Vol 3, No 2 (2014)

Combination of surgical treatment and neoadjuvant chemoradiotherapy is the main treatment tactics for cT3 or cN+ rectal cancer patients. Integration of chemoradiotherapy in clinical practice reduced recurrence rate but had impact on overall survival only in patients with R0 resection. Disease progression in most rectal cancer patients occurs mainly by distant metastases development, which dictates the necessity of systemic treatment improvement. Yet till today there was no clinical evidence to support adjuvant chemotherapy after preoperative chemoradiation in rectal cancer patients. This review article focuses on prospective and retrospective data on adjuvant chemotherapy efficacy in rectal cancer patients, who received previous chemoradiation.

High-efficiency inhibitors of EGFR (panitumumab and cetuximab) in combination with chemotherapy in patients with advanced colorectal cancer is the result of the targeting special group of the patients based on studies of genes. Previously it was shown that the presence of mutation in exon 2 of KRAS gene (40 % of patients) determines the effectivity of this group of drugs. However, the search for additional indicators was continued. The result is that the presence of mutations in exons 3 and 4 of KRAS gene and in exons 2, 3 and 4 of NRAS gene also predict EGFR inhibitors efficacy. These mutations are defined in 10 % of patients. Analysis showed that the efficiency of panitumumab and cetuximab in combination with chemotherapy significantly increased in patients with wild-type KRAS and NRAS.

New prognostic factors for disseminated colorectal cancer (dCRC) are being investigated in this article.

Subjects and methods. In this study we have analyzed three clinical groups. First group – 60 patients with dCRC had not specifical therapy. Second group – 200 patients had specifical therapy, but without identification of prognostic and predictive markers. And third group – 93 patients had individual therapy which was based on prognostic and predictive markers of each patient.

Results. Definition of prognostic factors (TS, TP, DPD, Ercc-1, СОХ-2, MSI, KRAS) in patients with dCRC allowed to prescribe optimal specific therapy and improve results of treatment.

Conclusion. Investigation of prognostic markers allowed to differentiate prognostic groups among dCRC patients. Investigation of prognostic factors in patients with intermediate prognosis allows to improve treatment outcome and improve number of liver surgery.

The case report describes successful treatment of synchronous low rectal and sigmoid cancers with mini-invasive technologies. Transanal endoscopic microsurgery allowed to perform sphincter-saving treatment. Treatment tactics for described tumor localizations are discussed. This case represents individualized approach to colorectal cancer patient, use of modern technologies in oncological surgery.