Preoperative radiation and chemotherapy for locally advanced colorectal cancer with poor prognostic factors
The article presents immediate and delayed results of combined treatment of locally advanced colorectal cancer. 73 patients with cT3-4, cN0-2, cM0-1 locally advanced colorectal cancer were involved in the study. Before surgical operation all patients were treated with conventional fractionated radiation therapy (50 Gy) and concomitant CapOx chemotherapy. Toxic effect during combined radiation and chemotherapy were developed in 28 patients (38.3%). Complications of the grade 3 were developed in 4 (45%) patients. Surgical operation, total mesorectal excision, was performed on 70 patients (95.9%). Laparoscopic technique was used in 44 (62.9%) cases, the direct approach was used in 26 (37.1%) cases, difference in duration of operations was statistically significant (OR 2.865 [95% CI: 1.442-5.686], p=0.0039). 47 patients (67.1%) underwent sphincter-preserving operations. Post-operative complications were developed in 16 patients (22.9%). Radical R0 resection of the tumor was performed on 61 patients (87.1%), R1 resection - in 9 (12.9%) patients. Complete regression was observed in 13% of cases. Two-year survival rate in the group was 82.8±6.0%. Disease free survival of patients with yp-stage 0 and yp-stage I was 100%, the survival of patients with yp-stage III was 65.6±14.0%, statistically significant difference c2 was 5.853; р=0.016. Disease free survival after R0 resection was reliably higher than survival after R1 resection (R0 resection 84.7±6.4%, R1 resection 50.0±25.0%, р=0.041). Acceptable toxicological profile and good regression of the primary tumor were observed in patients with locally advanced colorectal cancer after preoperative radiation therapy (50 Gy) and concomitant CapOx chemotherapy. To a large extent treatment results, quality of life of cancer patients depend on the well-coordinated work of multidisciplinary team.