[Combined treatment of rectal cancer with moderate risk of tumor progression].

Autor:	Barsukov YA; Blokhin National Medical Research Center of Oncology, Moscow, Russia., Tkachev SI; Blokhin National Medical Research Center of Oncology, Moscow, Russia., Mamedli ZZ; Blokhin National Medical Research Center of Oncology, Moscow, Russia., Aliev VA; Blokhin National Medical Research Center of Oncology, Moscow, Russia., Vlasov OA; Russian Scientific Center of Roentgenoradiology, Moscow, Russia., Perevoshchikov AG; Blokhin National Medical Research Center of Oncology, Moscow, Russia., Oltarzhevskaya ND; Coletex LLC, Moscow, Russia., Korovina MA; Coletex LLC, Moscow, Russia., Dudaev ZA; Blokhin National Medical Research Center of Oncology, Moscow, Russia., Ovchinnikova AI; Blokhin National Medical Research Center of Oncology, Moscow, Russia.
Jazyk:	ruština
Zdroj:	Khirurgiia [Khirurgiia (Mosk)] 2022 (12. Vyp. 2), pp. 36-43.
DOI:	10.17116/hirurgia202212236
Abstrakt:	Objective: To increase the effectiveness of combined treatment in patients with rectal cancer and moderate risk of progression based on the concept of polyradiomodification (PRM). Material and Methods: The study included 337 patients with rectal cancer and moderate risk of tumor progression. A short course of radiotherapy (cRT) (5x5 Gy) combined with several radiomodifiers (cRT+PRM) was performed in 147 (43.6%) patients. Other 190 (56.4%) patients underwent cRT. The following radio modifiers were used: three-time application of local microwave hyperthermia (Yacht-3 or Yacht-4 devices), two-time intrarectal delivery of a biopolymer composition with Metronidazole before the 3rd and 5th irradiation sessions and two-week oral administration of Capecitabine (Xeloda) at a daily dose of 2.0 g/m 2 . Surgery was performed in 4-6 weeks after radiotherapy. Results: CRT+PRM program increased 5-year relapse-free survival up to 81.3% compared to 60.3% after cRT alone ( p =0.0003) due to significant reduction of the incidence of cancer recurrence from 8.4% to 0.7% ( p =0.0013). More effective local growth control expanded the indications for sphincter-sparing surgery. These procedures were performed in 89.1% and 70.5% of patients, respectively ( p =0.00001). In the cRT+PRM group, sphincter-sparing surgery reduced incidence of cancer recurrence from 13.7% to 0.8% ( p =0.0110), distant metastases - from 23.9% to 13.7% ( p =0.00349). Conclusion: Radiomodification in neoadjuvant radiotherapy is justified in patients with moderate risk of tumor progression, improves long-term results and increases the incidence of sphincter-sparing surgery.
Databáze:	MEDLINE
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