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1 . 2021

The frequency of achieving complete therapeutic pathomorphosis when using sandwich-therapy for locally advanced rectal cancer

Abstract

Background. Achievement of therapeutic pathomorphosis after preoperative treatment is a reliable positive prognostic factor in rectal cancer. Systemic chemotherapy in addition to chemora-diation therapy at the preoperative stage may increase the likelihood of achieving therapeutic pathomorphosis.

The aim of this work is to study the possibility of achieving a complete morphological response (pCR) when using sandwich-therapy for locally advanced rectal cancer.

Material and methods. In the period from 2013 to 2020 72 patients with T≥3 (CRM+) N0-2M0 lower- and mid-ampullar rectal cancer were included in the study using sandwich-therapy. At the first stage, 2 courses of induction polychemotherapy were carried out according to the CapOx scheme (capecitabine 2000 mg/m2 orally for 14 days and oxaliplatin 130 mg/m2 intravenously once every 3 weeks). Further, chemoradiation therapy was carried out with a total focal dose (SOD) of 50-56 isoGy while taking capecitabine 1650 mg/m2 in day orally on the days of irradiation. After completion of chemotherapy, the patients underwent 2 courses of consolidating PCT according to the CapOx scheme (capecitabine 2000 mg/m2 orally for 14 days and oxaliplatin 130 mg/m2 intravenously once every 3 weeks). The control group consisted of 72 patients who underwent neoadjuvant treatment in accordance with clinical guidelines, including a course of chemotherapy with a total focal dose of 50-56 isoGy while taking capecitabine 1650 mg/m2 in day orally on the days of irradiation. Further, chemoradiation therapy was carried out with a total focal dose of 50-56 isoGy while taking capecitabine 1650 mg/m2 in day orally on the days of irradiation. After completion of chemotherapy, the patients underwent 2 courses of consolidating PCT according to the CapOx scheme (capecitabine 2000 mg/m2 orally for 14 days and oxaliplatin 130 mg/m2 intravenously once every 3 weeks). The control group consisted of 72 patients who underwent neoadjuvant treatment in accordance with clinical guidelines, including a course of chemotherapy with a total focal dose of 50-56 isoGy while taking capecitabine 1650 mg/m2 in day orally on the days of irradiation. 

Results. In 19 (26.4%) patients from the study group and in 6 (8.3%) patients from the control group, the achievement of pCR was recorded (p=0.006). The overall complication rate was 48 (66.7%) in the study group and 37 (51.4%) in the control group (p=0.072), the frequency of grade III-IV toxicity was 8 (11.1%) and 7 (9.7%), respectively (p=0.072). Sphincter-sparing surgical interventions were performed in 52 (72.2%) and 40 (55.6%) patients in the sandwich-therapy group and in the CRT control group, respectively (p=0.037). Resection in the volume R0 was achieved in 71 (98.6%) and 72 (100%) patients, respectively (p=0.316).

Conclusion. The use of sandwich-therapy is a promising trend in the treatment of patients with locally advanced rectal cancer. The study demonstrated the possibility of increasing the achievement of complete therapeutic pathomorphosis in the tumor using an alternative to the conventional neoadjuvant treatment regimen. Further research is required for definitive conclusions.

Keywords:locally advanced rectal cancer, complex treatment, consolidation chemotherapy, induction chemotherapy, medical pathomorphosis

Funding. The study had no sponsor support.
Conflict of interests. The authors declare no conflict of interests.
For citation: Aniskin A.A., Kuzmichev D.V., Mamedli Z.Z., Gordeyev S.S., Polynovskiy A.V., Madyarov Zh.M., Lebedko M.S. The frequency of achieving complete therapeutic pathomorphosis when using sandwich-therapy for locally advanced rectal cancer. Clinical and Experimental Surgery. Petrovsky Journal. 2021; 9 (1): 45-54. DOI: https://doi.org/10.33029/2308-1198-2021-9-1-45-54 (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

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