Aim: In this article extramural venous invasion (EMVI) in patients with locally advanced rectal cancer (LARC) is evaluated as a risk factor of distant metastasis. Materials and methods: This study is based on experience made in proctological department of N.N. Blokhin National Medical Research Center of Oncology. Retrospective analysis was performed on a group of 230 patients with LARC with stage mrT3(CRM+)/T4N0-2M0. All patients underwent long course of chemoradiotherapy with capecetabine, then 2-4 courses of chemotherapy CapOx were conducted in induction and/or consolidation scheme. Results: There were no critical differences in the effect of EMVI (+) on the development of reccurences in comparison with the EMVI (-) group (p>0.05). Along with that EMVI(+) patients were significantly associated with distant metastasis (43 patients - 27,4%) then in EMVI(-) group (2 - 2,74%) (p<0,05). The positive mr-EMVI result was more likely to be present in patients with T4 then in T3 group (p<0,05). A positive EMVI status was 81,4% in patients with the III stage, which is significant higher than in patients with II stage - 55,7% (p<0,05). 3-year recurrent-free survival of patients with EMVI(+) was 64%, compared with the group of patients with EMVI (-) - 93%, which was a significant difference (HR 0.03; 95% CI, 0.08-0.19 p<0.001). Conclusion: The definition of extramural vascular invasion indicates a poor prognosis and could be used for treatment planning of neoadjuvant chemoradiation and adjuvant chemotherapy.

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The aim of the study: to increase the frequency of achieving pathologic complete response and increase disease-free survival in the investigational group of patients with locally advanced rectal cancer T3(MRF+)–4N0–2M0 by developing a new strategy for neoadjuvant therapy.Materials and methods. In total, 414 patients were assigned to treatment. Control group I included 89 patients who underwent radiotherapy (RT) 52–56 Gy/26–28 fractions with concurrent capecitabine twice daily 5 days per week. Control group II included 160 patients who underwent RT 52–56 Gy/26–28 fractions with concurrent capecitabine twice daily 5 days per week and oxaliplatin once a week, during the course of RT. Study group III consisted of 165 patients. This group combined RT 52–56 Gy/26–28 fractions with concurrent capecitabine twice daily 5 days per week and additional consecutive CapOx cycles. This group was divided into 2 subgroups: subgroup IIIa included 106 patients with consolidating chemotherapy (after CRT); subgroup IIIb included 59 patients who underwent “sandwich” treatment. Therapy consisted of conducting from 1 to 2 cycles of induction CapOx (up to CRT) and from 1 to 2 cycles of consolidating CapOx with an interval of 7 days. In the interval between the courses of drug therapy, RT 52–56 Gy/26–28 fractions was performed. According to the results of the control examination, further treatment tactics were determined. The primary end points were 5-year disease-free survival and the achievement of a pathologic complete response.Results. Pathologic complete response was significantly more often recorded in patients in the investigational group III (17.48 %; p = 0.021) compared with control groups (7.95 % in the I group and 8.28 % in the II group). 5-year disease-free survival in patients in the study groups was: 71.5 % in the III group, 65.6 % in the II group and 56.9 % in the I group.Conclusion. The shift in emphasis on strengthening the neoadjuvant effect on the tumor and improving approaches to drug therapy regimens have significantly improved disease-free survival of patients with locally advanced rectal cancer.

ЦЕЛЬ: разработка программы психологической реабилитации больных колоректальным раком и оценка ее эффективности. ПАЦИЕНТЫ И МЕТОДЫ: в клинико-психологическое пилотное исследование были включены 26 больных, перенесших хирургическое лечение по поводу колоректального рака. Средний возраст больных -64,6 ± 7,1 лет. Давность проведенного лечения -от 6 до 12 мес. Исследование проводилось проспективно. Больные были разделены на две группы: основная группа -12 больных, с которыми параллельно с медицинской реабилитацией индивидуально проводилась психотерапия в течение 14 дней; контрольная группа -14 больных, которые прошли только медицинскую реабилитацию и однократное консультирование психологом с целью заполнения опросника (без психотерапии). Психологическая реабилитация включала когнитивно-поведенческую психотерапию и методы биологической обратной связи. Оценка эффективности программы психологической реабилитации проводилась с помощью госпитальной шкалы тревоги и депрессии (HADS) до начала реабилитации и после ее завершения. РЕЗУЛЬТАТЫ: первичная диагностика показала, что в обеих группах у всех больных была повышена тревога до субклинического уровня: 8,6 ± 0,5 баллов -в основной группе и 8,7 ± 0,2 баллов -в контрольной. Депрессивные симптомы различной степени тяжести исходно наблюдались у большинства больных обеих групп: 83,3% и 85,7%, соответственно. После проведения психологической реабилитации снизился уровень тревоги у больных основной группы с 8,6 ± 0,5 до 7,4 ± 0,3 балла (p = 0,052). В контрольной группе уровень тревоги практически не изменился: 8,7 ± 0,2 и 8,2 ± 0,6 балла (p = 0,436). Качественный анализ результатов тестирования показал, что после курса реабилитации, включающего проведение психотерапевтических мероприятий, достоверно увеличилось количество больных в основной группе без депрессии (41,7%). В контрольной группе количество больных с депрессией снизилось менее значительно -с 85,7% до 71,4%. ЗАКЛЮЧЕНИЕ: у больных колоректальным раком в течение первого года после завершения лечения, отмечается тревожно-депрессивное состояние, что требует психологической помощи. Эффективными психологическими методами для реабилитации больных являются сочетание когнитивно-поведенческой психотерапии и метода, основанного на биологической обратной связи.

To assess the efficacy of total neoadjuvant therapy (TNT) for rectal carcinoma in comparison with conventional chemoradiotherapy (CRT). Methods: A systematic review was performed according to the PRISMA guidelines. A Bayesian network meta-analysis was done using NetMetaXL and WinBUGS. This study was registered in PROSPERO on March 3, 2022 (No. CRD-42022307867). Results: Outcomes of 2,719 patients from 10 randomized trials between 2010 and 2022 were selected. Of these 1,191 (44%) had conventional long-course CRT (50-54 Gy) and capecitabine, 506 (18%) had induction chemotherapy followed by CRT (50-54 Gy) and capecitabine (iTNT), 230 (9%) had long-course CRT (50-54 Gy) followed by consolidation chemotherapy (cTNT), and 792 (29%) undergone modified short-course radiotherapy (25 Gy) with subsequent chemotherapy (mTNT). Total pathologic complete response (pCR) was 20% in the iTNT group, 21% in the mTNT group, 22% in the cTNT group, and 12% in the CRT group. Statistically significant difference in pCR rates was detected when comparing iTNT with CRT (odds ratios [OR], 1.76; 95% credible interval [CrI], 1.06-2.8), mTNT with CRT (OR, 1.90; 95% CrI, 1.25-2.74), and cTNT with CRT groups (OR, 2.54; 95% CrI, 1.26-5.08). No differences were found in R0 resection rates. No significant difference was found in long-term outcomes. Conclusion: The early administration of systemic chemotherapy in the TNT regimen has improved short-term outcomes, though long-term results are underreported. Randomized trials with survival as the endpoint are necessary to evaluate the possible advantages of TNT modes.