Oncological Coloproctology (E-Journal) / Онкологическая колопроктология
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ИСПОЛЬЗОВАНИЕ ПАКЛИТАКСЕЛА В ХИМИОЛУЧЕВОЙ ТЕРАПИИ БОЛЬНЫХ ПЛОСКОКЛЕТОЧНЫМ РАКОМ АНАЛЬНОГО КАНАЛА: ПИЛОТНОЕ ИССЛЕДОВАНИЕ
Get PDFObjectives: to assess the feasibility of a combination of the intensity-modulated radiation therapy (IMRT) with a triplet chemotherapy with paclitaxel, capecitabine, and mitomycin C in the treatment of patients with anal cancer, and to evaluate the toxicity of the proposed treatment regimen.Materials and methods. All patients included in the study had stage I–IIIB anal cancer. All patients underwent IMRT radiotherapy 52–58 Gy (the dosage is calculated according T symbol) by 1.8 to 2.2 Gy fractions daily. The proposed chemotherapy scheme includes mitomycin C 10 mg/m2 on day 1, paclitaxel 45 mg/m2 on days 3, 10, 17, 24, 31, capecitabine 625 mg/m2 during radiotherapy. A complete response to treatment after 26 weeks, and the compliance to the study protocol were the primary end points of the study.Results. The study included 38 patients. Among patients stage I anal cancer occurred in 1 (2.6 %) case, II – in 5 (13.2 %), IIIA – 15 (39.5 %) and IIIB – in 17 (44.7 %). A significant deviation from the protocol reported in 6 (15.8 %) patients, in 11 (28.9 %) patients a slight alteration from the treatment was documented, and 21 (55.3 %) patients completed the treatment of chemoradiotherapy with full compliance to the study protocol. The high profile of toxicity (grade III–IV) was recorded in 23 (60.5 %) patients. An incomplete clinical response at 26 weeks after treatment was reported in 5 (13.2 %) patients, one whom continued watchful waiting and achieved complete response at 9 months posttreatment. Median followup was 27 months. 1 patient developed a local recurrence 1 year posttreatment.Conclusions. The proposed triplet chemotherapy regimen using IMRT is feasible and has acceptable toxicity. For further assess the continuous research is needed.
КОРОТКИЙ КУРС ПРЕДОПЕРАЦИОННОЙ ЛУЧЕВОЙ ТЕРАПИИ В КОМБИНАЦИИ С ХИМИОТЕРАПИЕЙ, ЛОКАЛЬНОЙ ГИПЕРТЕРМИЕЙ И ПРОЛОНГИРОВАННЫМ ИНТЕРВАЛОМ ДО ОПЕРАЦИИ В ЛЕЧЕНИИ РАКА ПРЯМОЙ КИШКИ: ИССЛЕДОВАНИЕ II ФАЗЫ
Get PDFObjective: to evaluate efficacy and safety of the short-course radiotherapy combined with capecitabine chemotherapy, intracavitary hyperthermia and delayed surgical treatment as neoadjuvant therapy of rectal cancerMaterials and methods. Patients with T2–3N0–2M0 newly diagnosed rectal cancer were included. All patients received short-course radiotherapy with total dose of 25 Gy in several fractions of 5 Gy each, along with capecitabine and metronidazole therapy and local hyperthermia. Capecitabine (1000 mg/m2 ) was administrated twice daily on days 1–14. Local hyperthermia (41–45 °С, 60 min) was applied on days 3–5. Metronidazole (10 g/m2 per rectum) was given on days 3 and 5. Patients underwent surgical treatment not earlier than 4 weeks after neoadjuvant therapy completion. The primary endpoint of the study was assessment of pathologic complete response rate. Secondary endpoints included evaluation of neoadjuvant treatment toxicity, tumor regression, surgical treatment results and oncological results.Results. 81 patients were enrolled. 10 of them (12.3 %) were found to have grade III toxicity, 1 (1.2 %) – grade IV toxicity. Sphincter preservation surgery was carried out in 78 (96.3 %) patients. Postoperative mortality was 0 %. Postoperative complications were registered in 11 (13.8 %) cases. Pathologic complete responses (pCR) were observed in 16 (19.8 %) patients. Median follow-up time was 40.9 months. Distant metastases developed in 10 (12.3 %) patients. Three-year overall survival rate was 97 %, three-year relapse-free survival rate was 85 %.Conclusion. Short-course radiotherapy combined with chemotherapy, radiomodificators and delayed surgical treatment is a safe method for rectal cancer treatment; its results are comparable with the results of prolonged chemoradiotherapy course in terms of tumor regression frequency.
Анализ выживаемости при осложненном колоректальном раке
Get PDFIntroduction. Emergency surgical interventions for complicated colorectal cancer (CCRC) are characterized by high frequency of postoperative complications and mortality, as well as worse prognosis, compared to planned interventions. The study objective is to evaluate overall survival (OS) and relapse-free survival (RFS) in patients with CCRC who underwent emergency surgery in specialized and general surgical in-patient facilities. Materials and methods. An electronic database (registry) includes data on 1098 patients with urgent complications of colorectal cancer who underwent treatment in general surgical and specialized in-patient facilities in Smolensk in 2001–2013. Depending on the specialty of an in-patient facility, all patients were divided into 3 groups: coloproctological (n = 352), oncological (n = 69), general surgical (n = 677) in-patient facility. Results. The percentage of R1-resections in general surgical in-patient facilities was 22.3 %, examination of 12 or more lymph nodes was performed only in 11.4 % of cases. Patients with CCRC who underwent surgery in general surgical in-patient facilities didn’t receive adjuvant treatment in 55.5 % of observations. OS and RFS were higher in CCRC patient groups who underwent surgery in an oncological dispensary or department of coloproctology compared to general surgical facilities (p <0.0001). The type of surgical intervention significantly affected survival: OS and RFS were higher after multi-stage surgeries with tumor removal at the 2>nd stage compared to other types of surgical interventions (p < 0.0001). Conclusion. Analysis of OS and RFS demonstrates that oncologically adequate surgical interventions are performed in specialized in-patient facilities.
Роботическая экстралеваторная брюшно-промежностная экстирпация прямой кишки с трансабдоминальным пересечением леваторов в литотомическом положении пациента
Get PDFObjective: to evaluate safety and efficacy of robot-assisted extralevatory abdominoperineal extirpation of the rectum with transabdominal levator transеction in a patient in lithotomy position.Materials and methods. Within this study, we analyzed clinical observations of several patients who underwent robot-assisted extralevatory abdominoperineal extirpation of the rectum with transabdominal levator transеction at lithotomy position, conducted in the Saint Petersburg City Hospital No 40 during 2015–2016. We assessed the main intraoperative characteristics, postoperative complications, and pathological features of removed organs.Results and discussion. We analyzed the data on 5 patients. All of them underwent R0 resection. The number of resected lymph nodes varied from 15 to 21. Maximum blood loss was 100 ml. The duration of surgery was between 150–210 min. One patient had a postoperative complication – intrapelvic bleeding in the early postoperative period.Conclusion. The use of the described surgical method allowed to perform R0 resections in all patients without losing the advantages of minimally invasive surgery, including small blood loss, early recovery of peristalsis, and rapid rehabilitation of the patients
Фармакоэкономические особенности выбора системной терапии больных метастатическим раком толстой кишки
Get PDF Addition of monoclonal antibodies to metastatic colorectal cancer therapy increases both the survival and treatment costs. This raises the question of economic efficacy of these agents. This review focuses on trials with pharmacoeconomical analysis of chemotherapy and targeted therapy of colorectal cancer. Добавление моноклональных антител к режимам химиотерапии в лечении больных метастатическим раком толстой кишки значимо увеличивает не только продолжительность жизни пациентов, но и стоимость лечения. Соответственно, это ставит вопрос о необходимости экономической оценки применения данных агентов. В настоящем обзоре будет проведен анализ результатов исследований, посвященных фармакоэкономической целесообразности применения различных схем химиотерапии и таргетных препаратов в лечении больных метастатическим раком толстой кишки.
СИМУЛЬТАННАЯ ГИБРИДНАЯ ЛАПАРОСКОПИЧЕСКАЯ ЭКСТИРПАЦИЯ ПРЯМОЙ КИШКИ И ОТКРЫТАЯ РЕЗЕКЦИЯ ПЕЧЕНИ ПРИ РАКЕ С СИНХРОННЫМИ ОТДАЛЕННЫМИ МЕТАСТАЗАМИ (клиническое наблюдение)
Get PDFA new approach to combined treatment of patients with colorectal cancer with synchronous distant liver metastases is discussed in the article. The approach is based on simultaneous surgical treatment of the colon using laparoscopic method and via open liver resection. This hybrid technology allows to reduce the frequency of postoperative complications, minimize the duration of in-patient care, therefore decreasing time until drugs administration as well as treatment costs, ensuring early start of combined treatment. The description of clinical observations demonstrated the benefits of this method implementation. В статье представлен и обоснован новый подход к комбинированному лечению больных колоректальным раком с синхронными отдаленными метастазами в печень, основанный на использовании одномоментного хирургического вмешательства на толстой кишке лапароскопическим методом и посредством открытой резекции печени. Данная гибридная технология позволяет снизить частоту послеоперационных осложнений, минимизирует период нахождения пациентов в стационаре, тем самым ускоряет сроки до начала лекарственного лечения, что уменьшает стоимость терапии и обеспечивает оптимальное начало комбинированного лечения. Описания клинических наблюдений продемонстрировали преимущества внедрения данной методики.
Локализация первичной опухоли толстой кишки: есть ли принципиальные отличия?
Get PDFColon cancer is a heterogenous disease with each subtype having a distinct clinical picture and, consequently, different prognosis. Therefore, the tumors can be classified according to their localization: as emerging from the left or right side of the colon. The proximal and distal colon have different embryogenesis which determines the boundary between the right and left colon at the level of the distal margin of the middle third of the colon. In literature, there’s enough data to consider other differences apart from embryogenesis. Right- and left-side colon tumors differ epidemiologically, clinically and pathomorphologically, molecularly and genetically. This, presumably, explains differences in screening, prevention, and treatment of these tumors. The objective of this review is to analyze differences between colon tumors with different localizations and to determine if such subdivision of colon cancer in clinical practice affects treatment and prevention approaches
Ручной колоанальный или аппаратный колоректальный анастомоз? Сравнительный анализ лапароскопических низких резекций прямой кишки.
No full textТопографическая анатомия и онкологическая хирургия ободочной кишки: новое или хорошо забытое старое?
Get PDFThe article is devoted to the surgery standards for colorectal cancer, specific features of colon mobilization in patients with locally advanced colon cancer and the use of germ cell layers as anatomical landmarks. We describe the features and the volume of lymph node dissection during surgeries for left and right colon, the level of central vessels ligation during intervention and the criteria for assessing the quality of mesocolic excision. We studied the impact of these factors on overall and relapse-free survival, highlighted some aspects of mobilization of the right and left colon. The objective of this article was to contribute to the development of methodological guidelines for colon cancer surgery in compliance with the principles of complete mesocolic excision with central vessels ligation.Статья посвящена принципам соблюдения стандартов в хирургии колоректального рака, особенностям мобилизации при местнораспространенном раке ободочной кишки и использования эмбриональных слоев в качестве анатомических ориентиров.Указываются особенности и объем лимфодиссекции при операциях на правой и левой половинах ободочной кишки, уровень пересечения основных сосудов в ходе хирургических вмешательств, критерии оценки качества выполнения мезоколонэктомии.Изучено влияние вышеуказанных факторов на общую и безрецидивную выживаемость пациентов, освещены некоторые аспекты техники выполнения мобилизации правой и левой половин ободочной кишки. Цель статьи – внести вклад в разработку методологии обучения хирургов стандартному выполнению основных этапов хирургии рака ободочной кишки с соблюдением принципов полной мезоколонэктомии с центральной перевязкой сосудов
Оценка влияния назначения противоопухолевых препаратов в популяции больных метастатическим раком толстой кишки на уменьшение смертности
Get PDFBackground. Colorectal cancer (CRC) is the 4th most frequent cause of death among patients with malignant tumors worldwide. In 2012, approximately 1.3 million people were diagnosed with CRC, nearly 690 000 patients died.Objective: to assess the impact of various chemotherapeutic drugs and monoclonal antibodies penetration on the dynamics of CRC-associated mortality in patients with metastatic CRC in Russia.Materials and methods. We analyzed the mortality data for 2014 obtained from the National Cancer Register and the data from the Register of Chemotherapy Drugs (oxaliplatin, irinotecan, capecitabine) and Monoclonal Antibodies (bevacizumab, cetuximab, panitumumab) Procurement for cancer centers from 82 regions of Russia. We performed correlation and regression analysis to estimate the impact of various chemotherapeutic drugs and monoclonal antibodies penetration on the CRC-associated mortality, as well as the mortality from colon cancer and rectal cancer.Results. We observed a correlation between the mortality reduction in patients with metastatic CRC and penetration of irinotecan (k = –0.324, р = 0.003), capecitabine (k = –0.223, p = 0.04), bevacizumab (k = –0.229, p = 0.04), panitumumab (k = –0.232, p = 0.04), any anti-EGFR monoclonal antibody (k = –0.201, p = 0.07) and all monoclonal antibodies (k = –0.256, p = 0.02). Regression analysis demonstrated a decreased mortality rates in patients receiving irinotecan (β = –0.26, р = 0.02), anti-EGFR monoclonal antibodies (β = –0.19, р = 0.09) and oxaliplatin or irinotecan (β = –0.2, р = 0.06).Conclusion. Our results suggest a correlation between the administration of irinotecan and monoclonal antibodies and mortality reduction in patients with metastatic CRC