Intenzivnejše neoadjuvantno zdravljenje lokalno napredovalega raka danke

doktorska disertacija

Danijela Golo (Author), Vaneja Velenik (Mentor), Stojan Potrč (Thesis defence commission member), Pavel Skok (Thesis defence commission member), Matjaž Horvat (Thesis defence commission member), Stojan Potrč (Co-mentor)

Abstract

Izhodišče in namen Z namenom izboljšanja učinkovitosti zdravljenja lokalno napredovalega raka danke (LNRD) smo okrepili neoadjuvantni del z umestitvijo treh krogov sicer adjuvantne kemoterapije kot en indukcijski in dva konsolidacijska kroga. Materiali in metode Med oktobrom 2011 in aprilom 2013 je bilo v raziskavi zdravljenih 66 bolnikov z LNRD z uvodnim krogom, kemoradioterapijo in dvema konsolidacijskima krogoma kemoterapije. Operacija je sledila po 2 tednih, nato so bolniki prejeli še 3 kroge adjuvantne kemoterapije. Obsevani so bili na linearnem pospeševalniku, s tumorsko dozo 45 Gy ter dodatkom doze do 50,4 Gy na T2-3 in do 54 Gy na T4 tumor, v dnevnih odmerkih po 1,8 Gy. Sočasno so prejemali kapecitabin v odmerku 825 mg/m² dvakrat dnevno, vključno z vikendi. Uvodno, konsolidacijsko in pooperativno so prejemali kapecitabin v odmerku 1250 mg/m²/12 ur v 14-ih zaporednih dneh s tedenskim razmikom med krogi. Primarni cilj je bil popolni patološki odgovor (pCR). Rezultati Triinštirideset (65.1%) bolnikov je prejelo zdravljenje po protokolu. Skladnost z indukcijsko, konsolidacijsko in adjuvantno kemoterapijo je bila 98,5 %, 92 % in 87,3 %. Radiokemoterapijo je zaključilo 65/66 bolnikov z 13,6 % G ≥ 3 ne-hematološko toksičnostjo. Stopnja pCR (17,5 %) sicer ni bila statistično značilno boljša, opazovali pa smo precejšnje znižanje N (77,7 %) in celokupnega stadija (79,3 %). V srednjem času sledenja 55 mesecev smo zabeležili en lokalni recidiv (LR = 1,6 %), 64,0 % (95 % IZ 63,89 – 64,11) 5 letno preživetje brez bolezni (PBB) in 69,5 % (95 % IZ 69,39 – 69,61) 5 letno celokupno preživetje (CP). Zaključki Okrepitev predoperativnega zdravljenja LNRD z dodatno kemoterapijo s kapecitabinom pred in po kemoradioterapiji spremlja sprejemljiva toksičnost, zato jo bolniki dobro prenašajo in jih večina tudi zaključi zdravljenje po protokolu. Z njim sicer ne izboljšamo lokalnega učinka, dosegamo pa dobro lokalno kontrolo, PBB in CP.

Keywords

neoadjuvantna kemoterapija;konsolidacijska kemoterapija;kemoradioterapija;kapecitabin;kirurško zdravljenje;

Data

Language:	Slovenian
Year of publishing:	2018
Typology:	2.08 - Doctoral Dissertation
Organization:	UM MF - Faculty of Medicine
Publisher:	D. Golo]
UDC:	616.351-006-036.8-085(043.3)
COBISS:	297815552
Views:	1421
Downloads:	88
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Other data

Secondary language:	English
Secondary title:	Intensified neoadjuvant treatment of locally advanced rectal cancer
Secondary abstract:	Background and Purpose To improve the treatment efficacy for locally advanced rectal cancer (LARC) by shifting half of adjuvant chemotherapy (ChT) preoperatively to one induction and two consolidation cycles. Materials and Methods Between October 2011 and April 2013, 66 patients with LARC were treated with one induction chemotherapy cycle followed by chemoradiotherapy (CRT) and two consolidation cycles. After two weeks, the patients were operated and administered three adjuvant capecitabine cycles. Patients were irradiated with a linear accelerator, using a 1.8 Gy daily fraction to 45.0 Gy with a sequential boost to 5.4 Gy in T2-3, and to 9.0 Gy in T4 tumors. The dose of concomitant capecitabine was 825 mg/m²/12h and the dose of neo/adjuvant capecitabine 1250 mg/m²/12h in 14 consecutive days. The primary endpoint was pathologic complete response (pCR). Results 43 (65.1 %) patients were treated according to protocol. The compliance rates for induction, consolidation, and adjuvant ChT were 98.5 %, 92 % and 87.3 %, respectively. CRT was completed by 65/66 patients, with G ≥ 3 non-hematologic toxicity at 13.6 %. The rate of pCR (17.5 %) was not increased, but N and the total-down staging rates were 77.7 % and 79.3 %, respectively. In a median follow-up of 55 months, we recorded one local relapse (LR = 1.6 %). The 5-year disease-free survival and overall survival rates were 64.0 % (95 % CI 63.89 – 64.11) and 69.5 % (95 % CI 69.39 – 69.61), respectively. Conclusions In LARC, the intensification of preoperative treatment by means of capecitabine before and after radiotherapy is well tolerated, with a high compliance rate and acceptable toxicity. Though it does not improve the local effect, it achieves a high LR rate, DFS, and OS.
Secondary keywords:	Rektum;Disertacije;Lokalno napredovali rak;Neoadjuvantna terapija;
URN:	URN:SI:UM:
Type (COBISS):	Dissertation
Thesis comment:	Univ. v Mariboru, Medicinska fak.
Pages:	XI, 75 str.
ID:	10906184