Preoperative radiation and chemotherapy for locally advanced colorectal cancer with poor prognostic factors

«Radiation and Risk», 2017, vol. 26, No. 1, pp.60-77

DOI: 10.21870/0131-3878-2017-26-1-60-77

Authors

Berdov B.A. – Head of Dep., MD, Prof. A. Tsyb MRRC, Obninsk, Russia.
Erygin D.V. – Lead. Res., C. Sc., Med. A. Tsyb MRRC, Obninsk, Russia. Contacts: 4 Korolyov str., Obninsk, Kaluga reg., Russia, 249036. Tel.: (484) 399-32-59; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. .
Berezovskaya T.P. – Main Res., MD, Prof. A. Tsyb MRRC, Obninsk, Russia.
Titova L.N. – Physician, C. Sc., Med. A. Tsyb MRRC, Obninsk, Russia.
Karpov A.A. – Res. Assistant. A. Tsyb MRRC, Obninsk, Russia.

Abstract

The article presents immediate and delayed results of combined treatment of locally advanced colorectal cancer. 73 patients with cT3-4, cN0-2, cM0-1 locally advanced colorectal cancer were involved in the study. Before surgical operation all patients were treated with conventional fractionated radiation therapy (50 Gy) and concomitant CapOx chemotherapy. Toxic effect during combined radiation and chemotherapy were developed in 28 patients (38.3%). Complications of the grade 3 were developed in 4 (45%) patients. Surgical operation, total mesorectal excision, was performed on 70 patients (95.9%). Laparoscopic technique was used in 44 (62.9%) cases, the direct approach was used in 26 (37.1%) cases, difference in duration of operations was statistically significant (OR 2.865 [95% CI: 1.442-5.686], p=0.0039). 47 patients (67.1%) underwent sphincter-preserving operations. Post-operative complications were developed in 16 patients (22.9%). Radical R0 resection of the tumor was performed on 61 patients (87.1%), R1 resection – in 9 (12.9%) patients. Complete regression was observed in 13% of cases. Two-year survival rate in the group was 82.8±6.0%. Disease free survival of patients with yp-stage 0 and yp-stage I was 100%, the survival of patients with yp-stage III was 65.6±14.0%, statistically significant difference χ² was 5.853; р=0.016. Disease free survival after R0 resection was reliably higher than survival after R1 resection (R0 resection 84.7±6.4%, R1 resection 50.0±25.0%, р=0.041). Acceptable toxicological profile and good regression of the primary tumor were observed in patients with locally advanced colorectal cancer after preoperative radiation therapy (50 Gy) and concomitant CapOx chemotherapy. To a large extent treatment results, quality of life of cancer patients depend on the well-coordinated work of multidisciplinary team.

Key words
Сolorectal cancer, radiation therapy, chemotherapy, side effects of radiation therapy, clinical pathomorphosis, surgical treatment, anterior resection of the rectum, lower anterior resection, abdominoperineal resection, combined treatment.

References

1. Status of cancer care in Russia in 2014. Eds.: A.D. Kaprin, V.V. Starinskiy, G.V. Petrova. Moscow, Р. Hertsen MORI, 2015. 250 p. (In Russian).

2. Siegel R., Miller K., Jemal A. Cancer statistics. CA Cancer J. Clin., 2016, vol. 66, pp. 7-30.

3. Erygin D.V., Berdov B.A. Neoadjuvant chemoradiotherapy prognostically unfavorable and locally advanced rectal cancer. Onkologiya. Zhurnal imeni P.A. Gertsena – P.A. Herzen Journal of Oncology, 2013, no. 6, pp. 72-76. (In Russian).

4. Rödel C., Graeven U., Fietkau R., Hohenberger W., Hothorn T., Arnold D., Hofheinz R.D., Ghadimi M., Wolff H.A., Lang-Welzenbach M., Raab H.R., Wittekind C., Ströbel P., Staib L., Wilhelm M., Grabenbauer G.G., Hoffmanns H., Lindemann F., Schlenska-Lange A., Folprecht G., Sauer R., Liersch T.; German Rectal Cancer Study Group. Oxaliplatin added to fluorouracil-based preoperative chemoradiotherapy and postoperative chemotherapy of locally advanced rectal cancer (the German CAO/ARO/AIO-04 study): final results of the multicentre, open-label, randomised, phase 3 trial. Lancet Oncol., 2015, vol. 16, no. 8, pp. 979-989.

5. Berdov B.A., Nevolskih A.A., Neborak Y.T. Lateral resection margin as a factor in the prognosis of rectal cancer. Sibirskiy onkologicheskiy zhurnal – Siberian Journal of Oncology, 2010, no. 5, pp. 5-10. (In Russian).

6. Eriksen M., Wibe A., Haffner J., Wiig J.N.; Norwegian Rectal Cancer Group. Prognostic groups in 1,676 patients with rectal cancer treated without preoperative radiotherapy. Dis. Colon Rectum., 2007, vol. 50, no. 2, pp. 156-167.

7. Erygin D.V., Berdov B.A., Nevolskih A.A., Titova L.N., Smirnova S.G. Neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Onkologiya. Zhurnal imeni P.A. Gertsena – P.A. Herzen Journal of Oncology, 2015, vol. 4, no. 1, pp. 13-20. (In Russian).

8. Burton S., Brown G., Radcliffe A.G., Newcombe R.G. Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Br. J. Surg., 2003, vol. 90, pp. 355-364.

9. Beyond TME Collaborative. Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes. Br. J. Surg., 2013, vol. 100, no. 8, pp. E1-33.

10. Berdov B.A., Erygin D.V., Nevolskih A.A., Kurpeshev D.C., Zakurdyaeva I.G., Titovа L.N. Interdiscipli-nary approach in the treatment of cancer of the rectum. Povolzhskiy onkologicheskiy vestnik – Povolzhskiy Oncology Newsletter, 2015, no. 4, pp. 21-28. (In Russian).

11. MERCURY Study Group. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ, 2006, vol. 333, pp. 779.

12. Manceau G., Panis Y. Laparoscopic colorectal surgery: why, when, how? Updates Surg., 2016, vol. 68, no. 1, pp. 3-5.

13. Francois Y., Nemoz C.J., Baulieux J. Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer: the Lyon R90-01 ran-domized trial. J. Clin. Oncol., 1999, vol. 17, pp. 2396.

14. Huntington C.R., Boselli D., Symanowski J., Hill J.S., Crimaldi A., Salo J.C. Optimal timing of surgical resection after radiation in locally advanced rectal adenocarcinoma: an analysis of the National Cancer Database. Ann. Surg. Oncol., 2016, vol. 23, no. 3, pp. 877-887.

15. Sauer R., Becker H., Hohenberger W.; German Rectal Cancer Study Group. Preoperative versus post-operative chemoradiotherapy for rectal cancer. N. Engl. J. Med., 2004, vol. 351, pp. 1731-1740.

16. Roh M.S., Colangelo L.H., O’Connell M.J. Preoperative multimodality therapy improves disease-free sur-vival in patients with carcinoma of the rectum: NSABP R-03. J. Clin. Oncol., 2009, vol. 27, pp. 5124-5130.

Full-text article (in Russian)