scholarly journals Postradiation Regression of Locally Advanced Rectal Cancer: Two Clinical Cases

2021 ◽  
Vol 14 (3) ◽  
pp. 221-227
Author(s):  
Sergey Sergeevich Malev ◽  
Ivan Petrovich Moshurov ◽  
Dmitry Anatolievich Golovkov ◽  
Anastasia Viktorovna Tsurikova ◽  
Maxim Borisovich Bykovtsev ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Radiation Therapy ◽  
Combined Treatment ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Malignant Neoplasms ◽  
Complete Regression ◽  
Preoperative Radiation

In the Russian Federation, the incidence of malignant neoplasms is more than 50 thousand new cases per year. Since 1990 the combined treatment method is the standard in the treatment of patients with locally advanced rectal cancer. During the evolution of this method, preoperative radiation / chemo-radiation therapy has taken a strong position in the standards for treatment of rectal cancer. Currently, preoperative remote radiation therapy at a dose of 45-52Gy is included in treatment standards for rectal cancer. The main objective of neoadjuvant treatment is to achieve tumor regression. When a complete regression of the tumor is achieved, the task of choosing tactics arises - to carry out surgical treatment, or to apply expectant tactics. In the first clinical case, the patient underwent preoperative chemoradiation treatment with 40.8 Gy combined with capecitabine, after which 4 courses of consolidating chemotherapy were carried out followed by surgery. In the second case, the patient underwent neoadjuvant chemoradiation therapy with 52.5 Gy combined with capecitabine. Given the pronounced positive dynamics, 4 courses of consolidating chemotherapy were performed. After the control study, a complete tumor response to the therapy was revealed. Considering the MRI data and the pronounced positive dynamics, the decision of the multidisciplinary team was the tactics of dynamic observation of the patient.

Rectal admission of chemotherapeutic drugs in neoadjuvant treatment schemes of locally advanced rectal cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15168-e15168
Author(s):  
Luiza Korytova
Keyword(s):  
Rectal Cancer ◽  
Sodium Alginate ◽  
Combined Treatment ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Control Group ◽  
Treatment Results ◽  
Similar Treatment

e15168 Background: High incidence and steady rise of rectal cancer morbidity, unsatisfactory treatment results, amount of disabling surgery, high rate of local recurrents advocate for searching for new methods of combined treatment of locally advanced rectal cancer. Methods: We had suggested to rectally install sterile hydrogel material based on sodium alginate with incorporated 5-FU for radio modification purposes during neoadjuvant chemo radiotherapy. 39 patients with histologically confirmed diagnosis were included into our study. 19 patients received preoperative radiotherapy with summary dose of 50-56 Gy and systemic chemotherapy with fluorpirimidines and rectally admitted hydrogel material with incorporated 5-FU twice per day. Control group consisted of 20 patients who had similar treatment, excluding rectal hydrogel installations. Results: There was no increase in early radiotherapy complications noticed. Three study group patients had complete response, 16 had partial response (versus 1 CR, 15 PR, 3 stabilization and 1 progression in control group). This allowed reduction of surgical assistance volume in seven patients - sphincter-preserving operations were performed. Grade 3-4 pathomorphosis by Dworak’s scale was identified in 17 out of 19 patients (13 out of 20 in control group). Conclusions: Use of hydrogel material based on sodium alginate with incorporated 5-FU does not increase amount and intensity of radiation induced complications, allows to improve patients quality of life and treatment results.

scholarly journals Future of Radiotherapy Delivery in Rectal Cancer— European and US Approaches

2014 ◽  
Vol 10 (02) ◽  
pp. 139
Author(s):  
Jordan A Torok ◽  
Brian G Czito ◽  
Christopher G Willett ◽  
Manisha Palta ◽  
◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Radiation Therapy ◽  
Randomized Clinical Trials ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Neoadjuvant Chemoradiotherapy ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Significant Difference ◽  
Long Course

Neoadjuvant radiation therapy is integral in the management of patients with localized rectal cancer. In parts of Europe, patients with operable rectal cancer are treated with short-course radiation therapy delivered in five daily, 5 Gy fractions to a total dose of 25 Gy, followed by surgery within 1 week. In the US, the standard for locally advanced rectal cancer is neoadjuvant chemoradiotherapy. This approach is principally based on the results of the German Rectal Cancer Study Group trial evaluating preoperative compared with postoperative chemoradiation. Surgery is typically performed at 4–8 weeks following completion of long-course chemoradiotherapy, facilitating tumor downstaging, and potential sphincter sparing surgery. No significant difference in clinical outcomes has been observed between these two approaches in two randomized clinical trials; however, further follow-up of these studies and new results from ongoing trials are anticipated to further clarify the optimal neoadjuvant treatment strategy.

Future of Radiotherapy Delivery in Rectal Cancer—European and US Approaches

2015 ◽  
Vol 11 (1) ◽  
pp. 45
Author(s):  
Jordan A Torok ◽  
Brian G Czito ◽  
Christopher G Willett ◽  
Manisha Palta ◽  
◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Radiation Therapy ◽  
Randomized Clinical Trials ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Neoadjuvant Chemoradiotherapy ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Significant Difference ◽  
Long Course

Neoadjuvant radiation therapy is integral in the management of patients with localized rectal cancer. In parts of Europe, patients with operable rectal cancer are treated with short-course radiation therapy delivered in five daily, 5 Gy fractions to a total dose of 25 Gy, followed by surgery within 1 week. In the US, the standard for locally advanced rectal cancer is neoadjuvant chemoradiotherapy. This approach is principally based on the results of the German Rectal Cancer Study Group trial evaluating preoperative compared with postoperative chemoradiation. Surgery is typically performed at 4–8 weeks following completion of long-course chemoradiotherapy, facilitating tumor downstaging, and potential sphincter sparing surgery. No significant difference in clinical outcomes has been observed between these two approaches in two randomized clinical trials; however, further follow-up of these studies and new results from ongoing trials are anticipated to further clarify the optimal neoadjuvant treatment strategy.

Prognostic value of the number of retrieved lymph node and lymph node ratio in locally advanced rectal cancer after preoperative radiation therapy.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 582-582
Author(s):  
Jin-hong Park ◽  
Young Seob Shin ◽  
Eun Kyung Choi ◽  
Seung Do Ahn ◽  
Sang Min Yoon ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Radiation Therapy ◽  
Lymph Node ◽  
Prognostic Value ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Preoperative Radiation ◽  
Node Negative ◽  
Preoperative Radiation Therapy

582 Background: To assess the prognostic impact of total number of retrieved lymph node (TNN) and lymph node radio (LNR) in patients with locally advanced rectal cancer who received preoperative radiation therapy and surgery Methods: We retrospectively analyzed data from 677 patients with locally advanced rectal cancer who underwent preoperative radiation therapy followed by mesorectal excision at Asan Medical Center between October 1999 and May 2009. The median radiation dose was 50 Gy, and 674 patients (99%) underwent concurrent chemotherapy. All patients were divided into two groups according to the status of lymph node involvement. We assessed the influence of TNN on overall survival (OS) and disease-free survival (DFS) in the patients with node-negative disease (pN0, n = 490), and the prognostic value of LNR, estimated by dividing the number of positive nodes by the number of lymph nodes examined, in the patients with node-positive disease (pN1-2, n = 187). Results: The median follow-up period was 74 months.Patients with pN0 had median 12 lymph nodes examined (range, 0-38). Comparing with patients who had ≤ 8 TNN, patients with > 9 TNN had significantly higher 5-year OS (89% vs. 95%, p = 0.038) and DFS rates (81% vs. 90%, p = 0.013). Multivariate analysis showed that TNN more than 9 was significant prognostic factor for OS (p = 0.032) and DFS (p = 0.007). For patients with pN1-2, patients with low LNR (≤ 0.33, n = 144) showed significantly higher 5-year OS (33% vs. 73%, p < 0.001) and DFS rates (18% vs. 56%, p < 0.001) than high LNR group (> 0.33, n = 43). Also, low LNR was independent prognostic factor for OS (p = 0.001) and DFS (p < 0.001) in multivariate analysis. Conclusions: TNN for node-negative rectal cancer and LNR for node-positive rectal cancer are independent prognostic factors for survival outcome in patients with locally advanced rectal cancer after preoperative radiation therapy. These factors could be considered as useful prognostic indicators irrespective of current TNM staging system.

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