Comprehensive treatment of rectal cancer

Abstract

Introduction. Malignant neoplasms of the rectum belong to the group leading in prevalence and mortality among oncological diseases. In 2018, about 1.8 million new cases of colorectal cancer were registered in the world. 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 review of the literature based on the data of randomized studies by various authors highlighted the features of complex treatment of rectal cancer. Aim. To conduct a multicenter analysis of the results of complex treatment of rectal cancer and its effect on the frequency of recurrence and five-year survival. Results. Complete or partial clinical response of the tumor to neoadjuvant therapy is a favorable factor that correlates with an increase in the overall and recurrence-free survival of patients with locally advanced rectal cancer. Achieving such a response may allow some of the unresectable tumors to be converted into a resectable state. Preoperative chemoradiotherapy can affect both the volume of viable tumor mass in the wall of the rectum and affected lymph nodes, including causing its complete elimination. Such regression of the tumor with a decrease in the assessment of T and N categories compared to the preoperative ones is used to evaluate the clinical response. Conclusions. It was established that a prolonged course of neoadjuvant chemoradiation therapy for patients with locally advanced rectal cancer statistically significantly increases the loco-regional control indicators. In addition, tumor downstaging can lead to a complete clinical response. These situations can be observed in 10–30% of patients and can be classified as stage 0 of the disease.