JOURNAL DESCRIPTION
The Medical Radiology and Radiation Safety journal ISSN 1024-6177 was founded in January 1956 (before December 30, 1993 it was entitled Medical Radiology, ISSN 0025-8334). In 2018, the journal received Online ISSN: 2618-9615 and was registered as an electronic online publication in Roskomnadzor on March 29, 2018. It publishes original research articles which cover questions of radiobiology, radiation medicine, radiation safety, radiation therapy, nuclear medicine and scientific reviews. In general the journal has more than 30 headings and it is of interest for specialists working in thefields of medicine¸ radiation biology, epidemiology, medical physics and technology. Since July 01, 2008 the journal has been published by State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency. The founder from 1956 to the present time is the Ministry of Health of the Russian Federation, and from 2008 to the present time is the Federal Medical Biological Agency.
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Medical Radiology and Radiation Safety. 2021. Vol. 66. № 5. P. 50–58
Role of Intensification of Neoadjuvant Treatment of Patients with Locally Expanded Rectal Cancer
A.V. Polynovsky1, D.V. Kuzmichev1, Z.Z. Mamedli1, S.I. Tkachev1, M.V. Chernykh1, Yu.E. Suraeva2, Zh.M. Madyarov1, A.A. Aniskin2, E.S. Kolobanov 3
1N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia
2Research Institute of Healthcare Organization and Medical Management of the Moscow Department of Healthcare, Moscow, Russia
3PET-Technology, Podolsk, Moscow Region, Russi
Contact person: Andrey Vladimirovich Polynovsky: This email address is being protected from spambots. You need JavaScript enabled to view it.
ABSTRACT
Purpose: To improve the effectiveness of treatment of patients with locally advanced rectal cancer (LARC) stage T3(MRF+)-4N0-2M0 by developing a new strategy of therapy.
Material and methods: The study included 414 patients with LARC. Control group I included 89 patients who underwent neoadjuvant CRT 52–56 Gy with capecitabine. Control group II included 160 patients, underwent neoadjuvant CRT 52–56 Gy with capecitabine and oxaliplatin once a week, during the course of RT. Study group III - 165 patients. This group combined neoadjuvant CRT 52–56 Gy with capecitabine and additional consecutive courses of chemotherapy (CT) in the CapOx mode. This group, depending on the variant of chemotherapy, was divided into 2 subgroups: subgroup IIIa included 106 patients with consolidating CT (after CRT); subgroup IIIb included 59 patients who underwent "sandwich" treatment. Therapy consists of conducting 1 or 2 courses of induction CT (up to CRT) in the CapOx mode and 1 or 2 courses of consolidating CT in the CapOx mode with an interval of 7 days. In the interval between the courses of drug therapy, prolonged CRT was performed. According to the results of the control examination, further treatment tactics were determined.
Results: IComplete therapeutic pathomorphosis in the tumor was significantly more frequently registered in patients in the study group III (17.5 %; p=0.021) compared to the control groups: in I – 8.0 % and II – 8.3 %. In total, relapses in the study were registered in 34 (8.3 %) of 410 patients. A comparative analysis of patients in the control groups (I and II) of treatment did not determine significant differences in the development of relapses (11.4 % vs. 10.8 %, respectively; p=0.884). When analyzing the subgroups (IIIa and IIIb) of the study group, there were also no significant differences in the development of relapses (4.8 % vs. 3.4 %; p=0.676). In the present study, long-term metastases at various times after treatment were diagnosed in 100 (24.4 %) of 410 patients. All metastases occurred at a median follow-up of 20.9 months (4 to 46 months). Metastases were significantly less frequent in patients in group III (18.3 %) compared to group I (31.8 %; p=0.015) and II (26.6 %; p=0.037). There were no significant differences between patients in group I and II (p=0.382). The analysis of the treatment subgroups of the study group (IIIa and IIIb) did not determine significant differences in the development of metastases (19.1 % vs. 17.0 %; p=0.456). The overall five-year survival rate in patients in group III was 90.5 %, in group I – 71.8% and in group II – 78.3%. Five-year relapse-free survival in patients in the study groups was: III – 71.5%, I – 56.9% and II – 65.6%, respectively.
Conclusion: The shift in the focus on strengthening the neoadjuvant effect on the tumor and the improvement of approaches to drug therapy regimens allowed to significantly increase the relapse-free survival in this category of patients.
Key words: locally advanced rectal cancer, chemo radiotherapy, induction chemotherapy, consolidation chemotherapy, sandwich therapy
For citation: Polynovsky AV, Kuzmichev DV, Mamedli ZZ, Tkachev SI, Chernykh MV, Suraeva YuE, Madyarov ZhM, Aniskin AA, Kolobanov ES. Role of Intensification of Neoadjuvant Treatment of Patients with Locally Expanded Rectal Cancer. Medical Radiology and Radiation Safety 2021;66(5):50-58.
DOI: 10.12737/1024-6177-2021-66-5-50-58
References
1. Jung K., Kim H., Park J., et al. Adjuvant Chemotherapy after Neoadjuvant Chemoradiation and Curative Resection for Rectal Cancer: is it Necessary for All Patients? // J. Surgical Oncology. 2015. V.111, No. 4. P. 439-444.
2. Bosset J.-F., Calais G., Mineur L., et al. Fluorouracil-Based Adjuvant Chemotherapy after Preoperative Chemoradiotherapy in Rectal Cancer: Long-Term Results of the EORTC 22921 Randomised Study // Lancet Oncol. 2014. V.15, No. 2. P. 184–190.
3. Sainato A., Cernusco Luna Nunzia V., Valentini V., et al. No Benefit of Adjuvant Fluorouracil Leucovorin Chemotherapy after Neoadjuvant Chemoradiotherapy in Locally Advanced Cancer of the Rectum (LARC): Long Term Results of a Randomized Trial (I-CNR-RT) // Radiother Oncol. 2014. V.113, No. 2. P. 223–229.
4. Rödel C., Graeven U., Fietkau R., et al. Oxaliplatin Added to Fluorouracil-Based Preoperative Chemoradiotherapy and Postoperative Chemotherapy of Locally Advanced Rectal Cancer (the German CAO/ARO/AIO-04 Study): Final Results of the Multicentre, Open-Label, Randomised, Phase 3 Trial // Lancet Oncol. 2015. V.16, No. 8. P. 979–989.
5. Hong Y.S., Nam B.-H., Kim K.-P., et al. Oxaliplatin, Fluorouracil, and Leucov-Orin Versus Fluorouracil and Leucovorin as Adjuvant Chemotherapy for Locally Advanced Rectal Cancer after Preoperative Chemoradiotherapy (ADORE): an Open-Label, Multicentre, Phase 2, Randomised Controlled Trial // Lancet Oncol. 2014. V.15, No. 11. P. 1245–1253.
6. Schmoll H.J., Stein A., Hofheinz R.D., et al. Preoperative Chemoradiotherapy and Postoperative Chemotherapy with Capecitabine and Oxaliplatin vs. Capecitabine Alone in Locally Advanced Rectal Cancer: Final Analyses // Ann. Oncol. 2016. V.27 (suppl 6). Available at: https://academic.oup.com /annonc/article/ 27/suppl _ 6/467PD/2799263 Last Accessed November 21, 2019.
7. Hu X., Li Y.-Q., Li Q.-G., Ma Y.-L., Peng J.-J., Cai S.-J. Adjuvant Chemotherapy Seemed not to Have Survival Benefit in Rectal Cancer Patients with YpTis-2N0 after Preoperative Radiotherapy and Surgery from a Population-Based Propensity Score Analysis // Oncologist. 2019. V.24, No. 6. P. 803–811.
8. Fernandez-Martos C., Garcia-Albeniz X., Pericay C., et al. Chemoradiation, Surgery and Adjuvant Chemotherapy Versus Induction Chemotherapy Followed by Chemoradiation and Surgery: Long-Term Results of the Spanish GCR-3 Phase II Randomized Trial // Ann. Oncol. 2015. V.26, No. 8. P. 1722–1728.
9. Kim C.W., Kang B.M., Kim I.Y., et al. Korean Society of Coloproctology (KSCP) Trial of CONsolidation Chemotherapy for Locally Advanced Mid or Low Rectal Cancer after Neoadjuvant Concurrent Chemoradiotherapy: a Multicenter, Randomized Controlled Trial (KONCLUDE) // BMC Cancer. 2018. V.18, No. 1. P. 538.
10. Glynne-Jones R., Grainger J., Harrison M., et al. Neoadjuvant Chemotherapy Prior to Preoperative Chemoradiation or Radiation in Rectal Cancer: Should We Be More Cautious? // Br. J. Cancer. 2006. No. 94. P. 363-371.
11. Gao Y.H., Lin J.Z., An X. et al. Neoadjuvant Sandwich Treatment with Oxaliplatin and Capecitabine Administered Prior to, Concurrently with, and Following Radiation Therapy in Locally Advanced Rectal Cancer: a Prospective Phase 2 Trial // Int. J. Radiat. Oncol. Biol. Phys. 2014. V.90, No. 5. P. 1153–1160.
12. Landry J.C., Feng Y., Prabhu R.S., et al. Phase II Trial of Preoperative Radiation with Concurrent Capecitabine, Oxaliplatin, and Bevacizumab Followed by Surgery and Postoperative 5-Fluorouracil, Leucovorin, Oxaliplatin (FOLFOX), and Bevaci-zumab in Patients with Locally Advanced Rectal Cancer: 5-Year Clinical Outcomes ECOG-ACRIN Cancer Research Group E3204 // Oncologist. 2015. V.20, No. 6. Р. 615-616.
13. Maas M., Nelemans P.J., Valentini V., et al. Long-Term Outcome in Patients with a Pathological Complete Response after Chemoradiation for Rectal Cancer: a Pooled Analysis of Individual Patient Data // Lancet Oncol. 2010. V.11, No. 9. P. 835-844.
14. Habr-Gama A., Perez R.O., Nadalin W., Sabbaga J., Ribeiro U.Jr., Silva e Sousa A.H.Jr., Campos F.G., Kiss D.R., Gama-Rodrigues J. Operative Versus Nonoperative Treatment for Stage 0 Distal Rectal Cancer Following Chemoradiation Therapy: Long-Term Results // Ann. Surg. 2004. V.240, No. 4. P. 711–717. Discussion 717-718.
15. Petrelli F., Sgroi G., Sarti E., et al. Increasing the Interval Between Neoadjuvant Chemoradiotherapy and Surgery in Rectal Cancer: A Meta-Analysis of Published Studies // Ann. Surg. 2016. V.263, No. 3. Р. 458-464.
PDF (RUS) Full-text article (in Russian)
Conflict of interest. The author declare no conflict of interest.
Financing. The study had no sponsorship.
Contribution. Article was prepared with equal participation of the authors
Article received: 05.03.2021.
Accepted for publication: 29.04.2021.