Medical Radiology and Radiation Safety. 2023. Vol. 68. № 5
DOI:10.33266/1024-6177-2023-68-5-77-81
D.A. Plaskeeva1, A.I. Konovalov2, Zh.A. Startseva2, S.G. Afanasyev2
Thermoradiochemotherapy in the Combined Treatment of Rectal Cancer
1 Tomsk Regional Oncology Center, Tomsk, Russia
2 Tomsk National Research Medical Center, Tomsk, Russia
Contact person: D.A. Plaskeeva, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
ABSTRACT
Currently, the treatment of rectal cancer requires a multidisciplinary approach. So the combined method of treatment, including chemoradiotherapy and the surgical stage, has proven itself reliably. However, the desired results that significantly increase the rates of relapse-free and metastatic survival have not yet been achieved. The use of radio modifiers makes it possible to enhance radiation exposure without increasing the total focal dose. One of the universal radio modifiers is local hyperthermia.
Purpose: To develop a method of thermoradiochemotherapy in the combined treatment of distal rectal cancer and evaluate its effectiveness.
Material and methods: This work is based on the analysis of the results of treatment of 141 patients with morphologically confirmed locally advanced distal rectal cancer. In accordance with the objectives of the study, all patients were divided into 2 groups. In the combined treatment of 75 patients, the first stage was performed chemoradiotherapy (CLT) in combination with local hyperthermia (LH). Local hyperthermia was not used in the treatment of 66 patients.
Results: Long-term results of complex treatment of patients with an independent course of chemoradiotherapy/thermochemoradiotherapy (dynamic observation group) and after surgical treatment are presented. One – year relapse-free survival in the group with an independent course of TRHT was 96.7 %, in the CLT group – 79.3 % (p=0.024). There was a significant increase in three–year relapse-free survival – 93.3 % versus 76.7 % in the control (p=0.041). Among patients who underwent surgical treatment at the second stage, the study of one-year relapse-free survival did not reveal statistical significance. Three – year relapse-free survival in patients with TRHT compared with the CLT group was 96.2 % versus 86.0 % (p=0.038). The effectiveness of thermoradiochemotherapy in patients of this category was evaluated. The tolerability of treatment in all patients is satisfactory. Among all radiation reactions, the most frequently observed phenomena of radiation epidermitis I–II art. in the projection of irradiation fields (Table 1). Acute radiation reactions were reversible and did not have a negative effect on the subsequent stages of treatment. Treatment for all patients (n=141) was implemented in full.
Keywords: rectal cancer, combined treatment, surgery, local hyperthermia, radiation therapy, chemotherapy
For citation: Plaskeeva DA, Konovalov AI, Startseva ZhA, Afanasyev SG. Thermoradiochemotherapy in the Combined Treatment of Rectal Cancer. Medical Radiology and Radiation Safety. 2023;68(5):77–81. (In Russian). DOI:10.33266/1024-6177-2023-68-5-77-81
References
1. World Health Statistics 2021: Monitoring Health for the SDGs, Sustainable Development Goals. Geneva, World Health Organization, 2021. Licence: CC BY-NC-SA 3.0 IGO, ISBN 978-92-4-002705-3.
2. Kaprin A.D., Starinskiy V.V., Shakhzadova A.O. Malignant Neoplasms in Russia in 2021 (Morbidity and Mortality). Moscow Publ., 2022 (In Russ.).
3. Starodubtseva D.A., Startseva Zh.A., Afanasyev S.G., Dobrodeyev A.Yu. Thermoradiotherapy in Combined Modality Treatment for Rectal Cancer (Literature Review). Sibirskiy Onkologicheskiy Zhurnal = Siberian Journal of Oncology. 2018;17;2:89–94. doi: 10.21294/1814-4861-2018-17-2-89-94 (In Russ.).
4. Barsukov Yu.A., Kuzmichev D.V. Tkachev S.I. Aliyev V.V., et al. Combination Neoadjuvant Thermochemical Therapy in Patients with Rectal Cancer. Oncological Coloproctology. 2014;3:23-28. DOI:10.17650/2220-34782014-0-3-23-28
(In Russ.).
5. Bray F., Ferlay J., Soerjomataram I., Siegel R.L., Torre L.A., Jemal A. Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J. Clin. 2018;68;6:394-424. doi: 10.3322/caac.21492.
6. Glimelius B. The Swedish Approach. Comprehensive Rectal Cancer Care. Ed. Kwaan M., Zbar A. Springer, Cham, 2019. P. 335-353. doi:10.1007/978-3-319-98902-0_19.
7. Lanning R.M., Goodman K.A. Radiation Therapy: The North American Approach. Comprehensive Rectal Cancer Care. Ed. Kwaan M., Zbar A. Springer, Cham, 2019. P. 365-403. doi: 10.1007/978-3-319-98902-0_21.
8. Dayde D., Tanaka I., Jain R., Tai M.C., Taguchi A. Predictive and Prognostic Molecular Biomarkers for Response to Neoadjuvant Chemoradiation in Rectal Cancer. Int. J. Mol. Sci. 2017;18;3:573. doi: 10.3390/ijms18030573.
PDF (RUS) Full-text article (in Russian)
Conflict of interest. The authors declare no conflict of interest.
Financing. The study had no sponsorship.
Contribution. Startseva Zh.A.: scientific management of the research, correction of the content of the article, approval of the final version of the article; Afanasyev S.G.: scientific management of the research, correction of the content of the article, approval of the final version of the article; Plaskeeva D.A.: analysis and interpretation of the results of the work, writing the text, collecting clinical material; Konovalov A.I.: development of the concept and design of the study, correction of the content of the article.
Article received: 20.04.2023. Accepted for publication: 27.05.2023.