 (26 %) patients. In the study and control groups, local relapse and distant metastases developed in 4.8 % vs. 13.1 % (p=0.03) and 20 % vs. 32.3 % (p=0.04), respectively. The overall three-year survival rate in patients in the study group was 92.9 %, in the control group 79.7 % (HR 0.2, 95 % CI 0.03‒0.24, p=0.01). Three-year relapse-free survival in patients in the study group was 75.5 %, and in the control group 59.6 % (HR 0.2, 95 % CI 0.05‒0.32, p=0.01). Conclusion: Up to date, the strategy of combined neoadjuvant treatment seems to be the most promising. With a high degree of probability, this approach in the treatment of patients with locally advanced rectal cancer may become a new standard of therapy with a similar treatment algorithm.