Oncological Coloproctology (E-Journal) / Онкологическая колопроктология
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Эпидемиология и статистика рака анального канала (обзор литературы)
Get PDFIn recent decades, there has been a marked increase in the incidence of anal cancer. The main risk factors for anal cancer include human papillomavirus infection, promiscuity, homosexuality in men, positive Papanicolaou test, and smoking.За последние десятилетия отмечается рост заболеваемости раком анального канала. Анализ показал, что развитие данной формы рака в большинстве случаев определяется такими факторами, как поражение вирусом папилломы человека, значительное число половых партнеров, половые взаимоотношения (гомосексуализм у мужчин), положительные результаты влагалищных мазков по Папаниколау, курение
Новые препараты в лечении метастатического колоректального рака: обзор литературы
Get PDFThis article provides an overview of drugs for metastatic colorectal cancer that are currently being evaluated in clinical trials. We discuss possible drug combinations and outlooks of their use in different lines of therapy. In addition to VEGF and EGFR inhibitors, we describe the molecules with fundamentally new mechanisms of action that can significantly expand the list of anticancer agents and increase the number of possible lines of therapy.В статье представлен обзор препаратов для лечения метастатического колоректального рака, находящихся в фазе клинических исследований. Представлены данные о возможных комбинациях, перспективах использования в различных линиях терапии. Помимо новых вариантов ингибиторов VEGFи EGFRрассматриваются молекулы с принципиально новыми механизмами действия, которые могут значительно расширить арсенал лекарственного лечения и потенциально увеличить число возможных линий терапии
Комбинированное лечение рака прямой кишки в сочетании с программой полирадиомодификации и показатели лечебного патоморфоза
Get PDFObjective: to evaluate the long-term outcomes of combined treatment with polyradiomodification in patients with rectal cancer depending on the grade of therapeutic pathomorphosis. Materials and methods. The study included 241 patients that received combined treatment with polyradiomodification for T2–3N0–2M0 resectable rectal adenocarcinoma of varying degree of differentiation. All patients received a course of preoperative radiation therapy (5 × 5 Gy) combined with capecitabine and metronidazole (in a polymer composition at a dose of 10 g/m2 per rectum) on days 3 and 5. Some patients additionally underwent local hyperthermia. Four different polyradiomodification regimens were used. We assessed the frequency of relapses, metastases, and relapse-free survival depending on the grade of therapeutic pathomorphosis and cancer stage. Results. Median follow-up time was 48.5 months. One patient with stage III therapeutic pathomorphosis had relapse. Distant metastases were diagnosed in 35 (19.7 %) out of 178 participants with grade 0–II therapeutic pathomorphosis and 4 (6.3 %) out of 63 participants with grade III therapeutic pathomorphosis; the difference between these groups was statistically significant (p = 0.01). No metastases were observed in patients with grade IV therapeutic pathomorphosis. Among patients with T2–3N1–2M0 rectal cancer, the five-year relapse-free survival was higher in the group with grade III–IV therapeutic pathomorphosis compared to the group with grade 0–II pathomorphosis: 95.7 % versus 56.7 % (p = 0.00422). Conclusion. Our treatment strategy ensures good local disease control. Patients with grade III–IV therapeutic pathomorphosis have significantly lower frequency of relapses and metastases and better relapse-free survival
Роль антиангиогенных препаратов в лечении больных метастатическим колоректальным раком
Get PDFThis review covers the latest data on antiangiogenic agents used in patients with colorectal cancer. In this article, we describe drugs that have already been included into therapy regimens for colorectal cancer and vascular endothelial growth factor (VEGF) inhibitors that have been approved for other indications. Targeted drugs with a similar mechanism of action that are currently in clinical trials are discussed separately. VEGF-inhibitors are one of the main groups of targeted drugs for colorectal cancer with an acceptable toxicity profile, which can be used both in combination with chemotherapeutic agents and as maintenance treatment. Moreover, these drugs are not dependent on mutational status, which is a significant advantage.В статье приводится обзор современных данных литературы о применении антиангиогенных препаратов в лечении больных колоректальным раком. Рассматриваются как препараты, уже использующиеся в схемах терапии рака толстой кишки, так и ингибиторы VEGF, зарегистрированные для других показаний. Отдельно обсуждаются таргетные препараты со схожим механизмом действия, находящиеся на стадии клинических испытаний. Ингибиторы VEGF – одна из основных групп таргетных препаратов в лечении больных колоректальным раком, с приемлемым профилем токсичности, доступная к использованию как в сочетании с химиотерапией, так и в качестве поддерживающего лечения. Одним из преимуществ их использования является отсутствие зависимости от мутационного статуса пациента.
Сравнительный анализ качества жизни пациентов после лапароскопических и открытых вмешательств при раке верхне- и среднеампулярного отделов прямой кишки
Get PDFBackground. In the last decades laparoscopic technologies have been actively implemented for rectal cancer surgery, however randomized control trials have not demonstrated overt advantages of laparoscopic technique comparing to open surgery. The improvement of quality of life is expected to be one of advantages of laparoscopic approach. Objective: a prospective study of the dependence of the quality of life on the type of operative access (open or laparoscopic) in patients with rectal cancer after low anterior resection of the rectum. Materials and methods. There were 30 patients in the study: 20 of them were operated laparoscopically and 10 were underwent open surgery. The current versions of the general questionnaire EORTC QLQ-C30 and the special module for patients with colorectal cancer EORTC QLQ-CR29 were used in the study, that were filled on the day before the surgery and also on days 3, 7 and 60 after the surgery. Results. In the first 7 days after laparoscopic operations patients had less frequent dysuric dysfunctions (p = 0.047), less pain syndrome (p = 0.0005) and flatulence (p = 0.007) comparing to open operations. At 60 days after surgery patients that were operated laparoscopically were satisfied by their appearance more often (p = 0.047) than patients after open surgery, more rarely had anxiety (p = 0.007) and discomfort in the area of postoperative wounds (p = 0.079). Conclusion. It has been proven that laparoscopic surgery of rectal cancer evidently improves quality of life in postoperative period
Влияние гиперэкспрессии топоизомеразы IIα в ткани первичной опухоли толстой кишки на прогноз у больных метастатическим колоректальным раком
Get PDFBackground. The evaluation of clinical and morphological characteristics is not sufficient to predict the prognosis of metastatic colorectal cancer (mRCC). Tumor aggressiveness may vary significantly even in patients with similar clinical and morphological disease characteristics. These differences are believed to be associated with molecular tumor characteristics and can be used as additional prognostic factors for patient survival.Objective: to evaluate the effect of topoisomerase IIα overexpression (topoIIα) in primary colon tumor on the mRCC prognosis.Materials and methods. The study cohort included patients with mRCC that have not previously received treatment for disseminated disease. All participants had a morphologically verified diagnosis of colon adenocarcinoma and received first-line chemotherapy with oxaliplatin and capecitabine. We evaluated both short-term and long-term treatment outcomes. We also assessed the expression of topoIIα in primary colon tumors (biopsy/surgical specimens obtained prior to initiation of first-line treatment) using immunohistochemical methods. We aimed to evaluate the association between the level of topoIIα expression and short-term/long-term treatment outcomes. We analyzed the impact of topoIIα expression in the primary tumor on the efficacy of first-line chemotherapy, progression-free survival (PFS) and overall survival (OS) in patients with mRCC.Results. Immunohistochemical evaluation of topoIIα expression in the primary tumor was conducted for 39 patients with mRCC. We found no correlation between topoIIα expression and PFS, i.e. median PFS did not differ significantly between patients with topoIIα-positive and topoIIα-negative tumors (p >0.05). Individuals with low levels of topoIIα expression in the primary tumor and those with topoIIα-negative cancer demonstrated significantly higher OS than patients with topoIIα overexpression (median OS 16.30 ± 2.0 months; 95 % confidence interval 12.32–20.28 vs 7.7 ± 4.98 months; 95 % confidence interval 0.00–17.46; p = 0.007).Conclusion. Overexpression of topoIIα is a factor of poor prognosis associated with poorer OS in patients with mRCC that received first-line chemotherapy with oxaliplatin and capecitabine.Введение. Использование клинико-морфологических характеристик недостаточно для прогнозирования заболевания у больных метастатическим колоректальным раком (мКРР). Агрессивность опухолевого процесса может значительно различаться у пациентов со сходными клиническими и морфологическими признаками заболевания. Предполагается, что эти различия обусловлены молекулярно-биологическими особенностями опухолей и являются дополнительными факторами, прогнозирующими выживаемость больных.Цель исследования – изучить влияние гиперэкспрессии топоизомеразы IIα (topoIIα) в ткани первичной опухоли толстой кишки на прогноз у больных мКРР.Материалы и методы. В исследование включали пациентов с мКРР, ранее не получавших лекарственного лечения по поводу диссеминированной болезни, с морфологически верифицированным диагнозом аденокарциномы толстой кишки и получивших в рамках настоящего исследования в качестве 1-й линии лекарственного лечения двухкомпонентный режим химиотерапии на основе оксалиплатина и капецитабина. Проводили оценку непосредственных и отдаленных результатов лечения. Иммуногистохимическим методом в ткани первичной опухоли толстой кишки (в биопсийном / операционном материале), полученной до начала 1-й линии лекарственной терапии, оценивали уровень экспрессии молекулярно-биологического маркера – topoIIα. Полученные данные по экспрессии topoIIα сопоставляли с непосредственными и отдаленными результатами лечения. Проводили анализ влияния экспрессии topoIIα в ткани первичной опухоли на непосредственную клиническую эффективность 1-й линии химиотерапии, выживаемость без прогрессирования и общую выживаемость (ОВ) больных мКРР.Результаты. У 39 больных мКРР иммуногистохимическим методом проведен анализ экспрессии topoIIα в ткани первичной опухоли. Статистически достоверной взаимосвязи между экспрессией topoIIα в опухоли и выживаемостью без прогрессирования не получено, т. е. медиана последней достоверно не различалась у больных, положительных и отрицательных по topoIIα (p >0,05). При оценке влияния экспрессии topoIIα на ОВ обнаружено статистически достоверное увеличение ОВ в группе пациентов с низкой экспрессией или отсутствием экспрессии topoIIα в опухоли (медиана ОВ 16,30 ± 2,03 мес; 95 % доверительный интервал 12,32–20,28) по сравнению с больными, у которых отмечалась гиперэкспрессия topoIIα (медиана ОВ 7,7 ± 4,98 мес; 95 % доверительный интервал 0,00–17,46), p = 0,007.Заключение. Гиперэкспрессия topoIIα – фактор неблагоприятного прогноза ОВ больных мКРР, получивших в 1-й линии лекарственного лечения двухкомпонентный режим химиотерапии на основе оксалиплатина и капецитабина
Роль адъювантной химиотерапии у больных раком прямой кишки после предоперационной химиолучевой терапии: результаты ретроспективного исследования
Get PDFПРЕДВАРИТЕЛЬНЫЕ РЕЗУЛЬТАТЫ ИСПОЛЬЗОВАНИЯ ФТОРАФУРА В КОМБИНАЦИИ С ИРИНОТЕКАНОМ И ОКСАЛИПЛАТИНОМ У ПАЦИЕНТОВ С РАСПРОСТРАНЕННЫМ КОЛОРЕКТАЛЬНЫМ РАКОМ
Get PDFObjective: to develop an effective, well-tolerated, convenient for outpatient care (without installing a subclavian catheter) three-component treatment regimen that includes ftorafur – an original oral fluoropyrimidine drug.Materials and methods. The study included 25 patients with disseminated colorectal cancer that have never received specific pharmacotherapy. We evaluated the efficacy and safety of a new first-line three-component treatment regimen with oxaliplatin + irinotecan + ftorafur. Patients in group 1 (n = 6) received this regimen for 3 weeks, whereas patients in group 2 (n = 19) received it for 2 weeks.Results. Only preliminary results of the study are currently available. Median time to progression and overall survival are not yet estimated. Three (50 %) patients from group 1 achieved partial regression of metastases; 3 patients from this group had long-term (≥6 months) disease stabilization. Therapeutic effect (partial remission + long-term stabilization) was observed in all patients. Time without progression varied between 6 and 20 months. In group 2, therapeutic effect was estimated in 18 patients that received at least 2 courses of chemotherapy. Eight out of these 18 patients had partial response (2 of them underwent radical surgery); 8 patients had disease stabilization. Thus, 88.8 % of patients from group 2 responded to treatment. In the whole study population (both groups), response to treatment was achieved in 91 % of patients.Conclusion. Our preliminary results suggest that the combination of oxaliplatin, irinotecan and ftorafur is safe and has an acceptable toxicity profile; therefore, it can be used in weakened patients
МОДИФИЦИРОВАННАЯ ОПЕРАЦИЯ ДЮАМЕЛЯ КАК МЕТОД РЕКОНСТРУКТИВНОЙ КОЛОПЛАСТИКИ ПОСЛЕ ОПЕРАЦИИ ГАРТМАНА
Get PDFObjective: to evaluate the efficacy and safety of a new method for restoration of intestinal continuity after Hartmann procedure in patients with rectal cancer.Materials and methods. We analyzed the results of reconstructive surgeries in patients that underwent obstructive resection of the rectum for rectal cancer between 1991 and 2011. We included patients with a rectal stump located under the pelvic peritoneum (its mean length was 8 (4–11) cm). All study participants underwent modified Duhamel procedure. We evaluated demographic characteristics of patients, as well as early and late postoperative complications.Results. A total of 9 patients were treated with this method. Median time between the resection and reconstructive surgery was 13.2 months; median surgery duration was 255 min; median blood loss was 800 mL. One patient had an intraoperative complication (spleen injury). Early postoperative complications were observed in 2 (22.2 %) participants; of them, 1 (50 %) patient had necrosis of the brought-out bowel. One patient (11.1 %) developed anastomosis stricture 6 months post surgery.Conclusion. We developed a new method to restore intestinal continuity after Hartmann procedure. None of the patients had complications associated with rectal stump isolation. The efficiency of this method should be confirmed by larger studies
