Anal Carcinoma A comparative analysis of the standard treatment vs An hypofractionated schedule (the Tlalpan Regime) experience at the Instituto Nacional de Cancerología, México

Abstract

Introduction: Stage II colon cancer is a pathologically heterogeneous group with a very heterogeneous prognosis. The prognosis of localized colorectal cancers is primarily based on the TNM classification. Survival after a diagnosis of colon cancer is strongly influenced by the histo-prognostic stage. Determination of MSI status is useful for discussing the indication of adjuvant chemotherapy for a patient with stage colon cancer II with factors of bad prognosis. Methods: This is a retrospective study including patients with stage II colon cancer managed in the medical oncology department of Hassan II university hospital, Fes Morocco, over the period from January 2014 to June 2018. The objective of our study is to describe the epidemiological, clinicopathological, and prognostic aspects of stage II colon cancer, and to report our experience regarding their therapeutic management.Results: Sixty-one cases have been identified. The average age of patients is 56.4 years (25-73), with a peak incidence between 40 and 50 years. A slight female predominance was noted with a sex ratio (M/F) of 0.94. The tumor location was on the right side in 29.7%, on the left side in 54.04%, and 16.1% were on the transverse colon. All our patients underwent surgical treatment, with 40.5% of the patients having a hemicolectomy. In our series, the determination of the MSI status was as follows: 43.3% of the patients had an MSI status, 56.7% had a stable phenotype. The other pathological prognostic factors were as follows: the diagnosis was revealed by an acute occlusive syndrome or colonic perforation in 23.5%, the number of the ganglia examined was insufficient in 13.7% of the cases. Histologically, the well-differentiated type was found in 59.4%, followed by moderately differentiated adenocarcinomas in 27.02% of cases. Regarding the TNM classification, parietal invasion (pt4) was found in 19.6%, the presence of vascular emboli in 18.4% of cases, and 13.5% had a peri-nerve injury. 67.5% of patients were eligible for adjuvant chemotherapy. The chemotherapy used was a combination of oxaliplatin and 5FU in 55.1% while capecitabine monotherapy was prescribed in 16.2% of cases. Patients were followed up to a median of 57 months. Median overall survival was 40.3 months and progression-free survival was 12.8 months. Survival has been prolonged in MSI patients; overall survival (OS) and relapse-free survival (SSR) were 42.6 and 14 months for MSI tumors, and 38 and 11.6 months for those with MSS status, respectively. Chemotherapy was relatively well tolerated hematologically and digestively. The acute toxicities observed were essentially grade 1 or 2. They consisted mainly of vomiting and diarrhea in 25% of cases, peripheral neuropathy in 21.5% of cases and neutropenia in 8.5% of cases. Conclusion: Factors predicting the prognosis of localized colorectal cancer are primarily based on the TNM classification. Other morphological factors could make their introduction but require a prospective validation for their use in clinical practice. Of the mole...