Email this article Tumor downstaging and therapeutic pathomorphosis in rectal cancer patients receiving combination therapy with various polyradiomodification regimens
- Authors: Vlasov O.A.1, Barsukov Y.A.1, Tkachev S.I.1, Gordeev S.S.1, Tsaryuk V.F.1, Aliev V.A.1
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Affiliations:
- N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
- Issue: Vol 8, No 2 (2018)
- Pages: 63-72
- Section: ORIGINAL REPORTS
- Published: 12.07.2018
- URL: https://onco-surgery.info/jour/article/view/252
- DOI: https://doi.org/10.17650/2220-3478-2018-8-2-63-72
- ID: 252
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Abstract
Objective: to evaluate therapeutic pathomorphosis and Tand N-downstaging in response to various polyradiomodification regimens used in the combination therapy for rectal cancer.
Materials and methods. A total of 241 patients received combination therapy for rectal cancer using 4 different polyradiomodification regimens. We assessed therapeutic pathomorphosis and tumor downstaging in these patients. Eighty-two participants (34 %) underwent polyradiomodification with a 14-day course of capecitabine (Cap) given in a therapeutic dose (2 g/m2body surface) (Cap14 + metronidazole (MZ) and Cap14 + MZ + microwave hyperthermia (MW-HT)), whereas the remaining 159 participants (66 %) underwent polyradiomodification with a 5-day course of Cap in a radiosensitizing dose (1.5 g/m2 body surface) (Cap5 + MZ and Cap5 + MZ + MW-HT).
Results. Grade IV therapeutic pathomorphosis was observed in 19.5 % of patients treated with a 14-day course of Cap (Cap14 + MZ and Cap14 + MZ + MW-HT) and 1.3 % of patients treated with a 5-day course of Cap (Cap5 + MZ and Cap5 + MZ + MW-HT) (p = 0.00001). Patients receiving a 14-day course of Cap demonstrated T-downstaging significantly more often than those receiving a 5-day course (41.5 % compared to 9.4 % respectively, p = 0,00001). Regression of regional lymph node metastases was diagnosed in 51.1 % of patients from the Cap14 group only.
Conclusion. Our findings suggest that grade III–IV therapeutic pathomorphosis and tumor downstaging are more frequently achieved in polyradiomodification regimens with a 14-day course of Cap at a dose of 2 g/m2 (Cap14 + MZ and Cap14 + MZ + MW-HT).
About the authors
O. A. Vlasov
N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
Author for correspondence.
Email: vlasoff@mail.ru
24 Kashirskoe Shosse, Moscow Russian Federation
Yu. A. Barsukov
N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
Email: fake@neicon.ru
24 Kashirskoe Shosse, Moscow Russian Federation
S. I. Tkachev
N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
Email: fake@neicon.ru
ORCID iD: 0000-0001-8965-8172
24 Kashirskoe Shosse, Moscow Russian Federation
S. S. Gordeev
N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
Email: fake@neicon.ru
ORCID iD: 0000-0002-9303-8379
24 Kashirskoe Shosse, Moscow Russian Federation
V. F. Tsaryuk
N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
Email: fake@neicon.ru
24 Kashirskoe Shosse, Moscow Russian Federation
V. A. Aliev
N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
Email: fake@neicon.ru
24 Kashirskoe Shosse, Moscow Russian Federation
References
- Janjan N.A., Crane C., Feig B.W. et al. Improved overall survival among responders to preoperative chemoradiation for locally advanced rectal cancer. Am J Clin Oncol 2001;24(2):107–12. PMID: 11319280
- Marijnen C.A., Kapiteijn E., van de Velde C.J. et al. Acute side effects and complications after short-term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 2002;20(3):817–25. PMID: 11821466. doi: 10.1200/JCO.2002.20.3.817.
- Lim S.B., Yu C.S., Hong Y.S. et al. Failure patterns correlate with the tumor response after preoperative chemoradiotherapy for locally advanced rectal cancer. J Surg Oncol 2012;106(6):667–73. PMID: 22688948. doi: 10.1002/jso.23198.
- Rodel C., Liersch T., Becker H. et al. Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer: initial results of the German CAO/ARO/AIO-04 randomised phase 3 trial. Lancet Oncol 2012;13(7):679–87. PMID: 22627104. doi: 10.1016/S1470-2045(12)70187-0.
- Glimelius B., Tiret E., Cervantes A. et al. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013;24(Suppl 6): vi81–8. doi: 10.1093/annonc/mdt240.
- Berdov B.A. Does modern surgery for resectable rectal cancer require radiotherapy? Onkologicheskaya koloproktologiya = Colorectal Oncology 2011;(2):52–5. (In Russ.).
- Fokstuen T., Holm T., Glimelius B. Postoperative morbidity and mortality in relation to leukocyte counts and time to surgery after short-course preoperative radiotherapy for rectal cancer. Radiother Oncol 2009;93(2):293–7. PMID: 19748694. doi: 10.1016/j.radonc.2009.08.034.
- Pettersson D., Glimelius B., Iversen H. et al. Impaired postoperative leucocyte counts after preoperative radiotherapy for rectal cancer in the Stockholm III Trial. Br J Surg 2013;100(7):969–75. PMID: 23553796. doi: 10.1002/bjs.9117.
- Boyko A.V., Daryalova S.L., Demidova L.V. et al. Radiomodification in radiotherapy for malignant tumors (guidelines). Moscow, 1996. 11 p. (In Russ.).
- Yarmonenko S.P. Polyradiomodification as a new approach to increase the effectiveness of radiotherapy for cancer: radiomodifiers in radiotherapy. Obninsk, 1982. Pp. 126–127. (In Russ.).
- Lavnikova G.A., Gosh T.E., Talalaeva A.V. Histological method for quantitative assessment of radiation damage to the tumor. Meditsinskaya radiologiya = Medical Radiology 1977;(3):6–9. (In Russ.).
- Dworak O., Keilholz L., Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorect Dis 1997;12(1):19–23. PMID: 9112145.
- Pettersson D., Lorinc E., Holm T. et al. Tumor regression in the randomized Stokholm III Trial of radiotherapy regimens for rectal cancer. Br J Surg 2015;102(8):972– 8. PMID: 26095256. doi: 10.1002/bjs.9811.
- Faria S., Kopek N., Hijal T. et al. Phase II trial of short-course radiotherapy followed by delyed surgery for locoregionally advanced rectal cancer. Colorectal Dis 2014;16(2):O66–70. PMID: 24148225. doi: 10.1111/codi.12466.
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