Therapeutic effectivness of the neoaduvante combine antitumor treatment of the squamous cell carcinoma and adenocarcinoma of the anal canal
The article describes therapeutic effectiveness of the chemotherapy with Cisplatin (c-DDP) in patients with cancer of the anal canal, after combined anti-tumor therapy. Cisplatin (c-DDP) has an anti-tumor effect by the phospho-lylation of the Chk 1 Chk 2 kinases, it causes the arrest of the cell cycle in the G2 phase (Zamay T.N., Starkov A.K., 2020). In the blood CIsplastin (c-DDP) is distributed to the at least three chemical pools a «free» or «filterable» fraction, a protein-bound fraction and an erythrocyte-bound fraction (Dewit L., 1986) [16]. Bleomycin can reduce the number of macrophages in the intestinal tissue of the lungs, has a toxic effect on the tissue of the lung, leads to hypertrophy of the peribronchal connective tissue, and a decrease in the volume of the lumen of the alveoli thereby disrupting immune processes and developed irreversible pulmonary fibrosis and drug pulmonitis [9, 10, 11, 12]. A retrospective analysis of the patients suffering from cancer of the anal canal was carried out at the N.N. Blochin National Medical Research Center of Oncology, RAMS of the Ministry of Health of the Russian Federation. The patients underwent EBRT for five days, daily, in a single dose of radiation (ROD5,0 Gy), total dose of radiation (SOD) to 25 Gy for adenocarcinoma. In 3-4 weeks after the beginning of radiation exposure, an operation was performed in an extended mode. The morphological assessment of the degree of therapeutic pathomorphosis was determined by the method of Dworak J., 1997, Lavnikova A.G., 1976. Mathematical calculation of indicators was carried out using the x2=(chi-square) criterion. Using a four-field table, the OR (odds ratio) was calculated, the risk of adverse events was assessed by comparing the indicators with 1 Values were considered statistically significant. In case of adenocarcinoma on the days of radiation therapy, microwave hyperthermia was carried out 2 times a week, at a temperature of 41-43°C for 60 minutes with an interval of 72 hours, on days 3, 4 and 5 of radiation exposure together with intra-rectal administration of metronidazole for 3,5 sessions of hyperthermia, in combination with Capecitabine (Xeloda) at a dose of 1300 mg / m2 and 5-FU at a dose of 1000 mg / m2 / day, 1st, 4th, 29th, 32nd days intravenously (Anan'ev V.S., Artamonov E.V. Achkasov S.I., 2014). In case of squamous cell carcinoma, total dose of radiation (SOD) 40-44 Gy, an additional boost in SOD10-26 Gy was used. On the 1st and 29th days of RT, Cisplatin (c-DDP) was used in a dose of 60 mg / m2 / day, by infusion, drip, as well as Bleomycin at a dose of 15 mg / m2 intramuscularly, for 3-4 weeks (Anan'ev V.S., Artamonov E.V. Achkasov S.I., 2014). Our data were statistically significant in the patient group with Cisplatin and Bleomycini, compared to the control group without Cisplatin and Bleomycini. The data show х2=3,38, х2=2,4 with survival, without metastasis, respectively. The presence of therapeutic pathomorphosis in the group with the use of Cisplatin (c-DDP), compared to the group without Cisplatin (c-DDP), was determined more frequently (х2=1,7, p<0,05). It is necessary to continue prescribing these medications regardless of their side and adverse effects.