Oncological Coloproctology (E-Journal) / Онкологическая колопроктология
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ДВЕ ПРОГРАММЫ ХИМИОТЕРАПИИ В КОМБИНАЦИИ С БЕВАЦИЗУМАБОМ В ЛЕЧЕНИИ ДИССЕМИНИРОВАННОГО КОЛОРЕКТАЛЬНОГО РАКА
Get PDFThe efficiency of 2 programs of chemotherapy in the treatment of 46 patients with disseminated colorectal cancer. The program of chemo-therapy of oxaliplatin + capecitabine (ОХА/САР), established authors, with bevacizumab (BEV) showed the best results compared with oxaliplatin + 5-fluorouracyl + leukovorin (ОХА/5-FU/LV) with bevacizumab. The overall efficiency OXA/5-FU/LV/BEV amounted to 40.91 ± 8.6 %, 4.54 ± 5.1 % of total regressions. The overall effect of therapy in the OXA/CAP/BEV amounted to 45.83 ± 8.6 %, full regression was achieved in 4 patients, which amounted to 16.66 ± 5.6 %. The median time to progression in the first group of patients was 8.3 months, in the second – 9.8 months. Clinical application of involving bevacizumab in combination with different modes of chemotherapy in patients with disseminated colorectal cancer is acceptable and manageable toxicity that doesn't require reduction of doses.Изучена эффективность 2 программ химиотерапии (ХТ) в лечении 46 больных диссеминированным колоректальным раком. Показано, что программа ХТ оксалиплатин + капецитабин (ОХА/САР), созданная авторами, в комбинации с бевацизумабом (BEV) позволила добиться лучших непосредственных результатов по сравнению с программами оксалиплатин + 5-фторурацил + лейковорин (ОХА/5-FU/LV) в комбинации с бевацизумабом. Общая эффективность программы ОХА/5-FU/LV/BEV составила 40,91 ± 8,6 %, из них 4,54 ± 5,1 % полных регрессий. Общий эффект терапии в группе ОХА/САР/BEV составил 45,83 ± 8,6 %, из них полной регрессии удалось добиться у 4 пациентов, что составило 16,66 ± 5,6 %. Медиана времени до прогрессирования в 1-й группе больных составила 8,3 мес, во 2-й – 9,8 мес. Амбулаторное применение бевацизумаба в комбинации с различными режимами ХТ у больных диссеминированным раком ободочной кишки сопровождается приемлемой и управляемой токсичностью, что не требует редукции доз
Комплексное лечение больных операбельным раком прямой кишки дистальной локализации
Get PDFMore than 30-year experience of the department of proctology of N.N. Blokhin Russian Cancer Research Center, which demonstrates the necessity in developing complex treatment for distal rectal cancer is presented in this article. An original treatment scheme has been developed, incorporating radiotherapy (short course 5 Ч 5 Gy) with 2 radiosensitizers and systemic cytotoxic therapy with fluorpyrimidines (capecitabine). The developed treatment scheme has acceptable toxicity and can be combined with all types of surgical interventions. A significant reduction in local and distant failures rates can be achieved as well an improvement of disease-free survival. This allows to increase indications to sphincter-sparing treatment by improving ablastics of surgery and provide high level of social rehabilitation
ВОЗМОЖНОСТИ СТАНДАРТНЫХ РЕЖИМОВ МАГНИТНО-РЕЗОНАНСНОЙ ТОМОГРАФИИ СОВМЕСТНО С ДИФФУЗИОННО-ВЗВЕШЕННОЙ МАГНИТНО-РЕЗОНАНСНОЙ ТОМОГРАФИЕЙ В ОЦЕНКЕ МЕСТНОЙ РАСПРОСТРАНЕННОСТИ РАКА ПРЯМОЙ КИШКИ
Get PDFIn this article we present up-to-date views on rectal cancer imaging. Accurate initial and follow-up staging of rectal cancer is vitally important and provides information essential for treatment decision making, preoperative therapy and surgery planning. Almost worldwide magnetic resonance imaging (MRI) is currently considered as the most advanced staging modality for rectal cancer; however conventional MRI sequences have some diagnostic limits and not always allow to differentiate fibrotic tissue (present either desmoplastic reaction or fibrotic changes due to preoperative radiotherapy) from tumor. On the basis of our own experience and published data we tried to demonstrate imaging possibilities of conventional and diffusion-weighted (DW) MRI in local staging of rectal cancer.Статья посвящена актуальным вопросам диагностики рака прямой кишки (РПК). Корректное первичное и предоперационное стадирование РПК позволяет выбирать необходимую тактику лечения, планировать предоперационную терапию и само хирургическое вмешательство. На сегодняшний момент во многих странах магнитно-резонансная томография (МРТ) является диагностическим методом выбора для стадирования РПК, но стандартные режимы МРТ имеют свои пределы и не всегда позволяют дифференцировать фиброзную ткань (которая может представлять десмопластическую реакцию или постлучевой фиброз) от опухолевой ткани.На основе литературных данных и собственного накопленного опыта мы попытались продемонстрировать возможности не только стандартных режимов МРТ, но и диффузионно-взвешенной МРТ ((ДВ)-МРТ) в оценке местной распространенности РПК
ИНТЕРСФИНКТЕРНЫЕ РЕЗЕКЦИИ ПО ПОВОДУ РАКА НИЖНЕАМПУЛЯРНОГО ОТДЕЛА ПРЯМОЙ КИШКИ С ПОРАЖЕНИЕМ АНОРЕКТАЛЬНОЙ ЗОНЫ АНАЛЬНОГО КАНАЛА
Get PDFPreoperative chemoradiotherapy and surgery for low rectal cancer involving anorectal region are discussed in this article.Subjects .and .methods . 42 patients were included in this study, 18 received neoadjuvant chemoradiotherapy 5 × 5 Gy and 24 had chemo-radiotherapy up to 40 Gy in 4 Gy fractions.Results . Treatment had acceptable toxicity levels with grade III toxicity of 11.1 % and 8.3 % accordingly. 20.8 % had pathological complete response following 40 Gy chemoradiotherapy. 22.2 % patients in 5 × 5 Gy group had intershinctering resections comparing to 75 % patients in 40 Gy group. No local or distant recurrences were observed with a median followup of 42.9 months and 18.1 months accordingly.Conclusions . Developed treatment scheme have high efficacy, improving surgery ablastics and leading to good long-term outcome, improving sphincter preservation rate and patients quality of life
ПРОБЛЕМЫ ЛЕКАРСТВЕННОЙ ТЕРАПИИ ПРИ ОКАЗАНИИ ПАЛЛИАТИВНОЙ МЕДИЦИНСКОЙ ПОМОЩИ В ОНКОЛОГИИ
Get PDFIntroduction. Palliative care for oncological patients requires dealing with multiple disease symptoms and requires multi-drug therapy. The search for wide-spectre drugs which can affect different pathological pathways is a pressing matter.Methods. The effect of hydralazine sulfate on life quality of 63 palliative care oncological patients ECOG > 3, who stopped all specific therapy was investigated.Results. Positive correlation between hydralazine sulfate use and dose of analgetics was observed, as well as reduction of need for symptomatic therapy. The median daily use of tramadol slightly increased from 263.5 ± 4.7 to 317.2 ± 3.4 mg. In 19.4 % patients after 1 month of hydralazine sulfate therapy pain was reduced to “low” and tramadol was cancelled. Decrease in symptomatic therapy need was observed in 85 % patients.Conslusion. Use of hydralazine sulfate in palliative oncological care improves treatment and life quality
ПРЕДОПЕРАЦИОННАЯ ЭНДОСКОПИЧЕСКАЯ МАРКИРОВКА НЕПАЛЬПИРУЕМЫХ ОПУХОЛЕЙ ОБОДОЧНОЙ КИШКИ
Get PDFThe identification of small colon lesions is one of the major problems in laparoscopic colonic resection.Research objective: to develop a technique of visualization of small tumors of a colon by preoperative endoscopic marking of a tumor.Materials and methods. In one day prior to operation to the patient after bowel preparation the colonoscopy is carried out. In the planned point near tumor on antimesentery edge the submucous infiltration of marking solution (Micky Sharpz blue tattoo pigment, UK) is made. The volume of entered solution of 1–3 ml. In only 5 months of use of a technique preoperative marking to 14 patients with small (the size of 1–3 cm) malignant tumors of the left colon is performed.Results. The tattoo mark was well visualized by during operation at 13 of 14 patients. In all cases we recorded no complications. Time of operation with preoperative marking averaged 108 min, that is significantly less in comparison with average time of operation with an intra-operative colonoscopy – 155 min (р < 0.001).Conclusions. The first experience of preoperative endoscopic marking of non palpable small tumors of a colon is encouraging. Performance of a technique wasn't accompanied by complications and allowed to reduce significantly time of operation and to simplify conditions of performance of operation
ОПЫТ ПРИМЕНЕНИЯ БЕВАЦИЗУМАБА ПРИ ЛЕЧЕНИИ МЕТАСТАТИЧЕСКОГО КОЛОРЕКТАЛЬНОГО РАКА В ДВУХ ЦЕНТРАХ МОСКВЫ И САНКТ-ПЕТЕРБУРГА
Get PDFThe aim of this study was to estimate efficacy of first line chemotherapy with bevacizumab in metastatic colorectal cancer patients and investigate the impact of different prognostic factors on treatment outcome.Methods.During 2004–2008 48 colorectal cancer patients were included (29 in Russian N.N. Blokhin Cancer Research Center, 19 in St. Petersburg), who had unresectable distant metastases. Primary tumor was resected in 93.8 % patients. 52.1 % had rectal cancer. 87.5 % had liver metastases, 43.8 % had more than 1 organ affected. 66.7 % received chemotherapy with bevacizumab 5 mg/kg biweekly, 33.3 % received bevacizumab 7,5 mg/kg every 3 weeks. 62.5 % patients had oxaliplatin-based regimens, 35.4 % – only fluorpyrimidines, 2.1 % – chemotherapy with irinotecan.Results.Median time of bevacizumab use was 7.8 months. 60.3 % had objective response, 87.4 % had stable diseases during more than 6 months. Median progression-free survival (PFS) was 11.5 months. Median overall survival (OS) was 24.1 months.Conclusions.Survival and efficacy results are comparable to international experience. Combination of fluorpyrimidines with bevacizumab had comparable efficacy to combined chemotherapy regimens with no impact on quality of life. Integration of bevacizumab in combined treatment regimens reduced the impact of negative prognostic factors on PFS and OS.
ОПЫТ ПРИМЕНЕНИЯ БЕВАЦИЗУМАБА У БОЛЬНЫХ НЕОПЕРАБЕЛЬНЫМ КОЛОРЕКТАЛЬНЫМ РАКОМ В КИРОВСКОЙ ОБЛАСТИ
Get PDFPurpose. To conduct retrospective analysis of treatment results of combined first line therapy of metastatic colorectal cancer with bevacizumab with further bevacizumab maintenance and second line treatment with or without bevacizumab use in Kirov regional clinical oncology dispensary.Materials and methods. The study was conducted in Kirov regional clinical oncology dispensary from 2008 until 2014. 35 patients treated with combined first line therapy including bevacizumab with further bevacizumab maintenance and second line treatment with or without bevacizumab were retrospectively evaluated. Overall response was evaluated using RECIST ver. 1.1 criteria. Long term outcomes – progression free and overall survival were evaluated. Treatment safety was evaluated using NCI CTCAE.Results. There were no complete remissions in second line bevacizumab treatment, partial remissions were detected for 4 (22.2 %) patients, stable disease for 14 (77.8 %). Median progression free survival in both groups was comparable 9.1 and 10.4 months respectively. Patients treated with bevacizumab in first and second lines of treatment had 8.2 months survival benefit (p > 0.05).Conclusions. Combined first line therapy of metastatic colorectal cancer with bevacizumab with further bevacizumab maintenance and second line treatment with bevacizumab improves overall survival on 8.2 months in comparison with patients who stopped bevacizumab treatment after first disease progression
Тотальные экзентерации малого таза у пациентов с местно-распространенными первичными и рецидивными опухолями прямой кишки: возможности реконструкции мочевыделительной системы
No full textSurgical and long-term results of 14 total pelvic exenteration were analyzed. The group included 6 patients (5 men, 1 woman) with primary rectal cancer, and 8 patients (7 men, 1 woman) with the locally-advanced recurrent rectal cancer. The mean operative time was 403 ± 133.1 min (from 240 to 680 min). The average blood loss — 5169 ml (1200 to 15 000 ml). Both female patients were underwent infralevatoric total pelvic exenteration. Supralevatoric total pelvic exenteration were performed in 5 male patients. In these patients full recovery of the colon passage, and in the urinary tract — orthotopic plastic of the urinary bladder (Studer procedure) was achieved. R0 resection was performed in 11 (78.5 %) cases, the presence of microscopic tumor growth in the lateral resection margin was found in 3 (21.5 %) patients (R1). Postoperative complications occurred in 8 patients, requiring surgical correction in 3 cases. Long-term results were followed up in 12 patients during the period from 16 to 57 months after surgery (median — 31 months). Overall survival in these periods was 83.3 % (10 patients). Disease-free survival — 75 % (9 patients). Influence of the reconstruction phase on the long-term results was not observed. Functional results are evaluated as good in all patients after orthotopic plastic of the bladder. Performing of pelvic exenteration for patients with locally advanced rectal cancer is a chance to achieve radical removal of the tumor and, as a consequence, the long-term survival in this extremely difficult group of patients. Performing of full reconstruction of the urinary tract allows to improve the quality of life of patientswith no adverse influence on oncologic outcomes.
ДАННЫЕ ИССЛЕДОВАНИЙ ПРИ КRAS- И RAS-НЕМУТИРОВАННОМ (ДИКОМ) ТИПЕ КОЛОРЕКТАЛЬНОГО РАКА
Get PDF Analysis of latest trials, comparing treatment schemes including chemotherapy with anti-EGFR monoclonal antibodies or bevacizumab is presented in this article. The data in these trials is inconsistent, but detailed analysis of FIRE-3 trial allows to distinguish a wild-type RAS patient group that benefits most from chemotherapy with cetuximab or panitumumab as 1st line metastatic colorectal cancer treatment. A final analysis of this patient group in CALGB/SWOG 80 405 trial is pending. The RAS analysis is pivotal for choice of 1st line chemotherapy.В статье приводится анализ последних исследований, сравнивающих режимы лекарственной терапии, включающих антиEGFR моноклональные антитела, с теми же режимами химиотерапии (ХТ) с бевацизумабом. Данные этих исследований неоднозначны, однако обстоятельный анализ исследования FIRE-3 позволяет выделить подгруппы пациентов с предпочти- тельным назначением в качестве 1-й линии лечения метастатического колоректального рака с отсутствием мутации гена RAS (RAS дикого типа) схем ХТ в сочетании с цетуксимабом либо панитумумабом. Ожидается окончательный анализ данной категории пациентов в исследовании CALGB/SWOG 80 405. Обязательным является исследование опухолей на мутацию RAS для выбора 1-й линии