Surgery and OncologySurgery and OncologyХирургия и онкология2949-5857Publishing House ABV Press53810.17650/2686-9594-2022-12-2-55-59LITERATURE REVIEWОБЗОР ЛИТЕРАТУРЫCurrent therapeutic approaches to locally advanced rectal cancerСовременные подходы к лечению местно-распространенного рака прямой кишкиGasanliT. V.ГасанлиТ. В.
Russian Federation

Тural Vafadarovich Gasanli

24 Kashirskoe Shosse, Moscow 115478

23 Kashirskoe Shosse, Moscow 115230

Турал Вафадарович Гасанли

115478 Москва, Каширское шоссе, 24

115230 Москва, Каширское шоссе, 23

tural.gasanli@bk.ruMamedliZ. Z.МамедлиЗ. З.
Russian Federation

24 Kashirskoe Shosse, Moscow 115478

115478 Москва, Каширское шоссе, 24

TataevI. Sh.ТатаевИ. Ш.
Russian Federation

24 Kashirskoe Shosse, Moscow 115478

115478 Москва, Каширское шоссе, 24

N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of RussiaФГБУ «Национальный медицинский исследовательский центр онкологии им. Н. Н. Блохина» Минздрава РоссииDepartment of Oncology and Palliative Medicine named after acad. A. I. Savitsky, Russian Medical Academy of Postgraduate Education, Ministry of Health of Russiaкафедра онкологии и паллиативной медицины им. акад. А. И. Савицкого ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России0506202212255590506202205062022Copyright ©; 2022, Gasanli T.V., Mamedli Z.Z., Tataev I.S.Copyright ©; 2022, Гасанли Т.В., Мамедли З.З., Татаев И.Ш.2022Gasanli T.V., Mamedli Z.Z., Tataev I.S.Гасанли Т.В., Мамедли З.З., Татаев И.Ш.https://creativecommons.org/licenses/by/4.0https://onco-surgery.info/jour/article/view/538

Surgery remains the main treatment for non-metastatic colorectal cancer. These patients undergo radical operation (when possible) or cytoreductive surgery with the excision of most tumor tissue. Neoadjuvant radiotherapy is also an important step of treatment in patients with lower and middle rectal tumors. However, randomized clinical trials indicate that combination neoadjuvant treatment that includes polychemotherapy and radiotherapy is more effective.

В настоящее время основным методом лечения неметастатического колоректального рака остается хирургический. При технической возможности выполняется радикальная операция или же проводится хирургическое вмешательство с максимальной циторедукцией, т. e. с удалением большей части опухолевых тканей. В лечении рака прямой кишки нижне- и среднеампулярной локализации существенное место занимает лучевая терапия, которая применяется в качестве неоадъювантного лечения. Однако на основании результатов рандомизированных клинических исследований можно утверждать, что более эффективен метод комбинированного неоадъювантного лечения, при котором применяется комбинация полихимиотерапии и лучевой терапии.

rectal cancerradiotherapychemotherapycombination treatmentрак прямой кишкилучевая терапияхимиотерапиякомбинированное лечениеHolm T., Cedermark B., Rutqvist L. Local recurrence of rectal adenocarcinoma after “curative” surgery with and without preoperative radiotherapy. Br J Surg 1994;81(3):452–5. DOI: 10.1002/bjs.1800810344.Wiggers T., de Vries M., Veeze-Kuypers B. Surgery for local recurrence of rectal carcinoma. Dis Colon Rectum 1996;39(3):323–8. DOI: 10.1007/BF02049476.Sidorov D.V. Role of total mesorectal excision in surgical and combination treatment for rectal cancer. Summary of thesis … of doctor of medical sciences. Moscow, 2011. 226 p. (In Russ.).Сидоров Д.В. Роль тотальной мезоректумэктомии в хирургическом и комбинированном лечении больных раком прямой кишки. Автореф. дис. … д-ра мед. наук. М., 2011. 226 с.Delaney G., Jacob S., Featherstone C., Barton M. The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidencebased clinical guidelines. Cancer 2005;104(6):1129–37. DOI: 10.1002/cncr.21324.Tang Y., Jin J., Li S. et al. The initial results for a phase III study of short-term versus long-term chemoradiation therapy in locally advanced rectal cancer (STELLAR Trial). In J Radiol Oncol Biology Physics 2016;96(2):S108, S109.Malikhov A.G. Current treatment strategy for patients with operable rectal cancer. Summary of thesis … of doctor of medical sciences. Moscow, 2015. 346 p. (In Russ.).Малихов А.Г. Современная стратегия лечения больных операбельным раком прямой кишки. Автореф. дис. … д-ра мед. наук. М., 2015. 346 с.Cammà C., Giunta M., Fiorica F. et al. Preoperative radiotherapy for resectable rectal cancer: A meta-analysis. JAMA 2000;284(8):1008–15. DOI: 10.1001/jama.284.8.1008.Swedish Rectal Cancer Trial, Cedermark B., Dahlberg M. et al. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 1997;336(14):980–7. DOI: 10.1056/NEJM199704033361402.Kapiteijn E., Marijnen C.A., Nagtegaal I.D. et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001;345(9):638–46. DOI: 10.1056/NEJMoa010580.Bujko K., Nowacki M., Nasierowska-Guttmejer A. et al. Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 2006;93(10):1215–23. DOI: 10.1002/bjs.5506.Ceelen W., Fierens K., van Nieuwenhove Y., Pattyn P. Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer: a systematic review and meta-analysis. Int J Cancer 2009;124:2966–72.Latkauskas T., Paskauskas S., Dambrauskas Z. et al. Preoperative chemoradiation vs radiation alone for stage II and III resectable rectal cancer: a meta-analysis. Colorectal Dis 2010;12(11):1075–83. DOI: 10.1111/j.1463-1318.2009.02015.x.Wang X., Zheng B., Lu X. et al. Preoperative short-course radiotherapy and long-course radiochemotherapy for locally advanced rectal cancer: Metaanalysis with trial sequential analysis of long-term survival data. PLoS One 2018;13(7):e0200142.Ma B., Gao P., Song Y. et al. Short-course radiotherapy in neoadjuvant treatment for rectal cancer: A systematic review and meta-analysis. Clin Colorectal Cancer 2018;17(14):320–30. DOI: 10.1016/j.clcc.2018.07.014.Erlandsson J., Holm T., Pettersson D. et al. Optimal fractionation of preoperative radiotherapy and timing to surgery for rectal cancer (Stockholm III): A multicentre, randomised, non-blinded, phase 3, non-inferiority trial. Lancet Oncol 2017;18(3):336–46. DOI: 10.1016/S1470-2045(17)30086-4.Sparreboom C., Wu Z., Lingsma H. et al. Short interval between preoperative shortcourse radiotherapy and operation for rectal cancer increases anastomotic leakage. J Am Coll Surg 2018;227(2):223–31.Ngan S., Burmeister B., Fisher R. et al. Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: Tans-Tasman Radiation Oncology Group Trial 01.04. J Clin Oncol 2012;30(31):3827–33. DOI: 10.1200/JCO.2012.42.9597.Bujko K., Wyrwicz L., Rutkowski A. et al. Long-course oxaliplatin-based preoperative chemoradiation versus 5 × 5 Gy and consolidation chemotherapy for cT4 or fixed cT3 rectal cancer: Results of a randomized phase III study. Ann Oncol 2016;27:834–42. DOI: 10.1093/annonc/mdw062.Ciseł B., Pietrzak L., Michalski W. et al. Long-course preoperative chemoradiation versus 5 × 5 Gy and consolidation chemotherapy for clinical T4 and fixed clinical T3 rectal cancer: Long-term results of the randomized Polish II study. Ann Oncol 2019;30:1298–303. DOI: 10.1093/annonc/mdz186.Marijnen C. OC-0429 Neoadjuvant chemoradiotherapy or 5 × 5 Gy followed by chemotherapy in rectal cancer: The RAPIDO trial. ESTRO 36 abstract book, 2017.Hospers G., Bahadoer R.R., Dijkstra E.A. et al. Short-course radiotherapy followed by chemotherapy before TME in locally advanced rectal cancer: The randomized RAPIDO trial. ASCO Meeting Library, 2020.Rombouts A.J.M., Hugen N., van Beek J.J.P. et al. Does pelvic radiation increase rectal cancer incidence? – A systematic review and meta-analysis. Cancer Treat Rev 2018;68:136–44. DOI: 10.1016/j.ctrv.2018.05.008.Ansari N., Solomon M.J., Fisher R.J. et al. Acute adverse events and postoperative complications in a randomized trial of preoperative short-course radiotherapy versus longcourse chemoradiotherapy for T3 adenocarcinoma of the rectum. Ann Surg 2017;265:882–8. DOI: 10.1097/SLA.0000000000001987.