Initial results of total neoadjuvant therapy pre-operative in stage II, III rectal cancer patients at 108 Military Central Hospital

  • Nguyễn Thị Hà Bệnh viện Trung ương Quân đội 108
  • Nguyễn Xuân Kiên Bệnh viện Trung ương Quân đội 108
  • Nguyễn Đình Châu Bệnh viện Trung ương Quân đội 108
  • Bùi Quang Biểu Bệnh viện Trung ương Quân đội 108
  • Lê Văn Nguyên Bệnh viện Trung ương Quân đội 108
  • Trịnh Thị Mai Bệnh viện Trung ương Quân đội 108
  • Nguyễn Thị Minh Phương Bệnh viện Trung ương Quân đội 108
  • Triệu Triều Dương Bệnh viện Trung ương Quân đội 108
  • Lê Văn Quốc Bệnh viện Trung ương Quân đội 108
  • Nguyễn Minh Hoàng Học viện Y dược học cổ truyền Việt Nam

Main Article Content

Keywords

Total neoadjuvant therapy, rectal cancer

Abstract

Objective: To evaluate the early results of total neoadjuvant therapy (TNT) pre-operative in stage II, III rectal cancer patient at 108 Military Central Hospital and commented on some of the side effects and toxicity of this treatment. Subject and method: A descriptive retrospective study in 35 patients with stage II and III rectal cancer who received radiation therapy dose of 50.4Gy in combination with Capecitabine at the dose of 835mg/m2 × 2 times/day on the days of radiation therapy, then added neoadjuvant chemotherapy and followed surgery with total mesorectal excision 6-8 weeks later. Result: After TNT, there was 74.3% reduction in tumor stage and 93.4% reduction in lymph node stage, 100% of patients responded on pathology in which the completie response pathology (pCR) rate was 73.4%; Overall sphincter prevention rate reached 74.3%, with low rectal cancer reached 46.7%. Side effects were mainly at grade 1, 2. Conclusion: Total neoadjuvant therapy resulted in high rates of tumor and lymph node downstaging and sphincter preventation with acceptable side effects.

Article Details

References

1. Sung H, Ferlay J, Siegel RL et al (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71(3): 209-249. doi:10.3322/caac.21660.
2. Petrelli F, Trevisan F, Cabiddu M et al (2020) Total neoadjuvant therapy in rectal cancer: A systematic review and meta-analysis of treatment outcomes. Ann Surg 271(3): 440-448. doi:10.1097/SLA. 0000000000003471.
3. Conroy T, Bosset JF, Etienne PL et al (2021) Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol 22(5): 702-715. doi:10.1016/S1470-2045(21)00079-6
4. Thies S, Langer R (2013) Tumor regression grading of gastrointestinal carcinomas after neoadjuvant treatment. Front Oncol 3. doi:10.3389/fonc. 2013.00262
5. Santos MD, Silva C, Rocha A, Matos E, Nogueira C, Lopes C (2014) Prognostic value of mandard and dworak tumor regression grading in rectal Cancer: Study of a single tertiary center. ISRN Surg: 1-8. doi:10.1155/2014/310542.
6. Liu S, Jiang T, Xiao L et al (2021) Total neoadjuvant therapy (tnt) versus standard neoadjuvant chemoradiotherapy for locally advanced rectal Cancer: A systematic review and meta‐analysis. The Oncologist 26(9): 1555-1566. doi:10.1002/ onco.13824.
7. Zhai Z, Zhang K, Wang C et al (2021) Adding three Cycles of CAPOX after neoadjuvant chemoradiotherapy increases the rates of complete response for locally advanced rectal cancer. Curr Oncol 28(1): 283-293. doi: 10.3390/curroncol 28010033.
8. Perez K, Safran H, Sikov W et al (2017) Complete neoadjuvant treatment for rectal cancer: The brown university oncology group CONTRE study. Am J Clin Oncol 40(3): 283-287. doi:10.1097/COC. 0000000000000149.
9. Nguyễn Văn Hiếu, Lê Văn Quảng, Bùi Công Đoàn (2018) Đánh giá kết quả hóa xạ trị tiền phẫu trong ung thư trực tràng giai đoạn xâm lấn. Tạp chí khoa học công nghệ Việt Nam, tr. 1-4.
10. Nguyễn Xuân Kiên, Nguyễn Đình Châu, Nguyễn Thị Hà (2017) Đánh giá kết quả điều trị hóa xạ trị tiền phẫu với capecitabine ở bệnh nhân ung thư trực tràng giai đoạn tiến triển còn khả năng phẫu thuật tại Bệnh viện Trung ương Quân đội 109. Tạp chí Y dược lâm sàng 108, tr. 135-140.
11. Garcia-Aguilar J, Chow OS, Smith DD et al (2015) Effect of adding mFOLFOX6 after neoadjuvant chemoradiation in locally advanced rectal cancer: A multicentre, phase 2 trial. Lancet Oncol 16(8): 957-966. doi:10.1016/S1470-2045(15)00004-2
12. Nilsson PJ, van Etten B, Hospers GA et al (2013) Short-course radiotherapy followed by neo-adjuvant chemotherapy in locally advanced rectal cancer – the RAPIDO trial. BMC Cancer 13: 279. doi:10.1186/1471-2407-13-279.