Results of combined treatment with neoadjuvant chemotherapy without radiation therapy and a short-course of radiation therapy in patients with intermediate-risk rectal cancer

Lebedko, M. S.; Гордеев, С. С.; Fedyanin, Mikhail; Козлов, Н. А.; Малихов, А. Г.; Мамедли, З. З.

doi:10.33029/2308-1198-2021-9-1-29-36

Clinical and Experimental Surgery. Petrovsky journal

2021

DOI: 10.33029/2308-1198-2021-9-1-29-36

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Results of combined treatment with neoadjuvant chemotherapy without radiation therapy and a short-course of radiation therapy in patients with intermediate-risk rectal cancer

M. S. Lebedko¹,

С. С. Гордеев²,

Mikhail Fedyanin³

et al.

Abstract: Ключевые слова: рак прямой кишки, неоадъювантная химиотерапия, лучевая терапия Актуальность. Неоадъювантная химиотерапия (НАХТ) является потенциальной альтернативой химиолучевой терапии (ХЛТ) у больных раком прямой кишки промежуточного риска. Она позволяет избежать побочных действий лучевой терапии и проводить раннюю профилактику отдаленного метастазирования. Цель работы -изучить безопасность и эффективность НАХТ у больных раком прямой кишки промежуточного риска. Материал и методы. В ретроспективном исследован… Show more

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Cited by 3 publications

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Preliminary results of surgical treatment and neoadjuvant chemotherapy in upper rectal cancer

Lukmonov,

Belenkaya,

Gordeev

et al. 2024

Malignant Tumours

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Introduction: There is a lack of information on the role of neoadjuvant chemotherapy in upper rectal cancer. The aim of our research was to investigate the role of neoadjuvant chemotherapy in upper rectal cancer treatment.Materials and methods: We conducted a retrospective cohort multicenter study to analyze the medical records of patients with upper rectal cancer from 2007 to 2020 obtained from the archive of Research Institute FSBI «N. N. Blokhin Cancer Research Center» of the Ministry of Health of Russia, A. N. Ryzhikh National Medical Research Centre for Coloproctology, Stavropol regional Clinical oncological Dispensary and Kaliningrad oncological Center. All patients were divided into 2 groups: group 1 included patients who underwent neoadjuvant chemotherapy with CAPOX as the first treatment step, and group 2 included patients who underwent upfront surgery. Primary endpoint was 3‑year disease-free survival (DFS) rate. We also estimated the pathological complete response (pCR) rate, treatment toxicity, postoperative morbidity rate (Clavien – Dindo), degree of tumor regression, local recurrence rate, distant metastases rate, 3‑year overall survival (OS) and the neoadjuvant chemotherapy completion rate.Results: 118 patients were included in the neoadjuvant chemotherapy group and 103 patients — in the surgery group. Study groups were well balanced and comparable for gender, the ASA status and the tumor differentiation grade. More patients in the neoadjuvant chemotherapy group had clinically positive lymph nodes (p = 0.002). Median follow-up period was 36 months. There were no significant differences in 3‑year OS and DFS. The local recurrence rate was 3.9 % in the surgery group versus 0 % in the neoadjuvant chemotherapy group (p = 0.046). There were no significant differences between study groups in the distant metastases rate (p = 0.293). Sixteen (13.6 %) patients had a pCR after neoadjuvant chemotherapy. The neoadjuvant chemotherapy completion rate was 91.5 %. The hematological toxicity grade 3–4 was observed in 3.3 % (4 patients), the non-hematological toxicity grade 3–4 in 3.3 % (4 patients).Conclusion: NACT has an acceptable toxicity profile, does not impede oncological treatment results, and can be used in a selected group of patients for early systemic control.

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Preliminary results of surgical treatment and neoadjuvant chemotherapy in upper rectal cancer

Lukmonov,

Belenkaya,

Gordeev

et al. 2024

Malignant Tumours

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Neoadjuvant chemotherapy for treatment patients with rectal cancer with adverse prognostic factors: A review

Nevolskikh

Avdeenko²,

Belokhvostova³

et al. 2022

J. Mod. Onco.

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Rectal cancer (RC) is one of the leading tumor location in the structure of the incidence of malignant neoplasms in the Russian Federation and the world. And the standard approach to the treatment of patients with locally advanced forms of RC is preoperative chemo-radiotherapy (CRT) with delayed surgery. The use of such sort of approach in the recent decades has led to the reduction of the frequency of local recurrence up to 10% and even less. However, approximately a third of patients die of distant metastases. In this regard, one of the main tasks in the treatment of patients with locally advanced forms of RC with adverse prognostic factors is the prevention of distant metastasis formation. Early initiation of the systemic therapy before surgery is aimed at solving this issue. Conducting neoadjuvant chemotherapy (NCT) instead of CRT in RC treatment allows to avoid radiation reactions and injuries, occurring in some patients. Two-component oxaliplatin-containing regimens are the most well studied types of NCT in the treatment of patients with non-metastatic RC. In this connection, despite the differences in the treatment regimens and the number of cycles, a good tolerability of the method as well as no effect on the frequency of postoperative complications and in general a satisfactory results comparable to the effects of CRT were observed. The use of NCT in combination with targeted treatment modalities as well as three-component chemotherapy regimens are promising and encouraging treatment options for patients with RC with adverse prognostic factors.

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Neoadjuvant chemotherapy without radiation therapy for rectal cancer with negative prognosis

et al. 2022

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Aim: to assess the effectiveness of neo-CT in the FOLFOX6 regimen in patients with mid- and upper rectal cancer (RC)associated with poor prognosis. Patients and methods: fifty-two patients were included into study. All had neo-CT with subsequent surgical treat-ment between 2017 and 2021. Of them 94.2% had stage III and 5.8% had stage II. An extramural vascular invasionwas detected by MRI in 33 (63.5%) patients. The distance between the tumor and the mesorectal fascia was ≤ 2 mmin 17%. All patients had 4 cycles of neo-CT in FOLFOX6 regimen followed by surgery. Results: the compliance (≥ 4 cycles of neo-CT) was 82.7 % (n = 43). The overall toxicity rate was 35.6 %. Sphincter-saving surgery was performed in 51 (98.1 %) patients. Postoperative morbidity was 25.0 %. Final pathology revealed stage III in 29 (55.8 %) patients, stage 0 — stage II — in 22 (42.3 %). In accordance with the degree of pathomorphosis (CAP, 2019), 12 (23.1 %) patients showed a partial response. In one patient (1.9 %) no signs of residual tumor were detected. Downstaging of the T stage compared with MRI data before neo-CT was noted in 23 (44.2 %) patients, N stage — in 29 (55.8 %). With a mean follow-up of 31 (3-54) months, local recurrences were detected in 5 (9.6 %) patients, and distant metastases in 4 (7.7 %). The cumulative 3-year recurrence rate was 11.3 ± 4.8 %. The three-year overall and recurrence-free survival rate was 88.2 ± 5.8 % and 76.4 ± 7.4 %, respectively. Conclusion: the multimodal approach for RC with adverse prognostic factors using neo-CT in the FOLFOX6 regimenis well tolerated by patients, has a small toxicity and postoperative morbidity as well. It is necessary to develop newpathology criteria for tumor response to neo-CT.

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Results of combined treatment with neoadjuvant chemotherapy without radiation therapy and a short-course of radiation therapy in patients with intermediate-risk rectal cancer

Cited by 3 publications

References 12 publications

Preliminary results of surgical treatment and neoadjuvant chemotherapy in upper rectal cancer

Preliminary results of surgical treatment and neoadjuvant chemotherapy in upper rectal cancer

Neoadjuvant chemotherapy for treatment patients with rectal cancer with adverse prognostic factors: A review

Neoadjuvant chemotherapy without radiation therapy for rectal cancer with negative prognosis

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