Complete histopathological regression in rectal cancer after neoadjuvant chemoradiotherapy and sphincter preserving surgical treatment

Petrović, Tomislav; Knežević-Ušaj, Slavica; Radovanović, Dragana; Lukić, Dejan; Petrović, Nemanja; Petrović, Tatjana

doi:10.2298/VSP160721382P

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Vojnosanitetski pregled

2018, vol. 75, br. 7, str. 698-703

Kompletna patohistološka regresija karcinoma rektuma nakon neoadjuvantne radiohemioterapije i sfinkter prezervirajućih operacija

Petrović Tomislav^a, Knežević-Ušaj Slavica^a

, Radovanović Dragana^a

, Lukić Dejan^a

, Petrović Nemanja^a, Petrović Tatjana^b

^aInstitut za onkologiju Vojvodine, Sremska Kamenica, Srbija
^bInstitut za plućne bolesti, Sremska Kamenica, Srbija

e-adresa: petrovic.tomislav@onk.ns.ac.rs

Ključne reči: rektum; neoplazme; karcinomi; hirurgija digestivnog sistema; procedure; radiohemioterapija; lečenje; neoadjuvantno; prognoza

Sažetak

Uvod/Cilj. Multimodalni pristup u lečenju lokalno uznapredovalog karcinoma rektuma rezultira boljom prognozom bolesti. Preoperativnom primenom kombinovane radioterapije i hemioterapije-radiohemioterapije (RHT) poboljšava se lokalna kontrola bolesti, smanjuje rizik od pojave lokalnih recidiva i vodi boljem preživaljavanju kod većine bolesnika kod kojih je postignuta kompletna ili nekompletna histološka regresija tumora. Oko 20% bolesnika nakon neoadjuvantne terapije ima potpunu patohistološku regresiju tumora. Cilj ovog istraživanja je bio evaluacija preživljavanja bolesnika nakon neoadjuvantne terapije i sfinkter prezervirajućih operacija. Metode. Retrospektivnom studijom obuhvaćen je 191 bolesnik. Bolesnici su primili neoadjuvantnu radiohemioterapiju a nakon toga su operisani u periodu od juna 2000. do decembra 2010. godine. Dijagnostika je izvođena prema sledećem algoritmu: anamneza, digito-rektalni tuše, kolonoskopija sa biopsijom i patohistološkom verifikacijom. U studiju su uključeni samo bolesnici sa tumorima lokalizovanim ispod promontorijuma. Iz studije su isključeni bolesnici sa udaljenim metastazama i sa reicidivima. Ukupna doza zračenja od 50.4 Gy je bila podeljena u dnevne doze od 1.8 Gy. Hemioterapija [5-fluorouracil i folna kiselina (Leucovorin® )] je pratila radioterapiju 1. 2. 10. 11. 20. i 21. dana. Šest do osam nedelja nakon ove terapije urađen je pregled male karlice magnetnom rezonancom (MR) radi novog stejdžinga. Bolesnici su operisani u periodu od 8 do 12 nedelja po završetku hemioiradijacije. Rezultati. Od svih bolesnika koji su primili neoadjuvantnu terapiju, kod 163 je urađena sfinkter prezervirajuća operacija sa totalnom mezorektalnom ekscizijom. Kod 28 bolesnika izvedena je palijativna operacija. Patohistološkim nalazom je utvrđeno da 21,4% bolesnika ima kompletnu histološku regresiju tumora, 63,2% nekompletnu, dok je 15,3% bolesnika bilo nepromenjenog statusa. Petogodišnje preživljavanje kod bolesnika sa kompletnom histološkom regresijom bilo je 63,3%, kod onih sa nekompletnom histološkom regresijom 50,5%. Razlika u preživljavanju između ove dve grupe bolesnika nije bila statistički značajna (p > 0,05). Zaključak. Preoperativna radiohemioterapija obezbeđuje optimalno kliničko zbrinjavanje bolesnika sa lokalno uznapredovalim karcinomom rektuma.

Abstract

Background/Aim. Multimodal approach to locally advanced rectal cancer treatment results in better disease outcome. Preoperative chemoradiotherapy improves disease local control, reduces risk of local recurrence and in the majority of patients with complete or substantial regression of the tumors significantly improves survival rates. According to the literature data, approximately 20% of patients had achieved complete histopathological response (pCR) after neoadjuvant chemoradiation therapy. The aim of this study was to evaluate overall survival in rectal cancer patients treated with preoperative chemoradiotherapy and sphincter preserving surgery. Methods. This retrospective study included 191 patients. Patients received preoperative radiation therapy and chemotherapy-chemoradiation therapy (CRT) followed by operation that favorized sphincter preservation with total mesorectal excision (TME) from June 2000 until December 2010. Diagnosis was established according to the following algorithm: patient history, digital rectal examiantion, colonoscopy with biopsy and histopathology verification, and preoperative clinical staging. Patients with tumors located below promontorium were included in the study and patients with metastatic disease and local recurrence were excluded from the study. For tumors located below the promontorium preoperative radiotherapy was used with total dose of 50.4 Gy, divided into daily doses of 1.8 Gy, during 28 days. Chemotherapy followed radiotherapy with 5- fluorouracil and folic acid (Leucovorin® ) on days 1, 2, 10, 11, 20 and 21. Six to ten weeks after neoadjuvant therapy, magnetic resonance imaging (MRI) to restage tumors and operation were performed. Results. Of all patients that received preopertive chemoradiation, 163 had radical sphincter preservig surgery and 28 patients had paliative operations. Histopathological examination of the specimens showed that the complete histopathological regression was achieved in 21.4% of the patients, downstaged was found in 63.2% of them and unchanged stage was found in 15.3% of the patients. The five-year survival rate was 63.3% and 50.5 % in the patients with pCR and patients with incomplete histopathological regression, respectively. Survival rates between two groups were not statistically significant (p > 0.05). Conclusion. The preoperative chemoradiotherapy is very important in achieving optimal clinical care for patients with locally advanced rectal cancer.

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O članku

jezik rada: engleski
vrsta rada: izvorni naučni članak
DOI: 10.2298/VSP160721382P
objavljen u SCIndeksu: 09.08.2018.
metod recenzije: dvostruko anoniman

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