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MULTIDISCIPLINARY APPROACH IN THE TREATMENT OF PATIENTS WITH RECTAL CANCER

https://doi.org/10.18027/2224-5057-2014-3-64-67

Abstract

Surgical treatment is the "gold standard" in the treatment of patients with rectal cancer. The aim of surgical treatment is to minimize the rate of local recurrence, the occurrence of which depends largely on the quality of procedures.

Relationship between the tumor and own fascia of the rectum is the cornerstone in the choice of treatment strategy. Even using modern surgical techniques, most tumors of the rectum below the peritoneum should be treated using preoperative radiotherapy. Preoperative radiation can reduce the incidence of local recurrence and to create conditions for increasing the number of sphincter-preserving operations. The degree of tumor regression after chemoradiation is directly correlated with survival and local recurrence. Tumor regression creates prerequisites for decrease of postoperative complications and mortality related to the implementation of extensive radical surgery in patients with a tumor of the rectum. The use of standardized systems for the assessment of tumor regression can provide valuable information for centers specializing in the treatment of patients with such pathology. MRI of the pelvic organs is a very effective tool in the initial evaluation of the degree local and regional spreading of colorectal cancer including relationship to the mesorectal fascia. Difficulties in predicting of complete pathologic regression of the tumor by MRI are associated primarily with the problem of differential diagnosis between tumor and post-radiation changes in the rectal wall and surrounding tissues. A multidisciplinary approach provides the accuracy of staging and facilitates the development of an optimal treatment strategy in patients with rectal cancer.

About the Author

Igor V. Pravosudov
НИИ онкологии им. Н.Н. Петрова Минздрава РФ, Санкт Петербург
Russian Federation


References

1. Злокачественные новообразования в России в 2004 году (заболеваемость и смертность) / под ред. В. И. Чиссова, В. В. Старинского. – М.: Антиф, 2005. – 258 с.

2. Sauer R., Becker H., Hohenberger W. et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004; 351 (17): 1731–1740.

3. Vauthey J. N., Marsh R. W., Zlotecki R. A. et al. Recent advances in the treatment and outcome of locally advanced rectal cancer. Ann Surg 1999; 229 (5): 745–754.

4. Kapiteijn E., Marijnen C. A.M., Nastegaal I. D. et al. Preoperative radiotherapy combined with total mesorectal excision for resectabl rectal cancer. N Engl Med 2001; 345: 638–646.

5. Perez R. O., Habr-Gama A., Proscurshim I. et al. Local excision for ypT2 rectal cancer-much ado something. J Gastrointest Surg 2007; 11: 1431–1440.

6. Chan A. K., Wong A., Jenken D., et al. Posttreatment TNM staging is a prognostic indicator of survival and recurrence in tethered or fixed rectal carcinoma after preoperative chemotherapy and radiotherapy. Int J Radiat Oncol Biol Phys 2005; 61: 665–677.

7. Kim D. W., Kim D. Y., Kim T. H., et al. Is T classification still correlated with lymph node status after preoperative chemoradiotherapy for rectal cancer? Cancer 2006; 106: 1694–1700.

8. Stipa F., Chessin D. B., Shia J., et al. A pathologic complete response of rectal cancer to preoperative combined-modality therapy results in improved oncological outcome compared with those who achieve no downstaging on the basis of preoperative endorectal ultrasonography. Ann Surg Oncol 2006; 13: 1047–1053.

9. Quirke P., Dixon M. F. The prediction of local recurrence in rectal adenocarcinoma by histopathological examination. Int J Colorectal Dis 1988; 3 (2): 127–131.

10. Wittekind Ch., Compton C., Quirke P. et al. A uniform residual tumour classification. Integration of the R classification and the circumferential margin status. Cancer 2009; 115: 3483–3488.

11. Capirci C., Valentini V., Cionini L. et al. Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer: long-term analysis of 566 ypCR patients. Int J Radiat Oncol Biol Phys 2008; 72 (1): 99–107.

12. Rоdel C., Martus P., Papadoupolos T. et al. Prognostic significance of tumor regression after preoperative radiotherapy for rectal cancer. J Clin Oncol 2005; 23 (34): 8688–8696.

13. Chen C. C., Lee R. C., Lin J. K. et al. How accurate is magnetic resonance imaging in restaging rectal cancer in patients receiving preoperative combined chemoradiotherapy? Dis colon rectum 2005; 48 (4): 722–728.

14. MERCURY study group. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. B.M.J. 2006; 333 (7572): 779–784.

15. Smith N. J., Barbahano Y., Norman A. R. et al. Prognostic significance of magnetic resonance imaging-detected extramural vascular invasion in rectal cancer. Br. J. Surg. 2007; 95 (2): 229–236.

16. Eisenhauer E. A. et al. New response evalution criteria in solid tumors: revised RECIST guideline (version 1.1). Eur. J. Cancer 2009; 45 (2): 228–47.

17. Blomqvist L., Machado M., Rubio C. et al. Rectal tumour staging: MR imaging using pelvic phased-array and endorectal coils-vs endoscopic ultrasonography // Eur. Radiol. – 2000. – Vol. 10, № 4. – P. 653–660.

18. Habr-Gama A., Perez R. O., Nadalin W. et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann.Surg. 2004; 240: 711–717.

19. Правосудов И. В., Алиев И. И., Шулепов А. В. с соавт. Мультидисциплинарный подход к лечению больных раком прямой кишки: оценка клинического и патологического ответа у больных, получавших предоперационную химиолучевую терапию. Онкологическая колопроктология 2012; № 1: 7–11.

20. Fuchsjager M. H., Maier A. G., Schima W. et al. Comparison of transrectal sonography and double – contrast MR imaging when staging rectal cancer. Am. J. Roentgenol. 2003; 181 (2): 421–427.

21. Theodoropoulos G., Wise W. E., Padmanabhan A. et. al. T-level downstaging and complete pathologic response after preoperative chemoradiation for advanced rectal cancer results in decreased recurrence and improved disease-free survival. Dis. Colon Rectum 2002; 45: 895–903.

22. Garcia-Aguilar J. Hernandez de Anda E., Sirivongs P. et al. A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision. Dis. Colon Rectum 2003; 46: 298–304.

23. Crane C. H. Skibber J. M. Birnbaum E. H., et al. The addition of continuous infusion 5-FU to preoperative radiation therapy increases tumour response, leading to increased sphincter preservation in locally advanced low rectal cancer. Int.J.Radiat. Oncology Biol. Phys. 2003; 57: 84–9.

24. Guillem J. G. Chessin D. B. Shia J. et al. Clinical examination following preoperative chemoradiation for rectal cancer is not a reliable surrogate endpoint. J. Clin. Oncol. 2005; 23: 3475–9.

25. Hoffmann K. T., Rau B., Wust P. et al. Restaging of locally advanced carcinoma of the rectum with MR imaging after preoperative radio-chemotherapy plus regional hyperthermia. Strahlenther Oncol. 2002; 178 (7): 386–392.

26. Maier A. G., Barton P. P., Neuhold N. R. et al. Peritumoral tissue reaction at transrectal US as a possible cause of overstaging in rectal cancer: histopathologic correlation. Radiology 1997; 203 (3): 785–789.


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For citations:


Pravosudov I.V. MULTIDISCIPLINARY APPROACH IN THE TREATMENT OF PATIENTS WITH RECTAL CANCER. Malignant tumours. 2014;(3):64-67. (In Russ.) https://doi.org/10.18027/2224-5057-2014-3-64-67

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