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Short-term outcomes after complex treatment scheme for IV stage rectal cancer.

 Even at the end of the last century, patients with IV stage rectal cancer mainly were treated symptomatically, 80% of them underwent symptomatic operations (colostomy or bypass formation). Life expectancy for patients with isolated liver metastases without specific treatment not exceeding 1 year, for patients with synchronous metastases more then one organ - not exceeding 4,5 months. The simultaneous use of neoadjuvant chemotherapy with radiotherapy most justified for patients with resectable distant metastases.

Aim: to investigate the role of neoadjuvant chemoradiotherapy for treatment patients with disseminated rectal cancer and the ability to perform sphincter-preserve surgery after new neoadjuvant treatment scheme.

Materials and methods: neoadjuvant chemoradiotherapy underwent 75 patients with rectal cancer and synchronous distant metastases: 41 - Т3NxM1 and 34 - Т4NxM1.   In first groupe of patients (n=41) liver metastases were diagnised in 30(73,1%); lung metastases - 5(12,1%); synchronous liver and lung metastases - 4(9,6%); ovary metastases - 1(2,4%); canceromatosis - 1(2,4%). In second groupe (n=34): liver metastases were diagnised in 17(50%); lung metastases - 5(14,7%); synchronous liver and lung metastases - 5(14,7%); retroperitoneal lymph nodes - 5(14,7%); ovary metastases - 2(5,9%).

All patients with T3 primary tumor invasion underwent 3 courses of chemotherapy in FOLFOX-6 regimen with local radiotherapy 25 Gy (5 days by the 5 Gy). Patients with T4 primary tumor invasion underwent 3 courses of chemotherapy in XELOX regimen with local radiotherapy 36-40 Gy (3 times a week by the 4 Gy–21 days). After treatment gastro-intestinal toxicity 2-3 degree were detected in 17,6%, hematologic toxicity 2 degree - 10,3%, radiation rectitis - 20,5%, neurotoxicity - 13,2%, epitheliitis - 2,9%.

Results: after neoadjuvant chemoradiotherapy 60(80%) patients underwent surgical treatment, 6 patients at the present time under chemoradiotherapy, 1 patient have die of acute cardiovascular disease, 8 patients under chemotherapy (2 patients with complete  primary tumor response after treatment, 6 – with tumor progression Т4NxM1b). Low rectal resection with primary sigmo-anal anastomosis were performed in 22(36,7%) patients; abdominoperineal excision – 12(20%); rectal resection – 15(25%); Hartman’s procedure – 7(11,7%), combined resection – 10(16,7%); explorative surgery – 3 ( 1 colostomy and 2 bypass formation in patients with total canceromatosis). Sphincter-preserving operations have performed in 38(63,3%) patients, 5(8,3%) of theme with prevention colostomy formation. R0 resection performed in 27(45%) patients, 15(55,5%) of theme – simultaneously. Unfortunately, in-patient with simultaneous liver and lung metastases (M1) the cytoreductive operation couldn’t be done. The anastomosis leakage were diagnosed in 3 (8,1%) patients, bowel obstruction – 1(2,7%), pelvis abscess – 2(3,3%), postoperative bleeding – 2(8,7%), pleuritis – 1(2,7%), urological complications – 2(3,3%).

Conclusion: median follow-up was 11.5 months, overall 1-year survival in Т3NxM1 group was 85%, in group Т4NxM1- 80% respectively. After combined treatment were admitted the certain increase of 1 - year overall survival from 60 to 79% in comparison with those group of patients who firstly underwent primary tumor removal. The good tumor response after chemoradiotherapy should by the main argument for cytoreductive surgical treatment.


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