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.
Интервью Хатькова Игоря Евгеньевича, директора МКНЦ, главного внештатного специалиста-онколога ДЗМ, д.м.н., профессора, члена-корреспондента РАН в свежем выпуске «Медицинской газеты».