Abstract
Objective: to analyze the outcomes of sphincter-sparing surgeries in patients with advanced distal rectal cancer depending on the therapy they receive.Materials and methods. This study included 289 patients with advanced (stage T3N0–2M0) distal rectal cancer who have undergone sphincter-sparing surgeries. Patients were divided into three groups according to their treatment scheme. In group 1, we used combination treatment that included a short course of neoadjuvant radiotherapy supplemented by 3 multidirectional radiomodifiers (local microwave hyperthermia, rectal administration of a biopolymer composition containing metronidazole, and chemotherapy with capecitabine). Patients in group 2 received combination treatment that included neoadjuvant radiotherapy alone. Treatment outcomes in patients receiving combination therapy was compared to those of patients with similar characteristics and location of rectal tumors who have undergone surgery alone in N. N. Blokhin National Medical Research Center of Oncology (group 3).Results. We observed a significant decrease in the incidence of locoregional cancer metastasis in patients from group 1 compared to those from groups 2 and 3 (0.8 % vs 7.9 % and 18.2 % respectively). Moreover, patients in group 1 demonstrated better relapse-free survival than participants in groups 2 and 3 (79.6 % vs 52.6 % and 51 % respectively). The new scheme of combination therapy developed by our team (used in group 1) did not increase the incidence of postoperative complications. The best local disease control in group 1 was achieved in patients with middle rectal cancer who have undergone sphincter-sparing surgeries: none of 81 patients developed relapses, whereas the relapse-free survival rate reached 83 % compared to 56.9 % in group 1 and 41.7 % in group 3.Conclusions. The new treatment scheme that includes neoadjuvant radiotherapy supplemented by 3 multidirectional radiomodifiers can be used as one of the options increasing efficacy of radiotherapy and, therefore, efficacy of combination treatment in patients with advanced rectal cancer who undergo sphincter-sparing surgeries.
Highlights
Objective: to analyze the outcomes of sphincter-sparing surgeries in patients with advanced distal rectal cancer depending on the therapy they receive
In group 1, we used combination treatment that included a short course of neoadjuvant radiotherapy supplemented by 3 multidirectional radiomodifiers
The best local disease control in group 1 was achieved in patients with middle rectal cancer who have undergone sphincter-sparing surgeries: none of 81 patients developed relapses, whereas the relapse-free survival rate reached 83 % compared to 56.9 % in group 1 and 41.7 % in group 3
Summary
Запущенный рак дистального отдела прямой кишки: возможности сфинктеросохраняющего лечения в условиях неоадъювантной терапии. Результаты комбинированных вариантов лечения сопоставлены с результатами лечения пациентов с аналогичными характеристиками и локализациями опухолевого процесса в прямой кишке, ранее оперированных в онкопроктологическом отделении ФГБУ «Национальный медицинский исследовательский центр онкологии им. Лучший локальный конт роль заболевания при использовании созданного варианта комбинированного лечения получен при выполнении сфинктеросохраняющих операций и локализации рака в среднеампулярном отделе прямой кишки: ни у одного из 81 пациента не выявлено рецидивов рака, а показатель безрецидивной выживаемости составил 83 % по сравнению с 56,9 % при одном комбинированном лечении и 41,7 % при хирургическом. Созданный вариант лечения на базе короткого курса неоадъювантной лучевой терапии с модуляцией эффекта облучения 3 разнонаправленными модификаторами может быть использован как один из вариантов, повышающих эффективность лучевого, а следовательно, и комбинированного метода лечения у пациентов с запущенным раком прямой кишки при выполнении сфинктеросохраняющих операций.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
