Organ-sparing treatment for cancer of the lower ampulla of the rectum and anal canal

Solodkiy VA, Panshin GA, Kreinina YuM, Shevchenko LN, Petrovskiy VYu, Kaskulova MKh, Titova VA. Organ-sparing treatment for cancer of the lower ampulla of the rectum and anal canal. P.A. Herzen Journal of Oncology. 2023;12(3):5‑12. (In Russ.)
https://doi.org/10.17116/onkolog2023120315

Подписка 2026 Онкология. Журнал им. П.А. Герцена (P.A. Herzen Journal of Oncology)

Использование инфографики авторами научных работ

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OBJECTIVE

Improving the effectiveness of treatment of patients with lower ampullary rectal cancer (RC) and anal cancer (AC) when using external beam radiation therapy (EBRT) with brachytherapy (BT).

MATERIAL AND METHODS

The treatment of 85 patients with T1—3 using the TNM system was analyzed. The average age of the patients is 62.3 years, among them 38 men and 47 women. Due to the spread of the tumor, 70 (82.3%) patients were denied surgery. In the 1st group with EBRT, gamma radiation of 2 Gy/fraction was used, a total of 44—46 Gy. BT with a source of ⁶⁰Co was carried out on the primary tumor, 2Gy/fraction, 2 times a day, a total of 24 Gy. In the 2nd group, 3D conformal EBRT on LUE is 8—18 MeV, 2 Gy/fraction, a total of 44 Gy and BT with a source of ¹⁹²Ir 3 Gy/session, a total of 12—15 Gy. In the 1st group, neoadjuvant polychemotherapy was performed on 8 patients with cisplatin/fluorouracil or cisplatin/paclitaxel. In the 2nd group, all 27 patients used mitomycin at a dose of 8 mg/m² on the 1st day and capecitabine orally (1650 mg/m²) on the days of EBRT and in 9 patients with a residual tumor of more than 5 cm³, local laser hyperthermia was used. All patients at all stages of treatment/observation underwent dynamic monitoring using ultrasound/colonoscopy/MRI (according to RECIST v.1.1) — control.

RESULTS

After the completion of BT in the 1st group of the RC, complete and partial regression was noted in 81% of patients, and in the 2nd group of the RC — in 88.8%, in AC — in 94.4% of patients. The one-year overall survival rate in both groups was 100%. In the 1st group, progression was diagnosed in 12 (20.7%) patients within 8—11 months; in the 2nd group — in 5 (18.5%) with a median observation of 24 months. Radiation complications in the form of early rectitis/cystitis for RTOG I-II degree were observed in 81 (95.3%) patients in both groups.

CONCLUSION

Conformal EBRT and BT with dynamic ultrasound/colonoscopy/MRI control are the basis for improving the effectiveness of treatment of patients with RC of the lower ampullary department and AC.

Keywords:

rectal cancer

anal cancer

conformal external beam radiation therapy

brachytherapy

local laser hyperthermia

Authors:

Solodkiy V.A.

Russian Research Center of Radiology

SPIN RSCI: 440543
Scopus AuthorID: 57204298158
ResearcherID: T-6803-2017
ORCID: 0000-0002-1641-6452

Panshin G.A.

Russian Research Center of Roentgenology and Radiology

ORCID: 0000-0003-1106-6358

Kreinina Yu.M.

Russian Radiology and Nuclear Medicine Research Center of the Ministry of Health of Russia

ORCID: 0000-0002-7229-594X

Shevchenko L.N.

Russian Radiology and Nuclear Medicine Research Center of the Ministry of Health of Russia

ORCID: 0000-0003-0032-1747

Petrovskiy V.Yu.

Russian Research Center of Roentgenology and Radiology

ORCID: 0000-0001-6588-5557

Kaskulova M.Kh.

Russian Radiology and Nuclear Medicine Research Center of the Ministry of Health of Russia

ORCID: 0000-0001-5467-1940

Titova V.A.

Russian Research Center of Roentgenology and Radiology

ORCID: 0000-0001-9927-7832

Received:

11.11.2022

Accepted:

06.02.2023

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