The choice of treatment option for patients with rectal cancer (RC) is determined by the stage, tumor location, involvement of the circular resection margin, the presence of extramural vascular invasion, and the degree of tumor differentiation. Existing clinical guidelines are cumbersome, with a complex and ambiguous algorithm for treatment selection.

OBJECTIVE

Development of a personalized approach to the treatment of RC patients depending on a set of prognostic factors.

MATERIAL AND METHODS

To increase the ablasticity of standard operations, a short course of preoperative radiation therapy (RT) with a total dose of 25 Gy with radiomodification by Capecitabine (RT25+CT) was used in 241 patients with resectable RC. A prolonged course of hypofractionated RT with a total dose of 40 Gy against the background of polychemotherapy (RT40+PCT) was used in 46 patients with a high risk of progression and in 116 patients with locally advanced primary unresectable cancer.

RESULTS

When using RT25+CT, cancer recurrence occurred in 0.4%, distant metastases — in 17.8% of patients, 5-year relapse-free survival (RFS) was 80.5%, sphincter-preserving operations (SPO) were performed in 82.5%. The use of RT40+PCT in 46 patients with a high risk of progression (stage T3d-4aN2M0, EMVI+, CRM+) allowed to perform SPO in 67.4%, and 3 patients were not operated due to complete tumor regression and no progression was noted within 5 years. No cancer recurrence was detected in 43 operated patients, distant metastases occurred in 11.6%, and the RFS was 88.6%. The same technique was used in 116 patients with primarily unresectable rectal cancer: resection operations were performed in 90.5%, of which 94.3% were R0 resections, SPO in 65.7%, relapses were detected in 17.1%, distant metastases in 21.9%, and RFS was 56%.

CONCLUSION

The developed classification of the progression risk is characterized by simplicity, allowing, based on clear prognostic criteria, to choose the treatment method for patients with non-disseminated rectal cancer, providing the most favorable long-term results.