scholarly journals Radiomodifiers in the combined treatment of rectal cancer patients

2021 ◽  
Vol 67 (4) ◽  
pp. 525-530
Author(s):  
Yury Barsukov ◽  
Sergey Tkachev ◽  
Zaman Mammadli ◽  
Vyacheslav Aliev ◽  
Oleg Vlasov ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Postoperative Complications ◽  
Combined Treatment ◽  
Cancer Recurrence ◽  
Distant Metastases ◽  
Polymer Composition ◽  
Short Course ◽  
Study Results ◽  
Two Component ◽  
Oncological Results

Objective. To evaluate the effectiveness of the combined method of treatment of patients with rectal cancer using several variants of polyradiomodification (CT+PRM). Material and methods. To increase the effectiveness of the «short» course of neoadjuvant radiation therapy (RT) 5×5 Gy until total focal dose Gy, the concept of polyradiomodification proposed by S. P. Yarmonenko (1982) was used [1]. Three radiomodifiers were used: local intracavitary microwave hyperthermia (MWH), Metronidazole (MZ) as part of a polymer composition for intrarectal administration, and the chemotherapy drug Capecitabine (Cap). Four variants of the PRM have been created, divided into two-component and three-component. Two-component variants were used when the MWH was not possible in the case of stenosis or localization of cancer in the upper ampullary rectum. Initially, Capecitabine was used at a daily dose of 1.5 g/m2 on 1–5 days in combination with a double administration of Metronidazole («Cap5+MZ») and surgery 3 weeks after RT, and later the dose of Capecitabine was increased to 2.0 g/m2 on 1–14 days («Cap14+MZ») with surgery 4–6 weeks after RT. With three-component versions of PRM, 3 additional sessions of MWH were used: «Cap5+MZ+MWH» and «Cap14+MZ+MWH». A total of 241 patients were included in the study. Results. The total toxicity in CT+PRM was 33.4%, and the overall rate of postoperative complications was 14.9%. The 5-year relapse-free survival (RFS) rate of 80.5% was achieved due to pronounced local control: cancer recurrence was detected only in 1 (0.4%) of 241 patients. This made it possible to perform sphincter-sparing operations (SSO) without compromising oncological results in 211 (86.7%) patients out of 241. The most pronounced therapeutic pathomorphosis in the tumor was achieved with «Cap14+MZ» and «Cap14+MZ+MWH»: pathomorphosis of the III degree was achieved in 9 (30.0%) of 30 patients with «Cap14+MZ», and in 13 (25.0%) of 52 patients with «Cap14+MZ+MWH», a complete pathomorphological response was detected in 7 (23.4%) of 30 patients with «Cap14+MZ», and in 9 (17.3%) of 52 patients with «Cap14+MZ+MWH». When reaching the III–IV degree of pathomorphosis, distant metastases were detected in 6.3% of patients, at the II degree and below — in 19.7% (p=0.01). Conclusion. When using CT+PRM, 5-year RFS rate was increased to 80.5%, and the frequency of SSO was increased to 86.7%, with a low level of postoperative complications (14.9%) and acceptable toxicity (33.4%).

scholarly journals COMBINED TREATMENT OF OPERABLE RECTAL CANCER WITH NEGATIVE PROGNOSIS FACTORS: A PROSPECTIVE STUDY

2021 ◽  
Vol 20 (4) ◽  
pp. 49-56
Author(s):  
S. O. Kochkina ◽  
S. S. Gordeyev ◽  
K. S. Petrov ◽  
Z. Z. Mammedli
Keyword(s):  
Rectal Cancer ◽  
Postoperative Complications ◽  
Neoadjuvant Chemotherapy ◽  
Prospective Study ◽  
Pathological Complete Response ◽  
Treatment Plan ◽  
Combined Treatment ◽  
Total Duration ◽  
Complete Response ◽  
Long Term Treatment

Introduction. Neoadjuvant chemotherapy (nact) is a potential alternative to chemoradiation therapy (crt) for rectal cancer and may allow early prevention of distant metastasis.Objective: to study the safety and efficacy of nact for patients with rectal cancer without damage to the mesorectal fascia.Material and methods. From 2016 to 2019, patients with cancer of the upper ampullar (сmrt2-t4an+m0, cmrt4an0m0), medium ampullar (cmrt3сn0m0, cmrt2n+m0) rectal regions were included in the pilot prospective study. All patients underwent nact according to the capox 4 scheme. Evaluation of the effect was carried out on the basis of mri of the small pelvis. In the case of regression or stabilization, surgery was performed, and in the case of progression, crt was followed by surgery. After surgery, all patients were scheduled for adjuvant chemotherapy for a total duration of 6 months. The primary endpoint was the rate of pathological complete response (mandard trg 1). Secondary endpoints included disease progression, toxicity (nci-ctc v. 5.0), postoperative complications (clavien-dindo), chemotherapy regimen, and long-term treatment outcomes.Results. 136 patients were included into the study. Of 130 (11 %) patients, who underwent only nact prior to surgery, 15 had pathological complete response. 99 patients (72.8 %) received a full course of chemotherapy for 6 months (nact + adjuvant pct). 6 (4.3 %) patients after neoadjuvant chemotherapy were treated with crt, 5 (3.67 %) of them due to local progression according to mri data, 1 (0.7 %) due to grade 3 toxicity during 1 course of pct and inability to continue chemotherapy treatment plan. Radiation therapy resulted in partial tumor regression in all patients. Systemic progression was not observed in any patient. Grade iii–iv toxicity was observed in 7 (5.1 %) patients, including bronchospasm (n=2, 1.4 %), thrombocytopenia (n=1, 0.7 %), neutropenia (n=1, 0.7 %), peripheral neuropathy (n=1, 0.7 %), cardiotoxicity (n=1, 0.7 %), diarrhea (n=1, 0.7 %). Grade v toxicity (acute myocardial infarction) was observed in 1 (0.7 %) patient. R0 resection was performed in all cases. Grade iiia postoperative complications occurred in 6 (4.4 %) patients, iiib complications in 5 (3.7 %) patients, and death due to sepsis after postoperative pneumonia in 1 (0.7 %) patient. The frequency of anastomotic leak was 3.6 % (n=5). The median follow-up was 31.4 months, the overall survival (os) and disease-free survival (dfs) rates were 94 % and 92.8 %.Conclusion. Neoadjuvant chemotherapy is a promising treatment option for rectal cancer patients with negative prognostic factors.

scholarly journals Effects of Neoadjuvant Radiotherapy on Postoperative Complications in Rectal Cancer: A Meta-Analysis

2022 ◽  
Vol 2022 ◽  
pp. 1-16
Author(s):  
Jianguo Yang ◽  
Yajun Luo ◽  
Tingting Tian ◽  
Peng Dong ◽  
Zhongxue Fu
Keyword(s):  
Rectal Cancer ◽  
Postoperative Complications ◽  
Wound Infection ◽  
Meta Analysis ◽  
Pelvic Abscess ◽  
Neoadjuvant Radiotherapy ◽  
Pooled Data ◽  
Short Course ◽  
Long Course ◽  
The Relationship

Objective. Neoadjuvant radiotherapy (nRT) is an important treatment approach for rectal cancer. The relationship, however, between nRT and postoperative complications is still controversial. Here, we conducted a meta-analysis to evaluate such concerns. Methods. The electronic literature from 1983 to 2021 was searched in PubMed, Embase, and Web of Science. Postoperative complications after nRT were included in the meta-analysis. The pooled odds ratio (OR) was calculated by the random-effects model. Statistical analysis was conducted by Review Manager 5.3 and STATA 14. Results. A total of 23,723 patients from 49 studies were included in the meta-analysis. The pooled results showed that nRT increased the risk of anastomotic leakage (AL) compared to upfront surgery (OR = 1.23; 95% CI, 1.07–1.41; p = 0.004 ). Subgroup analysis suggested that both long-course (OR = 1.20, 95% CI 1.03–1.40; p = 0.02 ) and short-course radiotherapy (OR = 1.25, 95% CI, 1.02–1.53; p = 0.04 ) increased the incidence of AL. In addition, nRT was the main risk factor for wound infection and pelvic abscess. The pooled data in randomized controlled trials, however, indicated that nRT was not associated with AL (OR = 1.01; 95% CI 0.82–1.26; p = 0.91 ). Conclusions. nRT may increase the risk of AL, wound infection, and pelvic abscess compared to upfront surgery among patients with rectal cancer.

scholarly journals Could the surgeon trust to radiotherapy help in rectal cancer?

2008 ◽  
Vol 55 (3) ◽  
pp. 55-59
Author(s):  
V. Valentini ◽  
M.A. Gambacorta ◽  
M.C. Barba
Keyword(s):  
Rectal Cancer ◽  
Local Control ◽  
Rectal Cancer Patient ◽  
Combined Treatment ◽  
Distant Metastases ◽  
Chemotherapeutic Agents ◽  
Preoperative Chemoradiation ◽  
Preoperative Radiation ◽  
Favorable Prognosis ◽  
Absolute Benefit

When the surgeon analyzes the ongoing literature on the evidence of the neoadjuvant approaches to rectal cancer finds a true paradox: from one side they seem to offer a relative less relevant contribute through the time, in fact whereas in the Swedish trial preoperative radiation yielded a significant improvement of local control and survival, after the introduction of TME the contribution of preoperative chemoradiation is relegate to local control with no or poor influence on survival, even if the absolute 5-year survival rate moved from 40% of the ?70 to 60-65% of the latest years1-3. From other side the growing evidence of an incidence of pCR approaching to 30%4, seems to identify a subset of patients with more favorable prognosis to neoadjuvant treatments5-6. Furthermore, the overall evidence that 30- 35% of rectal cancer patients treated with multimodality therapy still die from cancer namely by distant metastases in spite of the 4-8 % of absolute benefit of adjuvant 5Fu based adjuvant chemotherapy7, seems to vanish the efforts of the further optimization of the local treatments (surgery and radiotherapy) and of the ongoing modality of delivery the chemotherapeutic agents. We would like to address the main evidences from the literature and the main uncertainties that the surgeon could face to propose a combined treatment to his rectal cancer patient.

scholarly journals Metformin Combined with Local Irradiation Provokes Abscopal Effects in a Murine Rectal Cancer Model

2021 ◽  
Author(s):  
Mineyuki Tojo ◽  
Hedeyo Miyato ◽  
Koji Koinuma ◽  
Hisanaga Horie ◽  
Hidenori Tsukui ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
T Cells ◽  
Nk Cells ◽  
Lung Metastases ◽  
Combined Therapy ◽  
Combined Treatment ◽  
Locally Advanced ◽  
Distant Metastases ◽  
Cell Mediated Immunity ◽  
Abscopal Effects

Abstract BackgroundAlthough preoperative chemoradiation therapy can down-stage locally advanced rectal cancer (LARC), it has little effect on distant metastases. Metformin exerts an anti-cancer effect partly through the activation of host immunity. MethodLuM1, a highly lung metastatic subclone of colon 26, was injected subcutaneously in BALB/c mice and treated with metformin and/or local radiation (RT). Lung metastases and the primary tumor were evaluated and the phenotypes of immune cells in the spleen and lung metastases were examined with flowcytometry and immunohistochemistry.ResultsLocal RT, but not metformin, partially delayed the growth of sc tumor which was augmented with metformin. Lung metastases was unchanged in metformin or RT alone, but significantly reduce in the combined therapy. The ratios of splenic T cells tended to be low in the RT group, which were increased by the addition of metformin. IFN-gamma production of the splenic CD4(+) and CD8(+) T cells was enhanced and CD49b (+) CD335(+) activated NK cells was increased after combined treatment group. Density of NK cells infiltrating in lung metastases was increased after combination treatment. ConclusionMetformin effectively enhances local and abscopal effects of RT though the activation of cell-mediated immunity and might be clinically useful for LARC.

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