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

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.

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Intensification of neoadjuvant therapy in patients with locally advanced rectal cancer

Pelvic Surgery and Oncology ◽

10.17650/2686-9594-2021-11-2-19-28 ◽

2021 ◽

Vol 11 (2) ◽

pp. 19-28

Author(s):

Z. Z. Mamedli ◽

A. V. Polynovskiy ◽

D. V. Kuzmichev ◽

S. I. Tkachev ◽

A. A. Aniskin

Keyword(s):

Rectal Cancer ◽

Locally Advanced ◽

Pathologic Complete Response ◽

Disease Free Survival ◽

Complete Response ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Control Group ◽

Free Survival ◽

Disease Free

The aim of the study: to increase the frequency of achieving pathologic complete response and increase disease-free survival in the investigational group of patients with locally advanced rectal cancer T3(MRF+)–4N0–2M0 by developing a new strategy for neoadjuvant therapy.Materials and methods. In total, 414 patients were assigned to treatment. Control group I included 89 patients who underwent radiotherapy (RT) 52–56 Gy/26–28 fractions with concurrent capecitabine twice daily 5 days per week. Control group II included 160 patients who underwent RT 52–56 Gy/26–28 fractions with concurrent capecitabine twice daily 5 days per week and oxaliplatin once a week, during the course of RT. Study group III consisted of 165 patients. This group combined RT 52–56 Gy/26–28 fractions with concurrent capecitabine twice daily 5 days per week and additional consecutive CapOx cycles. This group was divided into 2 subgroups: subgroup IIIa included 106 patients with consolidating chemotherapy (after CRT); subgroup IIIb included 59 patients who underwent “sandwich” treatment. Therapy consisted of conducting from 1 to 2 cycles of induction CapOx (up to CRT) and from 1 to 2 cycles of consolidating CapOx with an interval of 7 days. In the interval between the courses of drug therapy, RT 52–56 Gy/26–28 fractions was performed. According to the results of the control examination, further treatment tactics were determined. The primary end points were 5-year disease-free survival and the achievement of a pathologic complete response.Results. Pathologic complete response was significantly more often recorded in patients in the investigational group III (17.48 %; p = 0.021) compared with control groups (7.95 % in the I group and 8.28 % in the II group). 5-year disease-free survival in patients in the study groups was: 71.5 % in the III group, 65.6 % in the II group and 56.9 % in the I group.Conclusion. The shift in emphasis on strengthening the neoadjuvant effect on the tumor and improving approaches to drug therapy regimens have significantly improved disease-free survival of patients with locally advanced rectal cancer.

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Ten fractions of preoperative radiotherapy for advanced rectal cancer: Is it a new protocol to follow?

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.439 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 439-439

Author(s):

J. Gu

Keyword(s):

Rectal Cancer ◽

Preoperative Radiotherapy ◽

Locally Advanced ◽

Disease Free Survival ◽

Complete Response ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Free Survival ◽

Short Course ◽

Disease Free

439 Background: This study is a retrospective analysis to investigate the efficiency of short-course preoperative radiotherapy following standardized total mesorectal excision (TME) for locally advanced rectal cancer. Methods: Clinical data of locally advanced mid-low rectal cancer who received TME in Beijing Cancer Hospital from 2001 to 2005 were collected retrospectively. Survival analysis was performed between patients who had TME following short-course preoperative radiotherapy (biological equivalent dose: 36Gy) or TME alone at the corresponding period. Results: Two hundred and sixty-three patients were eligible for analysis including 101 patients who received TME plus preoperative radiotherapy (PRT group) and 162 patients with TME alone (TME group). The occurrence of TNM downstaging in PRT group was 49.5%, including five percent who had complete response. The local reccurence rate was 4% in PRT group and 8.4% in TME group, with statistically different (p=0.04). An significant improved 5-year overall survival and disease-free survival was obtained in PRT group comparing with TME group (77.2% vs. 69.8%, p=0.04; 76.2% vs. 67.3%, p=0.03). Conclusions: Improved local control and survival benefits could be achieved by short-course preoperative radiotherapy on the basis of standardized TME for locally advanced rectal cancer. No significant financial relationships to disclose.

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Impact on overall survival and disease-free survival of adjuvant chemotherapy after neoadjuvant chemoradiotherapy for rectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e14173 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e14173-e14173

Author(s):

Rafael amaral de Castro ◽

Carlos Eduardo Paiva ◽

Rogerio Saad-Hossne ◽

Odair Carlito Michelin ◽

Cristiano de padua Souza

Keyword(s):

Rectal Cancer ◽

Overall Survival ◽

Adjuvant Chemotherapy ◽

Adjuvant Treatment ◽

Neoadjuvant Chemoradiotherapy ◽

Disease Free Survival ◽

Free Survival ◽

Group 2 ◽

Disease Free ◽

Group 1

e14173 Background: Colorectal cancer is the second most common cancer with 2,4 million people diagnosed. The rectal cancer (RC) is 27% of these cases. Neoadjuvant chemoradiotherapy (NCRT) has become standard but brought controversy in the adjuvant treatment. The objective was to assess the impact of adjuvant chemotherapy after NCRT. Methods: Between mar/96 and Oct/2010, 84 patients received NCRT, and 58 patients underwent resection of the rectum. The NCRT consisted of 5-FU 350mg/m2, D1-D5 (50% of cases) or 5-FU 425mg/m2, D1-D3 (43%) with LV 20mg/m2 bolus in the 1st and 5th week of the 25 sessions of radiotherapy in linear accelerator (total 45 - 50 Gy). When performed, Adjuvant chemotherapy (ADJC) consisted of 5-FU 425mg/m2, LV 20mg/m2, both on D1-D5 for 4 cycles. Evaluation of Overall Survival (O.S) and Disease-Free Survival (DFS) performed using Kaplan-Meier curve in SPSS version 13.0 Results: Of the 58 patients who underwent surgery, 90% were stage II, 51% occurred in the lower rectum and 66% were ECOG 1. Pathologic Complete Response (PCR) was obtained in 25.8% (15) of patients (group 1). Of these, 20% (3) received ADJC. Patients without PCR (group 2) received ADJC in 51% of the cases (22). The mean follow-up was 41 months. Both the DFS (HR: 2.594, 95% CI: 1134-5938, p = 0.024) and OS (HR: 2.615, 95% CI: 1005-6807, p = 0.0488) were higher in patients with PCR independent of the use of ADJC. On the other hand, patient treated with ADJC vs without ADJC, independent of presence of PCR, did not alter DFS (p = 0.74) or OS (p = 0.32). In PCR patients, ADJC do not interfere in the outcome (DFS, p = 0.76; SG, p = 0.73). In group 2 (patients without PCR), the subgroup with ADJC, there was a trend towards better SLD (p = 0.06) and OS (p = 0.06). Those who did not receive ADJC in group 2 had worse SLD (p = 0.011) and OS (p = 0.028) compared with group-1. Conclusions: Adjuvant treatment after NCRT did not increase OS or DFS. Patients without PRC had worse results without ADJC, compared to those with PCR. The first, probably, the subgroup of patients who benefited most from the use of ADJC. PCR improves OS and DFS regardless of ADJC, being perhaps the group that does not deserve ADJC.

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THE FEASIBILITY OF COMBINED TREATMENT OF COMPLICATED LOCALLY ADVANCED AND RECURRENT RECTAL CANCER. CASE-CONTROL STUDY

Problems in oncology ◽

10.37469/0507-3758-2019-65-2-263-271 ◽

2019 ◽

Vol 65 (2) ◽

pp. 263-271

Author(s):

Valeriy Ivanov ◽

Sergey Gordeev ◽

Zaman Mamedli ◽

Sergey Tkachev ◽

Dmitriy Kuzmichev ◽

...

Keyword(s):

Rectal Cancer ◽

Combined Treatment ◽

Locally Advanced ◽

Progression Free Survival ◽

Complete Response ◽

Recurrent Rectal Cancer ◽

Control Group ◽

Study Group ◽

Free Survival ◽

Control Study

INTRODUCTION: The goal of the study was to assess the feasibility of combined treatment in patients with a complicated course of locally advanced and recurrent colorectal cancer. METHODS: A case-control study was conducted. The study group included patients with locally advanced or recurrent rectal cancer complicated by external, rectovesical, rectovaginal fistulas and/or peritumoral abscesses received neoadjuvant chemoradiation (CRT). Patients without complications comparable to the study group by sex, age, ECOG status, cT value, and the nature of the tumor (primary/recurrent) treated with neoadjuvant CRT were selected in the control group. The primary end points of the study were CRT toxicity (NCI-CTC v.4.0) and postoperative complications (Clavien-Dindo). The secondary endpoints of the study were the pathologic complete response rate 2-year progression-free survival. RESULTS: 21 patients were included in both groups. In the study group the following complications were noted: external fistula (n = 7), rectovaginal fistula (n = 6), rectovesical fistula (n = 4), paraproctitis (n = 4), peritumoral abscess (n = 13), 16 patients (76%) required additional treatment prior the CRT: preventive colostomy (n = 14), antibacterial therapy (n = 5). Grade 3 toxicity was observed in 2 (9,52%) patients and in the study group (p = 1). Postoperative mortality was not registered in both groups. Postoperative grade III and higher complications in the study group were observed in 1 (5,2%) patient and in 3 patients (15,7) in the comtrol group (p = 0.129). 19 patients underwent surgery in each group, R0-resection was achieved in 17 patients in the study group and 19 in the control group. Pathological complete response was registered in 1 (5,2%) patient in the study group and in 4 patients in the control group (21,5%) (p = 0,14). Median progression-free survival was not achieved in both groups. CONCLUSION: the combined treatment of complicated locally advanced and recurrent rectal cancer after appropriate planning and concomitant symptomatic therapy does not increase the toxicity profile and postoperative complications rate.

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Preoperative vs postoperative radiotherapy in the management of rectal cancer: A systematic review

Radioterapi & Onkologi Indonesia ◽

10.32532/jori.v12i1.125 ◽

2021 ◽

Vol 12 (1) ◽

pp. 17-23

Author(s):

Muhammad Fauzi Siregar

Keyword(s):

Rectal Cancer ◽

Overall Survival ◽

Locoregional Recurrence ◽

Randomized Clinical Trials ◽

Preoperative Radiotherapy ◽

Postoperative Radiotherapy ◽

Disease Free Survival ◽

Free Survival ◽

Radiotherapy Group ◽

Disease Free

Purpose. The objective of this study is to review randomized clinical trials systematically that compare the outcomes of preoperative and postoperative radiotherapy in the management of rectal cancer regarding locoregional recurrance, disease free survival and overall survival.Methods. The relevant randomized clinical trials are searched via online databases such as Pubmed, Ebsco, and Proquest. RCTs publised in English between 2000 until 2020 are selected and reviewed systematically.Result. Locoregional recurrence at 5 years was statistically lower in preoperative radiotherapy group than in postoperative radiotherapy group based on two studies. Disease free survival at 5-years was statistically higher in preoprative radiotherapy group than the postoperative one based on two studies. Overall survival at 5 years was not statistically significant between two groups for each study.Conclusion. Preoperative radiotherapy is superior to postoperative radiotherapy for controlling locoregional recurrence and disease free survival, but both are equal in overall survival.

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results of neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer. Comparative efficiency of hypofractionation and classical fractionation schedules

Pelvic Surgery and Oncology ◽

10.17650/2686-9594-2020-10-2-19-27 ◽

2020 ◽

Vol 10 (2) ◽

pp. 19-27

Author(s):

A. S. Abdujapparov ◽

S. I. Tkachev ◽

V. A. Aliev ◽

D. S. Romanov ◽

J. M. Madyarov ◽

...

Keyword(s):

Rectal Cancer ◽

Locally Advanced ◽

Neoadjuvant Chemoradiotherapy ◽

Disease Free Survival ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Main Group ◽

Control Group ◽

Free Survival ◽

Disease Free

Objective: comparison of the effectiveness of the results of neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer using classical and hypofractionated schedule of radiation therapy.Materials and methods. This study is based on a retrospective analysis of a database of patients with locally advanced rectal cancer (T3C–D, positive circumferential resection margin or T4) who underwent a prolonged course of neoadjuvant chemoradiotherapy followed by surgery. The patients were divided into two groups: the first (main) group, 71 patients who received a course of chemoradiotherapy in hypofractionation schedule as part of neoadjuvant treatment (4 Gy × 40 Gy, 3 fractions per week) in combination with chemotherapy with capecitabine 1650 mg / m2 in two doses on weekdays. The second group (control group) included 79 patients who treated with long-course chemoradiotherapy in the classic fractionation mode (2 Gy × 50–58 Gy, 5 fractions per week) in combination with chemotherapy with capecitabine 1650 mg / m2 in two doses on weekdays. In the preoperative period, along with chemoradiotherapy, 4–8 courses of the systemic chemotherapy in the CapOx mode was used. The primary endpoint of this study was pathological complete response. Secondary endpoints included the seve rity of early radiation and hematological toxicity, the incidence of local recurrence, distant metastases, overall and disease-free survival. Results. The study included 150 patients. The overall frequency of acute radiation toxicity of grade III–IV was 5.6 % in the main group and 8.9 % in the control group (p = 0.658), from them hematological toxicity – 2.82 % and 7.6 %, respectively (p = 0.350), skin and pelvic organ toxicity – 2.82 % and 1.3 %, respectively (p = 0.926). Complete pathological response of III degree in the groups achieved 22.5 % and 19 %, respectively (p = 0.593), grade IV – 18.3 % and 15.2 %, respectively (p = 0.829). In the main and control groups, 4.2 % and 3.8 % of local recurrence were registered, respectively (p = 0.954; hazard ratio (HR) 1.05; 95 % confidence interval (CI) 0.21–5.22). The median time of disease-free survival was 39.4 months. The three-year disease-free survival in the main group was 73.2 % and in the control group 64.6 %, respectively (p = 0.353; HR 0.79; 95 % CI 0.42–1.35). The three-year overall survival in the main and control groups were 84.5 % and 82.3 %, respectively (p = 0.743; HR 0.87; 95 % CI 0.39–1.92). Conclusions. The hypofractionation schedule can be considered as an alternative and not inferior to the standard dose fractionation regimen in a prolonged course of neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer.

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Routine short course pre-op radiotherapy or selective post-op chemoradiotherapy for resectable rectal cancer? Preliminary results of the MRC CR07 randomised trial

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.3511 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 3511-3511 ◽

Cited By ~ 41

Author(s):

D. Sebag-Montefiore ◽

R. Steele ◽

P. Quirke ◽

R. Grieve ◽

S. Khanna ◽

...

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Anal Verge ◽

Randomised Trial ◽

Disease Free Survival ◽

Free Survival ◽

Preliminary Results ◽

Resectable Rectal Cancer ◽

Short Course ◽

Disease Free

3511 Background: Radiotherapy reduces local recurrence (LR) when combined with surgery in resectable rectal cancer. The Medical Research Council CR07 trial was designed to compare two different radiotherapy policies when combined with mesorectal excision. Methods: Patients with operable non-metastatic adenocarcinoma of the rectum were randomised to either routine pre-op short course radiotherapy [25Gy/5F] (PRE) or selective post-op chemoradiotherapy (POST) for patients with involvement of the circumferential resection margin (CRM) - [45Gy/25F + 5fluorouracil]. Results: A total of 1350 patients were randomised from 52 centres in the UK, Canada, New Zealand and South Africa between March 1998 and August 2005. Median follow-up is 3 years. Patients (73% male, median age 65 years, 79% PS0) were well balanced between the 2 arms. 595 of 674 (88%) of the pre-op group received their allocated treatment. Of the 676 patients allocated to the selective post-op chemoradiotherapy arm, 73 (11%) were CRM +ve and 51 of these (70%) received chemoradiotherapy. Post operative chemotherapy was received by 85% of patients with stage III disease. At the time of analysis 23 PRE and 61 POST patients had confirmed LR, 96 and 106 patients respectively distant metastases, and 115 and 146 respectively had died. The 3 year rates for LR (primary end point) were 4.7% and 11.1% for PRE and POST groups respectively (HR 2.47, 95% CI 1.61–3.79), for disease free survival 79.5% and 74.9% (HR 1.31, 95% CI 1.02–1.67) and for overall survival 80.8% and 78.7% (HR 1.25, 95% CI 0.98–1.59. The LR benefit in favour of PRE was consistent for tumours 0–5,5–10 and >10cm from the anal verge (HR 2.00, 2.14 and 4.97 respectively). Further subset analysis based on TNM stage and operation performed will be presented. Conclusions: These preliminary results indicate that routine short course pre-operative radiotherapy results in a signifcant reduction in local recurrence and improved disease free survival at 3 years when compared with a highly selective post operative approach. No significant financial relationships to disclose.

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