OBJECTIVE

To improve the results of treatment of patients with locally advanced rectal cancer by creating a new variant of neoadjuvant therapy using polyradiomodification and systemic polychemotherapy.

MATERIAL AND METHODS

46 patients with locally advanced rectal cancer of stage T(3cd-4a)N(1c-2)M0, CRM+, EMVI+ were included in the program. RT was performed in hypofractionation mode from 4 G to SOD 40 G 3 times a week against the background of systemic polychemotherapy with Capecitabine 850 mg/m² per os 2 times a day for 1—22 days and Oxaliplatin 50 mg/m² iv on the 3rd, 10th and 17th days. Polyradiomodification was carried out by conducting 5 sessions of local microwave hyperthermia for 60 minutes at a temperature of 43—45 °C on the 8th, 10th, 15th, 17th and 22nd days and rectal administration of a biopolymer composition with Metronidazole at a dose of 10 g/m² on the 8th and 15thth days. The control group included 88 patients with neoadjuvant remote RT in a single focal dose 2Gy to to a total focal dose of 52—56 Gy while taking Capecitabine at 825 mg/m² twice a day during the course of treatment. The operations were performed 6—8 weeks after completion of the course of CRT and a control clinical examination.

RESULTS

When using the new treatment option, there was an increase in registered toxicity by 1.5 times and toxicity of 3—4 degrees by 2.5 times, however, in all patients the planned course of treatment was completed. Therapeutic pathomorphosis of the III and IV degrees was achieved in 76.4% compared with 30.6% in the control group (p=0.0001). The incidence of cancer recurrence was reduced from 12.5% to 2.2% (p=0.0469), and distant metastases — from 31.8% to 8.7% (p=0.0008). The five-year disease-free survival rate was increased from 56.8% to 81.0% (p=0.02031).

CONCLUSION

The results of the application of the created treatment option for patients with locally advanced rectal cancer indicate the prospects of combining polyradiomodification with systemic polychemotherapy.