Preliminary results of preoperative chemoradiotherapy with consolidating chemotherapy in patients with locally advanced rectal cancer
Preliminary results of complex treatment of patients with locally advanced rectal cancer with preoperative chemoradiotherapy (CRT) and consolidating chemotherapy (CT) are discussed in the article. The study includes 89 patients of a stage T3 (CRM +) - 4N0-2M0 of the tumor process. In group “A” there was performed preoperative CRT in an isozedosis of 56 Gy against a background of CT by capecitabine 825 mg / m2 twice daily per os with consolidating CT (2 courses of XELOX). In group “B” there was conducted a similar treatment without consolidating CT. Group “A” consisted of 49 patients, group “B” - 40 patients. In 9 (18.4%) patients of group “A” a complete clinical response was diagnosed in the follow-up survey, which was the reason for abstinence from surgical treatment and they were taken for dynamic observation. In 9 of 40 (22.5%) operated patients from group “A” there was noted a clinically significant complete morphological response in tumor (T0N0). In the control group “B” no complete clinical response was achieved in any patient. A complete morphological response in tumor was recorded in 5 of 40 (12.5%) (T0N0) operated patients. A 2-year recurrence-free survival in group “A” was 91.4%, in group B - 70.1%. Locoregional relapses, after treatment in group “A”, were not currently registered, in group “B” this indicator was 2.5%. The frequency of distant metastasis in the study groups was 2.1% and 7.5%, respectively. The average life expectancy was 13.1 months. Preliminary results confirmed strengthening of anticancer effect of consolidating CT after prolonged CRT, which was manifested in an increase in the frequency of complete clinical and morphological regression of tumor and, accordingly, an improvement of long-term results. A complete clinical response, achieved in every fifth patient, allowed refraining from a disabling operation and saved a quality of life.