ВведениеКолоректальный рак за последние 10-20 лет неуклонно наращивает своё присутствие в структуре опухолевых заболеваний [1, 2]. Сегодня это одна из наиболее распространённых опухолей в мире, занимающая 3-е место в структуре смертности от злокачественных новообра-зований. В РФ рак ободочной кишки находится на 4-м месте, рак прямой кишки -на 5-м: 7,6% и 5,9% соответственно. «Классическими» стали данные о том, что на момент выявления опухо-левого поражения толстой кишки у половины пациентов имеется метастатическое поражение печени, драматически ухудшающее прогноз заболевания [1]. Современное лечение колорек-тального рака базируется на двух важнейших составляющих -прогрессе хирургических техно-логий и внедрении новейших методик лучевой и лекарственной терапии [3, 4]. В настоящее время принято выделять в отдельные группы больных местнораспространён-ным раком прямой кишки и больных, течение заболевания у которых осложнилось целым рядом Бердов Б.А. -зав. отд., д.м.н., проф.; Ерыгин Д.В.* -вед. научн. сотр., к.м.н.;. Березовская Т.П. -гл. научн. сотр., д.м.н., проф.; Титова Л.Н. -врач, к.м.н.; Карпов А.А. -научн. сотр. МРНЦ им. А.Ф. Цыба -филиал ФГБУ «НМИРЦ» Минздрава России.
The purpose of the study was to evaluate the prognostic significance of carcinoerembryonic antigen in patients with rectal cancer and correlate its baseline with the degree of therapeutic pathomorphosis after neoadjuvant chemoradiotherapy.Materials and methods. An estimate of the informative value of carcinoerembryonic antigen (CEA) indices in 179 patients with colorectal cancer determined before and after preoperative chemoradiotherapy (CRT) in SOD 50 Gy.Results. Analysis of the results presented in the study showed that in all patients, CRT caused a significant decrease in the level of CEA (–71%) 10 weeks after its end (p < 0.001). In the course of the pathomorphological study, after the neoadjuvant treatment, the first degree of tumor pathomorphism was recorded in 4.5% of patients, II – 38.5%, III – 45%, IV – 12% (the degree of pathomorphosis is not related to the clinical stage and the degree of differentiation of colorectal cancer). It was revealed that patients with III and IV degrees of therapeutic pathomorphosis initially had a CEA level lower, in comparison with patients with grade I-II. Clinical progression of the disease is diagnosed in 24% of cases (43/179). It was noted that in patients with the IV degree of therapeutic pathomorphism of the tumor, no recurrence of the rectal cancer was detected in either case.Conclusion. The results of the study showed that the problem of individual prediction of the effectiveness of combined treatment of the rectal cancer remains very relevant, rather complicated and yet not completely solved. However, it can be assumed that the use of such an indicator as CEA in monitoring patients after the treatment, can serve as a criterion for the sensitivity of colorectal cancer to CRT. Initially low antigen level can be considered as a positive factor of tumor response to ongoing treatment and disease-free survival of patients with locally advanced rectal cancer.
OBJECTIVE. The article analyzed an efficacy and safety of application of neoadjuvant chemoradiotherapy (CRT) in elderly and senile patients with rectal cancer. MATERIAL AND METHODS. An analysis of treatment results was made in 267 patients, who were divided into two groups. The first group (n = 142) underwent combined treatment that included prolonged course of neoadjuvant CRT followed by surgery. The second group of 125 patients underwent surgery without application of CRT. The patients of both groups were subdivided according their age. The subgroup “A” consisted of young and middle age patients. The subgroup “B” included geriatric patients. Comparative analysis was made between the same age subgroups. RESULTS. The age factor didn’t significantly influence on the risk of complications of neoadjuvant CRT and its adverse effects on subsequent outcome of surgery. The application of preoperative CRT in geriatric patients accompanied by less significant growth of recurrence-free survival compared with young patients. CONCLUSIONS. The age factor shouldn’t restrict the application of neoadjuvant CRT in patients with satisfactory general health status and absence of tumor complication process.
Carcinoembryonic antigen (CEA) is widely used to evaluate the effectiveness of treatment in patients with rectal cancer.The aim of the studywas to investigate whether the CEA levels measured before and after neoadjuvant chemoradiotherapy (nCRT) can be used to predict pathological complete response (pCR) in patients with locally advanced rectal cancer.Material and methods.179 patients with locally advanced rectal cancer were treated with nCRT followed by surgical treatment. The serum CEA level was measured before and 610 weeks after the completion of nCRT. Preand post nCRT CEA levels were compared with pCR. The factors associated with pCR were studied.Results.pCR after nCRT was achieved in 12 % (22/179) patients. The incidence of pCR was higher in patients with normal (<5 ng/mL) pre-treatment CEA level (20 %vs8 %, p=0.019). In patients with the elevated pre-treatment CEA level (> 5 ng/mL), there were no significant differences in the incidence of pCR between cases with normalization and without normalization of CEA level after treatment (p=0.08). The maximum likelihood of pCR determined by the ROC curve was <2.8 ng/mL with pre-treatment CEA (31 %) and <1.8 ng/mL with post-treatment CEA (23 %). Well differentiated tumors (G1) had higher likelihood of pCR (46%) in patients with low pre-treatment CEA (<2.8 ng/mL).Conclusion.Low CEA before and after nCRT is a predictor of pCR. Well differentiated tumors increase the probability of pCR after nCRT.
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