scholarly journals Neoadjuvant chemoradiotherapy in combined treatment of patients with rectal cancer

2017 ◽  
Vol 176 (4) ◽  
pp. 31-38
Author(s):  
N. A. Maistrenko ◽  
V. N. Galkin ◽  
D. V. Erygin ◽  
A. A. Sazonov
Keyword(s):  
Rectal Cancer ◽  
Geriatric Patients ◽  
Combined Treatment ◽  
Neoadjuvant Chemoradiotherapy ◽  
Young Patients ◽  
Treatment Results ◽  
Free Survival ◽  
Age Factor ◽  
Outcome Of Surgery ◽  
Made In

OBJECTIVE. The article analyzed an efficacy and safety of application of neoadjuvant chemoradiotherapy (CRT) in elderly and senile patients with rectal cancer. MATERIAL AND METHODS. An analysis of treatment results was made in 267 patients, who were divided into two groups. The first group (n = 142) underwent combined treatment that included prolonged course of neoadjuvant CRT followed by surgery. The second group of 125 patients underwent surgery without application of CRT. The patients of both groups were subdivided according their age. The subgroup “A” consisted of young and middle age patients. The subgroup “B” included geriatric patients. Comparative analysis was made between the same age subgroups. RESULTS. The age factor didn’t significantly influence on the risk of complications of neoadjuvant CRT and its adverse effects on subsequent outcome of surgery. The application of preoperative CRT in geriatric patients accompanied by less significant growth of recurrence-free survival compared with young patients. CONCLUSIONS. The age factor shouldn’t restrict the application of neoadjuvant CRT in patients with satisfactory general health status and absence of tumor complication process.

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 COMPARATIVE RESULTS OF PREOPERATIVE OIL CHEMOEMBOLIZATION OF REACTAL ARTERIES IN COMBINED TREATMENT OF RESECTABLE RECTAL CANCER

2018 ◽  
pp. 59-67
Author(s):  
A. A. Zakharchenko ◽  
A. V. Popov ◽  
Y. S. Vinnik ◽  
N. M. Markelova
Keyword(s):  
Rectal Cancer ◽  
Preoperative Radiotherapy ◽  
Combined Treatment ◽  
Disease Free Survival ◽  
Control Group ◽  
High Dose ◽  
Free Survival ◽  
Resectable Rectal Cancer ◽  
Group 2 ◽  
Comparative Results

5-year results of combined treatment of 160 patients with respectable rectal cancer (TNM: IIab - IIIa-b) are analyzed. In 40 patients (study group)) neoadjuvant (72 h before surgery), endovascular oil Chemoembolization of the Rectal Arteries (RACHEL procedure) with a Lipiodol and 5-Fluorouraci was used. The results were compared with surgical treatment (control group 1, n=40) and preoperative radiotherapy methods (control group 2: 5 х 5 Gr, up to a Total Focal Dose of 25 Grandcontrolgroup3: High Dose radiotherapy with a Single Focal Dose of 13 Gr with program Endovascular Radio modification Metronidazole, for 40 patients). The preoperative RACHEL procedure in treatment of patients with resectable rectal cancer was effective with low local recurrence (2,6%) rate, at 5-year overall (89,7%) and disease -free survival (84,6%) and can compete with known preoperative radiotherapy in combined treatment of rectal cancer.

Preoperative Concomitant Radiotherapy and Chemotherapy in Ultrasound-Staged T3 and T4 Rectal Cancer

2003 ◽  
Vol 89 (2) ◽  
pp. 152-156 ◽  
Author(s):  
Gabriele Luppi ◽  
Mario Santantonio ◽  
Federica Bertolini ◽  
Francesco Fiorica ◽  
Francesca Zanelli ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Combined Treatment ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Disease Free Survival ◽  
Venous Catheter ◽  
Invasive Adenocarcinoma ◽  
Concomitant Radiochemotherapy ◽  
Distal Rectal Cancer ◽  
Early Results

Background To analyze early results of a single institution's experience using neoadjuvant chemoradiotherapy in locally advanced, ultrasound-staged rectal cancer. Patients and methods Since 1998, 67 consecutive patients (36 males and 31 females; mean age, 59.5) have received preoperative combined treatment for T3 or T4 rectal cancer. All patients were staged by endorectal ultrasound and computed tomography, and all had a pathology-demonstrated invasive adenocarcinoma of the rectum. Patients were treated preoper-atively with concomitant radiochemotherapy: pelvic irradiation (50 Gy in 25 fractions) and protracted-venous-infusion 5-fluorouracil (225 mg/m2/d, 7 days per week). Patients were restaged within 4 weeks, then submitted to surgery within 6-7 weeks after the end of therapy. Adjuvant postoperative chemotherapy with 5-fluorouracil plus folinic acid - the “de Gramont” schedule – for 24 weeks was purposed to all patients. Results Radiotherapy was completed in all cases; only one patient required suspension of the treatment for grade 4 toxicity (diarrhea). Instead, chemotherapy was interrupted in 3 cases (2 for central venous catheter thrombosis and 1 for grade IV diarrhea). Sixty-six patients underwent surgical resection (1 patient died before surgical treatment). Radical surgery was performed in 94%, and 46% of the 26 patients with distal rectal cancer had a conservative sphincter-sparing surgery. A complete pathologic response (defined as no evidence of viable tumor cells) was obtained in 22%. At a median follow-up of 17 months, distant metastases have been observed in 10 patients, and 3 of them developed a local recurrence. The actuarial estimations of 4-year overall survival, disease-free survival, local and distant control are 79%, 61%, 94% and 61%, respectively. Conclusions Preoperative chemoradiotherapy seems to be an effective and well-tolerated treatment with a low complication rate. The high percentage of downstaging and sphincter sparing, also in distal rectal cancer, shows the efficacy of the treatment, which could significantly influence the incidence of relapses and quality of life.

scholarly journals Addition of Platinum Derivatives to Fluoropyrimidine-Based Neoadjuvant Chemoradiotherapy for Stage II/III Rectal Cancer: Systematic Review and Meta-Analysis

2019 ◽  
Vol 111 (9) ◽  
pp. 887-902 ◽  
Author(s):  
Felix J Hüttner ◽  
Pascal Probst ◽  
Eva Kalkum ◽  
Matthes Hackbusch ◽  
Katrin Jensen ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Pathological Complete Response ◽  
Meta Analysis ◽  
Neoadjuvant Chemoradiotherapy ◽  
Disease Free Survival ◽  
Complete Response ◽  
Distant Recurrence ◽  
Stage Ii ◽  
Free Survival ◽  
Disease Free

Abstract Background Current guidelines recommend neoadjuvant therapy for patients with stage II or III rectal cancer. The addition of platinum derivatives to fluoropyrimidine-based chemoradiotherapy has been frequently investigated, but their role in this setting remains controversial. Methods PubMed, Cochrane Library, and Web of Science were systematically searched for randomized trials comparing chemoradiotherapy with or without platinum agents in stage II or III rectal cancer. Main outcome parameters were overall and disease-free survival, additional outcomes included pathological complete response, isolated local recurrence, distant recurrence, toxicity, and perioperative morbidity. Time-to-event data were pooled as hazard ratios (HRs) by the inverse variance method and binary outcomes as odds ratios (ORs) by the Peto method with their respective 95% confidence interval (CI). All statistical tests were two-sided. Results Ten randomized controlled trials with data on 5599 patients were included in the meta-analysis. Platinum derivatives did not statistically significantly improve overall survival (HR = 0.93, 95% CI = 0.82 to 1.05, P = .23), disease-free survival (HR = 0.91, 95% CI = 0.83 to 1.01, P = .07), or local recurrence (OR = 0.83, 95% CI = 0.66 to 1.05, P = .12). However, it led to a statistically significant increase of pathological complete response (OR = 1.31, 95% CI = 1.10 to 1.55, P = .002) and a statistically significant reduction of distant recurrence (OR = 0.78, 95% CI = 0.66 to 0.92, P = .004). Benefits were accompanied by higher rates of grade 3 or 4 toxicities. Conclusions Intensified neoadjuvant chemoradiotherapy with the addition of platinum derivatives cannot be recommended routinely because it did not improve overall or disease-free survival and was associated with increased toxicity. It needs to be elucidated whether the benefits in distant recurrence and pathological complete response may be advantageous for selected high-risk patients.

Oncologic outcome and morbidity for elderly rectal cancer patients compared to younger patients after preoperative chemoradiotherapy and curative surgery: A multi-institutional and case-matched control study.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 736-736
Author(s):  
Soo Yoon Sung ◽  
Jong Hoon Lee ◽  
Sung Hwan Kim
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Late Complication ◽  
Pathologic Complete Response ◽  
Neoadjuvant Chemoradiotherapy ◽  
Hematologic Toxicity ◽  
Recurrence Free Survival ◽  
Curative Surgery ◽  
Free Survival ◽  
Younger Patients

736 Background: To elucidate the toxicity and survival outcome of neoadjuvant chemoradiotherapy (CRT) followed by curative total mesorectal excision (TME) in elderly rectal cancer patients compared to younger patients. Methods: A total of 1232 rectal cancer patients who received neoadjuvant CRT and curative surgery were collected from 7 tertiary institutions. After propensity-score matching, 310 patients of < 70 years for younger arm and 310 patients of ≥ 70 years for elderly arm were identified, respectively and matched with 1:1 manner. Treatment response and toxicity, surgical outcome, recurrence, and survival were assessed and compared between two arms. Results: The two younger (< 70 years) and elderly (≥ 70 years) arms were well-matched and had similar baseline characteristics. Median ages were 58 years for younger arm and 74 years for elderly arm, respectively. Pathologic complete response rates were not significantly different between younger arm and elderly arm (17.1% vs. 14.8%, P = 0.443). The 5-year recurrence-free survival (70.0% vs. 69.8%, P = 0.773) and overall survival (79.5% vs. 82.9%, P = 0.270) rates were not significantly different between two arms. Adjuvant chemotherapy after surgery was less frequently delivered to elderly arm than younger arm (69.0% vs. 83.9%, P = 0.773). Grade 3 or higher acute hematologic toxicity was observed more frequently in elderly arm than in younger arm (9.0% vs. 16.1%, P = 0.008 ), but late complication was not significantly increased in elderly arm (2.6% vs. 4.5%, P = 0.193). Conclusions: Despite an increased acute toxicity, elderly rectal cancer patients with good performance status would have equivalent tumor response and recurrence-free survival compared to younger patients.

scholarly journals Local Recurrence in Patients with Upper Third Rectum Cancer Treated with Surgery Alone Compared with Surgery Plus Chemoradiotherapy

2020 ◽  
pp. 1-6
Author(s):  
Uriel Martinez ◽  
Beatriz Mota ◽  
David Rayas ◽  
Jesús Sansón ◽  
Manuel Martínez ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Multimodal Treatment ◽  
Neoadjuvant Chemoradiotherapy ◽  
Disease Free Survival ◽  
Rectum Cancer ◽  
Historical Cohort ◽  
Free Survival ◽  
Upper Third ◽  
Disease Free

Background: Colorectal cancer is the third most common neoplasm in Mexico, rectal cancer is the 16th most common neoplasm [1]. Due to the different behavior and prognostic factors of locally advance disease, manage should be tailored by a multidisciplinary approach. In tumors that rise in the upper third rectum cancer scenario there are no studies comparing the oncological results of multimodal treatment vs surgery alone. Objective: To compare the disease-free survival in patients with upper third rectal cancer treated with surgery alone vs multimodal treatment. Material and Methods: We conducted a descriptive, retrospective, longitudinal study using an historical cohort. Analysis was based from the information in patient`s records from diagnosed with cancer of the upper third rectum from 2011 to 2016. All patients with diagnosis of upper third rectum cancer were set in to two groups according to the treatment modality recited: Surgery alone and neoadjuvant chemotherapy. The records of patients diagnosed with cancer of the upper third rectum were reviewed and divided into two groups: with and without neoadjuvant chemoradiotherapy, both treated with surgery. Results: A total of 64 patient`s record were eligible, 48 of them were treated with surgery alone and 16 with a multimodal approach. The mean age was 65.5 years in those treated with surgery and 69 in the multimodal management group. The most frequent procedure was anterior resection, 45 cases (70.3%) in the group treated with surgery and 12 cases (18.7%) in the multimodal group. A case of complete pathological response was reported after a follow up of two years. Conclusion: The data suggests that there are no statistically significant differences in the local recurrence and disease-free survival with the use of neoadjuvant chemoradiotherapy.

scholarly journals Worse treatment response to neoadjuvant chemoradiotherapy in young patients with locally advanced rectal cancer

2020 ◽  
Author(s):  
Yiyi Zhang ◽  
Liangliang Yan ◽  
Yong Wu ◽  
Meifang Xu ◽  
Xing Liu ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Young Patients ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Curve Analysis ◽  
Age Group ◽  
Decision Curve Analysis ◽  
Cd133 Expression

Abstract Background: To evaluate the impact of age on the efficacy of neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced rectal cancer (LARC).Method: LARC patients undergoing NCRT and radical surgery from 2011 to 2018 were divided into young (<40 years) and old (≥40 years) groups. Multivariate analyses were performed to identify predictive factors for pathological complete response (pCR). Predictive nomograms and decision curve analysis were used to compare the models including/excluding age groups. Immunohistochemical analysis was performed to detect CD133 expression in LARC patients.Result: A total of 901 LARC patients were analyzed. The young group was associated with poorly differentiated tumors, more metastatic lymph nodes, higher perineural invasion, and a lower tumor regression grade (P = 0.008; P < 0.001; P < 0.001; P = 0.003). Logistic regression analysis demonstrated that age <40 years (HR = 2.190, P = 0.044), tumor size (HR = 0.538, P < 0.001), pre-NCRT cN stage (HR = 0.570, P = 0.036), and post-NCRT CEA level (HR = 0.877, P = 0.001) were significantly associated with pCR. Predictive nomograms and decision curve analysis demonstrated that the predictive ability of models including the age group was superior to that of models excluding the age group. Higher CD133 expression was more common in young LARC patients.Conclusion: Young patients with LARC were associated with lower pCR rates following NCRT. The ability of the predictive model was greater when based on the age group. Young LARC patients were associated with a higher CD133+ tumor stem cell burden, which contributed to the lower pCR rates.

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