Medical Radiology and Radiation Safety. 2021. Vol. 66. № 5. P. 39–44

Search of Predictors of Radiosensitivity in Rectal Adenocarcinoma

M.A. Vologirova¹, N.N. Volchenko¹, I.V. Droshneva¹, I.A. Zamulaeva², A.V. Boyko¹, D.V. Sidorov¹

¹P.A. Hertsen Moscow Oncology Research Institute, Moscow, Russia

²A.P. Tsyb Medical Radiological Research Center, Obninsk, Russia

Contact person: Milana Aslanovna Vologirova: This email address is being protected from spambots. You need JavaScript enabled to view it.

ABSTRACT

Purpose: To analyze a number of immunohistochemical markers as predictors of the radiosensitivity of rectal adenocarcinoma.

Material and methods: The study included 122 patients with histologically verified rectal adenocarcinoma, varying degrees of differentiation, and the stage of the tumor process I-IIIС, T2-T4b /N0-N2b/ M0, with the localization of the tumor in the lower-middle-ampullary parts of the rectum. Predictors included in the research: Ki67, р53, EGFR, Bcl2, COX2, P21, E-cadherin. Preoperative chemoradiotherapy was performed up to 48–50 Gy with the use of medications (5-FU, Cisplatin) as a radio modifiers. The analysis was carried out according to the degree of severity of therapeutic pathomorphosis (according to Mandard), a decrease in the stage before surgery.

Results: A full course of preoperative chemoradiotherapy followed by surgery was performed at 121 patients, one patient died of concomitant cardiac pathology during the break. The first degree of Mandard pathomorphosis (complete resorption) registered at 12 patients. The second degree (preservation of a few tumor cells against the background of fibrotic changes) – at 27 patients. The third degree (a large number of preserved tumor cells against the background of the predominance of fibrosis) – at 38 patients. The fourth degree (tumor cells predominate over fibrotic changes) – at 27 patients. The fifth degree (complete absence of signs of tumor regression, absence of fibrosis) – at 2 patients. A decrease in the stage of the tumor process according to the preoperative comprehensive examination registered in 114 (94.2%) patients, in 9 (7.4%) patients – there was no dynamics. During the observation period from 2006 until nowadays, 10 people are known to have died. Years in remission range from 3 months to 22 years. According to the results of multivariate and multiple regression analyses, it is possible to successfully predict the effectiveness of chemoradiotherapy, both with the use of biomarkers (Ki67, р53, EGFR, Bcl2, COX2, P21, E-cadherin), and traditional indicators (histological type, stage of the disease, gender, degree of differentiation). It turned out, that both traditional indicators and immunohistochemical indicators work equally well, regardless of each other.

Conclusion: Studied immunohistochemical predictors of radiosensitivity of rectal adenocarcinoma, allow to assess the degree of radiosensitivity or radioresistance of the tumor in each patient before the start of preoperative chemoradiotherapy by doing so, it warns us about the effectiveness or ineffectiveness of chemoradiotherapy in a specific clinical situation, which allows us to individualize the approach to treatment, choosing a more suitable treatment method for the patient: neoadjuvant chemotherapy or surgery.

Key words: locally advanced rectal cancer, preoperative chemoradiotherapy, therapeutic pathomorphosis, radiosensitivity predictors 

For citation: Vologirova MA, Volchenko NN, Zamulaeva IA, Sidorov DV, Boyko AV, Droshneva IV. Search of Predictors of Ra6iosensitivity in Rectal Adenocarcinoma. Medical Radiology and Radiation Safety. 2021;66(5):39-44.

DOI: 10.12737/1024-6177-2021-66-5-39-44

References

1. Sidorov D. V., 2011. Doctoral Dissertation: "Role of Total Mesorectumectomy in the Surgical and Combined Treatment of Patients with Rectal Cancer". (In Russian.).

2. Bailey C.E., Hu C.-Y., You Y.N., et al. 2015. Increasing Disparities in the Age-Related Incidences of Colon and Rectal Cancers in the United States, 1975–2010. JAMA Surg, 2015;150;1:17-22. https://doi.org/10.1001/jamasurg.2014.1756

3. Kaprin A.D., Starinsky V. V., Petrova G. V. State of Cancer Care in Russia in 2018. 2019; P. 80 (In Russian.).

4. Chernikovsky I. L. Multidisciplinary Approach to the Diagnosis and Treatment of Resectable Rectal Cancer. Practikal Oncology. 2015; 16. (2): 69-76. (In Russian.).

5. Rasulov A. O., 2012 Doctoral Dissertation: "Surgical Tactics after Chemoradiotherapy of Rectal Cancer". (In Russian).

6. Chernichenko M. A., 2016. PhD Thesis: "Optimization of Surgical and Combined Treatment of Patients with Lower Ampullary Rectal Cancer". P. 84, 121. (In Russian.).

7. Giralt J, Eraso A, Armengol M, Rossello J, et al. Epidermal Growth Factor Receptor of Tumor Response in Locally Advanced Rectal Cancer Patients Treated with Preoperative Radiotherapy. Int J Radiat Oncol Biol Phys 2002;54:1460-5. https://doi.org/10.1016/s0360-3016(01)01842-9.

8. Rau B, Sturm I, Lage H, Berger S, Schneider U, Hauptmann S, et al. Dynamic Expression Profile of P21waf1/Cip1 and Ki-67 Predicts Survival in Rectal Carcinoma Treated with Preoperative Radiochemotherapy. J Clin Oncol 2003;21:3391-401. https:// doi.org/10.1200/jco.2003.07.077.

9. Smith FM, Reynolds JV, Miller N, Stephens RB, Kennedy MJ. 2005. Pathological and molecular predictors of the response of rectal cancer to neoadjuvant radiochemotherapy. European Journal of Surgical Oncology: the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 01 Dec 2005, 32(1):55-64. https://doi.org/10.1016 /j.ejso.2005.09.010

10. Negri FV 1, Campanini N, Camisa R, Pucci F, Bui S, Ceccon G, Martinelli R, Fumagalli M, Losardo PL, Crafa P, Bordi C, Cascinu S, Ardizzoni A. Biological predictive factors in rectal cancer treated with preoperative radiotherapy or radiochemotherapy. British Journal of Cancer, 98:143–147.  2008 Jan 15.  https://doi.org/10.1038/sj.bjc.6604131.

 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: 18.01.2021. 

Accepted for publication: 25.03.2021. 

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 

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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.

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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. 

Medical Radiology and Radiation Safety. 2021. Vol. 66. № 5. P. 45–49

Patientoriented Algorithm for the X-ray Therapy Cabinet of Oncology Dispensary

J.A. Zuenkova¹, D.I. Kicha¹, A.Yu. Abramov¹, Y.G. Buynova², L.M. Klisova²

¹Peoples Friendship University of Russia, Moscow, Russia

²City Clinical Oncology Dispensary, Saint-Petersburg, Russia

Contact person: Zuenkova Yuliya Aleksandrovna: This email address is being protected from spambots. You need JavaScript enabled to view it.

ABSTRACT

Results: IIntroduction: Superficial X-ray therapy is a common treatment of non-melanoma skin cancer with a high incidence worldwide. Interrupting the course of radiation therapy can negatively affect patient survival and treatment results. Low treatment adherence may be associated with a lack of a patient-centered approach and ineffective communications. The original study shows that patients undergoing X-ray therapy for cancer may have different needs. Based on the study results an algorithm for a patient-oriented approach has been developed for the X-ray cabinets.

Purpose: To develop a patient-oriented algorithm of the X-ray therapy room to address the issues of increasing patient satisfaction and forming their adherence to treatment. The objectives of the study included studying and detailing the needs of the patients who passed the X-ray therapy and to develop the patient-oriented algorithm for the X-ray therapy room.

Material and methods: The study of the patient's values was carried out from 2019 to 2020 by interviewing using open-ended questions to find out the deep motives and beliefs of patients. The study was based on Milton Rokich’s (2005) model of value orientations, which was adapted to the objectives of the study.

Results: The study included 116 patients undergoing treatment with the X-ray therapy at the City Clinical Oncology Dispensary. As a result of the study, the following patient needs were identified: clinical outcome of the procedure 111 (96 %), safety of treatment and adverse reactions 106 (91 %), cosmetic outcome 53 (46 %), convenience of the treatment schedule 42 (36 %), painlessness of the procedure 39 (34 %), the ability to lead a normal lifestyle 27 (23 %), comfortable conditions for the procedure 16 (14 %), financial costs associated with treatment 10 (9 %), preservation of organ function 4 (3 %). On the basis of the data obtained, a patient-oriented algorithm for the X-ray therapy was developed, including a communication plan with the patient. The study results clearly demonstrate that even with the same disease and condition, patients may have different priorities hat need to be considered to improve patient experience and adherence to treatment.

Conclusion: Radiation treatment decision-making based on the patients values is important for the development of the patient-centered management in oncology since this directly affects patients’ adherence to treatment. Exploring the values and needs of patients is an opportunity to influence and improve the metrics of the patient experience. Due to the mass incidence of non-melanoma skin cancer, the introduction of patient-centered approaches is an important part of patient satisfaction and increase of patients adherence to the treatment.

Key words: quality of medical care, value-based healthcare, X-ray therapy, skin cancer

For citation: Zuenkova JA, Kicha DI, Abramov AYu., Buynova YG, Klisova LM. Patientoriented Algorithm for the X-ray Therapy Cabinet of Oncology Dispensary. Medical Radiology and Radiation Safety. 2021;66(5):45-49.

DOI: 10.12737/1024-6177-2021-66-5-45-49

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 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: 14.04.2021. 

Accepted for publication: 27.05.2021. 

Medical Radiology and Radiation Safety. 2021. Vol. 66. № 5. P. 59–65

Potential Possibilities of Nuclear Medicine Methods in Diagnostics Age Changes of the Cardiovascular System.

M.V. Vorontsova¹, A.A. Obrezan ², A.G. Obrezan ^1,2

¹JSC NOMECO, Saint-Petersburg, Russia

²Saint-Petersburg State University, Saint-Petersburg, Russia

Contact person: Andrei Andreevich Obrezan: This email address is being protected from spambots. You need JavaScript enabled to view it.

CONTENT

• Summary

• Introduction

• Structural and functional changes in the cardiovascular system during natural aging

• Methods for the study of age-related changes in the myocardium and large vessels used in clinical practice today

• The potential of nuclear medicine methods in the diagnosis of age-related changes in the cardiovascular system

• Conclusion

Key words: nuclear cardiology, radionuclide diagnostics, age changes, cardiovascular system, positron emission tomography 

For citation: Vorontsova MV, Obrezan AA, Obrezan AG. Potential Possibilities of Nuclear Medicine Methods in Diagnostics Age Changes of the Cardiovascular System. Medical Radiology and Radiation Safety. 2021;66(5):59-65.

DOI: 10.12737/1024-6177-2021-66-5-59-65

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Contribution. Article was prepared with equal participation of the authors

Article received: 23.12.2020. 

Accepted for publication: 20.01.2021.