THE RATE OF PATHOLOGICAL COMPLETE RESPONSE AND LONG-TERM OUTCOMES OF COMBINED TREATMENT FOR MIDDLE AND LOW RECTAL CANCER

The increasing rate of colorectal morbidity, in particular rectal cancer, and not always good results of the treatment form the necessity of searching for the new approaches to the treatment.

Purpose: The purpose of the study was the research of different regimens of inductive therapy for middle and low rectal cancer. The rate of the tumor pathological complete response (pCR) and long-term results of the treatment were evaluated.

Methods: 253 patients were included in the research. They were divided into four groups depending on the kind of preoperative treatment: the first group – radiotherapy (RT) with total focal dose of radiation 38–44 Gy, n = 71, the second group – RT 45–50 Gy, n = 34, the third group – chemoradiotherapy (CRT) 38–44 Gy, n = 49, the fourth group – CRT 45–50 Gy, n = 99. The RT was administered in daily fractions of 1.8 to 2.0 Gy, five days per week. Five-fluorouracil alone or combined with calcium folinate, capecitabine, tegafur, oxaliplatin combined with capecitabine or 5-fluorouracil and calcium folinate were used as a radiation sensitizer. The long term results were evaluated depending on pCR. There were 18 patients with pCR and median follow up of 31 months, 181 patients with no pCR and follow up of 30 months.

Results. The pCR was registered in: the first group – in five (7 %) cases, the second group – in three (9 %) cases, the third group – in one (2 %) case, the fourth group – in 15 (15 %) cases. The overall rate of pCR was 9.4 %. The rate of local relapses among patients with pCR was 5.5 %, without pCR – 7.7 % (р = 0.89). The rate of relapse free survival was 83 and 74.5 % respectively (р = 0.417). The rate of disease free survival was 94 и 83.9 % respectively (р = 0.228).

Conclusion. The best long-term outcomes of combined treatment for middle and low rectal cancer performed the patient with pCR, however, considering the paucity of this group, no evident differences between groups under study were identified, which requires further research.

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