Kết quả điều trị tân bổ trợ toàn bộ ở bệnh nhân ung thư trực tràng giai đoạn II, III tại Bệnh viện Trung ương Quân đội 108

Abstract

Objective: To evaluate the pathological Complete Response (pCR) results of patients with stage II and III rectal cancer treated with total neoadjuvant therapy (TNT) and several associated factors on these patients. Subject and method: This intervention study without control group on 51 patients with stage II and III rectal cancer who received radiation therapy with total dose of 50.4Gy in combination with capecitabine at the dose of 835mg/m² ´ 2 times/day ´ 28 radiothrapy days, then underwent 12-16 weeks of neoadjuvant chemotherapy. Radical surgery with total mesorectal excision was performed at 2-4 weeks later. To evaluate pCR base on tumor regression. Result: In the study, there was 98% (50/51 patients) responded on pathology, in which the pCR rate was 33.3%. There was only 1 patient had progressive disease after treatment accounting for 2%. Several factors associated with pCR included: tumor length, N stage, age group, and clinical response. The tumor length smaller than 4cm had a higher pCR rate at 60% compared to those > 4cm. N₀, N₁, N₂ stages had pCR rate of 100%, 60%, 25%, respectively (p=0.012). Patients from 65 years old had a higher pCR rate (52.9%) compared to those under 65, pCR 23.5%, p=0.036. Patients who achieved cCR (complete clinical response) had a higher pCR rate than who achieved non-cCR (62.5% vs 20%, p=0.003). Conclusion: Total neoadjuvant therapy before surgery resulted in high rates of the pathological complete response. Patients with a small tumor length, stage N_0-1, elder age have better chance of achieving pCR compared to the other groups with larger tumor, stage₂, younger age. Patients achieving cCR had a higher rate of pCR.