Neoadjuvan Kemoterapi Uygulanan Cerrahi Tedavi Görmüş Rektal Kanser Olgularında Beş Yıllık Takip Sonuçları
Yıl 2024,
Cilt: 8 Sayı: 3, 283 - 290, 30.12.2024
Enes Şahin
,
Kazim Şahin
,
Ecenur Varol
Fatih Koç
,
Haşim Köken
Sertaç Ata Güler
,
Zafer Utkan
Öz
Amaç: Neoadjuvan tedavi alan rektum kanserli olgularda cerrahi yapılmadan izle ve bekle yönteminin mi yoksa operasyon yapılmasının mı
daha üstün olduğunu araştırmak istedik.
Gereç ve Yöntemler: 2018-2023 yılları arasında rektum tümörü tanısı alan 18 yaş üstü olguların klinik verileri retrospektif olarak analiz
edildi.
Bulgular: Neoadjuvan tedavi sonrasında bazı olgularda kitle tamamen kayboldu. Tüm olgular neoadjuvan tedavi sonrası opere edildi.
Neoadjuvan tedavi sonrası opere edilen 140 (80%) olguda adenokarsinom, 10 (5.5%) olguda normal kolon duvarı ve 20 (11%) olguda kronik
inflamasyon görüldü.
Sonuç: Rektum kanserli olgularda hastalığın evresine göre neoadjuvan tedavinin önemi gün geçtikçe daha iyi anlaşılmaktadır. Erken evre
rektum kanserinde erken cerrahi, olumlu sonuçları nedeniyle ilk basamak tedavi olarak önerilmektedir. Ancak lenf nodu metastazı olan lokal
ileri veya ileri evre rektum kanserlerinde cerrahi öncesi neoadjuvan tedavinin olgularda sağkalım ve cerrahi sonrası sağkalım açısından çok
daha faydalı olduğu yaygın olarak kabul görmektedir
Kaynakça
- 1. Siegel, R. L., Miller, K. D. Jemal, A. Cancer statistics, 2018. CA
Cancer J. Clin. 68, 7–30 (2018).
- 2. Kanser İstatistikleri. Accessed April 23, 2024. https://hsgm.saglik.
gov.tr/tr/kanser-istatistikleri.html
- 3. Mary R. Kwaan, David B. Stewart Sr, and Kelli Bullard Dunn,
Schwartz’s Principles of Surgery Eleventh Edition, chapter 29;
Colon, Rectum, and Anus, pp 1259-1329.
- 4. Day DW. The adenoma-carcinoma sequence. Scand J Gastroenterol
Suppl. 1984;104:99-107.
- 5. Benjamin Yongcheng Tan MBBS, FRCPath, Puay Hoon Tan
MBBS, FRCPA, FRCPath, in Surgical Pathology Clinics, 2018
Tubular Adenoma - an overview | ScienceDirect Topics. Accessed
April 23, 2024. https://www.sciencedirect.com/topics/
medicine-and-dentistry/tubular-adenoma
- 6. David J. Myers; Komal Arora. Villous Adenoma - StatPearls
- NCBI Bookshelf. Accessed April 23, 2024. https://www.ncbi.
nlm.nih.gov/books/NBK470272/
- 7. Colorectal Cancer Collaborative Group. Surgery for colorectal
cancer in elderly case: a systematic review. Lancet.
2000;356:968–974.
- 8. Al-Abed Y, Parker M, Arulampalam T, Tutton M. Survival following
rectal cancer surgery: does the age matter? Acta Chir
Belg. 2019 Oct;119(5):282–8.
- 9. Bates DDB, Homsi ME, Chang KJ, Lalwani N, Horvat N,
Sheedy SP. MRI for Rectal Cancer: Staging, mrCRM, EMVI,
Lymph Node Staging and Post-Treatment Response. Clin
Colorectal Cancer. 2022 Mar;21(1):10–8.
- 10. Julio Garcia-Aguilar , Qian Shi, Charles R Thomas Jr, Emily
Chan, Peter Cataldo, Jorge Marcet, David Medich, Alessio Pigazzi,
Samuel Oommen, Mitchell C Posner. A phase II trial of
neoadjuvant chemoradiation and local excision for T2N0 rectal
cancer: preliminary results of the ACOSOG Z6041 trial. Ann
Surg Oncol. 2012;19:384-391.
- 11. Garcia-Aguilar J, Shi Q, Thomas CR, Chan E, Cataldo P,
Marcet J, Medich D, Pigazzi A, Oommen S, Posner MC. A
phase II trial of neoadjuvant chemoradiation and local excision
for T2N0 rectal cancer: preliminary results of the ACOSOG
Z6041 trial. Ann Surg Oncol. 2012 Feb;19(2):384–91.
- 12. You YN, Baxter NN, Stewart A, Nelson H. Is the Increasing
Rate of Local Excision for Stage I Rectal Cancer in the United
States Justified?: A Nationwide Cohort Study From the National
Cancer Database. Ann Surg. 2007 May;245(5):726.
- 13. van Oostendorp SE, Smits LJH, Vroom Y, Detering R, Heymans
MW, Moons LMG, Tanis PJ, de Graaf EJR, Cunningham
C, Denost Q, Kusters M, Tuynman JB. Local recurrence
after local excision of early rectal cancer: a meta-analysis of
completion TME, adjuvant (chemo)radiation, or no additional
treatment. Br J Surg. 2020 Dec 1;107(13):1719–30.
- 14. Garcia-Aguilar J, Renfro LA, Chow OS, Shi Q, Carrero XW,
Lynn PB, Thomas CR, Chan E, Cataldo PA, Marcet JE, Medich
DS, Johnson CS, Oommen SC, Wolff BG, Pigazzi A, McNevin
SM, Pons RK, Bleday R. Organ preservation for clinical T2N0
distal rectal cancer using neoadjuvant chemoradiotherapy and
local excision (ACOSOG Z6041): results of an open-label, single-
arm, multi-institutional, phase 2 trial. Lancet Oncol. 2015
Nov 1;16(15):1537–46.
- 15. Shaikh I, Askari A, Ourû S, Warusavitarne J, Athanasiou T,
Faiz O. Oncological outcomes of local excision compared with
radical surgery after neoadjuvant chemoradiotherapy for rectal
cancer: a systematic review and meta-analysis. Int J Colorectal
Dis. 2015 Jan 1;30(1):19–29.
- 16. Long-Term Survival After Transanal Excision of T1 Rectal
Can... : Diseases of the Colon & Rectum [Internet]. [cited 2024
Jan 7]. Available from: https://journals.lww.com/dcrjournal/abstract/
2009/04000/long_term_survival_after_transanal_excision_
of_t1.4.aspx
- 17. Zhifei Sun , Mohamed A Adam, Jina Kim, Daniel P Nussbaum,
Ehsan Benrashid, Christopher R Mantyh, John Migaly Determining
the optimal timing for initiation of adjuvant chemotherapy
after resection for Stage II and III colon cancer. Dis Colon
Rectum. 2016;59(2):87-93.
- 18. Cercek A, Garcia-Aguilar J. Rectal cancer: neoadjuvant therapy.
In: Steele SR, Hull TL, Read TE, Saclarides TJ, Senagore
AJ, Whitlow CB, eds. The ASCRS Textbook of Colon and Rectal
Surgery. 3rd ed. New York: Springer; 2016:481-494.
- 19. USA National İnstuties of Healty Guide for Grants and Contracts
- Vol. 19, No. 28 - July 27, 1990.
- 20.Rolf Sauer, Torsten Liersch, Susanne Merkel, Rainer Fietkau,
Werner Hohenberger, Clemens Hess, Heinz Becker, Hans-Rudolf
Raab, Marie Therese Villanueva, Helmut Witzigmann,
Christian Wittekind, Tim Beissbarth, and Claus Rödel ,Preoperative
versus postoperative chemoradiotherapy for rectal cancer.
N Engl J Med. 2004;351:1731-1740.
- 21. Smith FM, Wiland H, Mace A, Pai RK, Kalady MF. Clinical criteria
underestimate complete pathological response in rec tal
cancer treated with neoadjuvant chemoradiotherapy. Dis Colon
Rectum. 2014;57(3):311-315.
- 22. Sammour T, Price BA, Krause KJ, Chang GJ. Nonoperative
management of “watch and wait” for rectal cancer with com
plete clinical response after neoadjuvant chemoradiotherapy:
a critical appraisal. Ann Surg Oncol. 2017;24:1904-1915. doi:
10.1245/s10434-017-5841-3.
- 23. Habr-Gama A, Perez RO, Nadalin W, Sabbaga J, Ribeiro U,
Silva e Sousa AH, Campos FG, Kiss DR, Gama-Rodrigues J.
Operative versus nonoperative treatment for stage 0 distal rectal
cancer following chemoradiation therapy: long-term results.
Ann Surg. 2004 Oct;240(4):711–7; discussion 717-718.
- 24. Angelita Habr-Gama , Rodrigo O Perez, Gregory Wynn, John
Marks, Hermann Kessler, Joaquim Gama-Rodrigues.Complete
clinical response after neoadjuvant chemoradiation therapy for
distal rectal cancer: characterization of clinical and endoscopic
findings for standardization. Dis. Colon Rectum 53, 1692–1698
(2010).
- 25. Angelita Habr-Gama , Guilherme Pagin São Julião , Bruna
Borba Vailati , Jorge Sabbaga , Patricia Bailão Aguilar , Laura
Melina Fernandez , Sergio Eduardo Alonso Araújo , Rodrigo
Oliva Perez, Organ preservation in cT2N0 rectal cancer after
neoadjuvant chemoradiation therapy: the impact of radiation
therapy dose-escalation and consolidation chemotherapy. Ann.
Surg. 269, 102–107 (2019).
- 26. Påhlman L, Bohe M, Cedermark B, Dahlberg M, Lindmark G,
Sjödahl R, Öjerskog B, Damber L, Johansson R. The Swedish
rectal cancer registry. Br J Surg. 2007 Oct 1;94(10):1285–92.
- 27. Dulk M den, Putter H, Collette L, Marijnen CAM, Folkesson J,
Bosset JF, Rödel C, Bujko K, Påhlman L, Velde CJH van de.
The abdominoperineal resection itself is associated with an adverse
outcome: The European experience based on a pooled
analysis of five European randomised clinical trials on rectal
cancer. Eur J Cancer. 2009 May 1;45(7):1175–83.
- 28. Lujan J, Valero G, Biondo S, Espin E, Parrilla P, Ortiz H. Laparoscopic
versus open surgery for rectal cancer: results of a
prospective multicentre analysis of 4,970 case. Surg Endosc.
2013 Jan 1;27(1):295–302.
- 29. College of American Pathologists (CAP). Protocol for the Examination
of Specimens from Case with Primary Carcinoma
of the Colon and Rectum. Based on AJCC/UICC TNM, 7th
edition. ColonRectum 3.1.0.0 cap.org http://webapps.cap.
org/apps/ docs/committees/cancer/cancer_protocols/2009/
Colon_09protocol.pdf (2011).
- 30. Royal College of Pathologists. Standards and datasets for
reporting cancers. Dataset for histopathological reporting
of colorectal cancer. 2017. https://www.rcpath.org/uploads/
assets/c8b61ba0- ae3f-43f1-85ffd3ab9f17cfe6/G049-dataset-
forhistopathological-reporting-of-colorectal-cancer.pdf.
Five Year Follow Up Results of Surgically Treated Rectal Cancer Case, Who Had Neoadjuvan Chemotheraph
Yıl 2024,
Cilt: 8 Sayı: 3, 283 - 290, 30.12.2024
Enes Şahin
,
Kazim Şahin
,
Ecenur Varol
Fatih Koç
,
Haşim Köken
Sertaç Ata Güler
,
Zafer Utkan
Öz
Aim: We wanted to investigate whether the watch and wait method without surgery or surgery is superior in patients with rectal cancer
receiving neoadjuvant treatment.
Material and Methods: The clinical data of case above the age of 18 who were diagnosed with rectal tumors between 2018 and 2023 were
retrospectively analyzed.
Results: After neoadjuvant treatment, the mass disappeared completely in some case. All case were operated after neoadjuvant treatment.
Adenocarcinoma was seen in 140 (80%) case operated after neoadjuvant treatment, normal colon wall was seen in 10 (5.5%) case and
chronic inflammation was seen in 20 (11%) case.
Conclusion: The importance of neoadjuvant treatment according to the stage of the disease in case with rectal cancer is being better
understood day by day. Early surgery is recommended as the first-line treatment for early-stage rectal cancer due to its favorable outcomes.
However, it has been widely accepted that in locally advanced or advanced rectal cancers with lymph node metastasis, neoadjuvant
treatment before surgery is much more beneficial in terms of disease-free survival and survey after surgery
Kaynakça
- 1. Siegel, R. L., Miller, K. D. Jemal, A. Cancer statistics, 2018. CA
Cancer J. Clin. 68, 7–30 (2018).
- 2. Kanser İstatistikleri. Accessed April 23, 2024. https://hsgm.saglik.
gov.tr/tr/kanser-istatistikleri.html
- 3. Mary R. Kwaan, David B. Stewart Sr, and Kelli Bullard Dunn,
Schwartz’s Principles of Surgery Eleventh Edition, chapter 29;
Colon, Rectum, and Anus, pp 1259-1329.
- 4. Day DW. The adenoma-carcinoma sequence. Scand J Gastroenterol
Suppl. 1984;104:99-107.
- 5. Benjamin Yongcheng Tan MBBS, FRCPath, Puay Hoon Tan
MBBS, FRCPA, FRCPath, in Surgical Pathology Clinics, 2018
Tubular Adenoma - an overview | ScienceDirect Topics. Accessed
April 23, 2024. https://www.sciencedirect.com/topics/
medicine-and-dentistry/tubular-adenoma
- 6. David J. Myers; Komal Arora. Villous Adenoma - StatPearls
- NCBI Bookshelf. Accessed April 23, 2024. https://www.ncbi.
nlm.nih.gov/books/NBK470272/
- 7. Colorectal Cancer Collaborative Group. Surgery for colorectal
cancer in elderly case: a systematic review. Lancet.
2000;356:968–974.
- 8. Al-Abed Y, Parker M, Arulampalam T, Tutton M. Survival following
rectal cancer surgery: does the age matter? Acta Chir
Belg. 2019 Oct;119(5):282–8.
- 9. Bates DDB, Homsi ME, Chang KJ, Lalwani N, Horvat N,
Sheedy SP. MRI for Rectal Cancer: Staging, mrCRM, EMVI,
Lymph Node Staging and Post-Treatment Response. Clin
Colorectal Cancer. 2022 Mar;21(1):10–8.
- 10. Julio Garcia-Aguilar , Qian Shi, Charles R Thomas Jr, Emily
Chan, Peter Cataldo, Jorge Marcet, David Medich, Alessio Pigazzi,
Samuel Oommen, Mitchell C Posner. A phase II trial of
neoadjuvant chemoradiation and local excision for T2N0 rectal
cancer: preliminary results of the ACOSOG Z6041 trial. Ann
Surg Oncol. 2012;19:384-391.
- 11. Garcia-Aguilar J, Shi Q, Thomas CR, Chan E, Cataldo P,
Marcet J, Medich D, Pigazzi A, Oommen S, Posner MC. A
phase II trial of neoadjuvant chemoradiation and local excision
for T2N0 rectal cancer: preliminary results of the ACOSOG
Z6041 trial. Ann Surg Oncol. 2012 Feb;19(2):384–91.
- 12. You YN, Baxter NN, Stewart A, Nelson H. Is the Increasing
Rate of Local Excision for Stage I Rectal Cancer in the United
States Justified?: A Nationwide Cohort Study From the National
Cancer Database. Ann Surg. 2007 May;245(5):726.
- 13. van Oostendorp SE, Smits LJH, Vroom Y, Detering R, Heymans
MW, Moons LMG, Tanis PJ, de Graaf EJR, Cunningham
C, Denost Q, Kusters M, Tuynman JB. Local recurrence
after local excision of early rectal cancer: a meta-analysis of
completion TME, adjuvant (chemo)radiation, or no additional
treatment. Br J Surg. 2020 Dec 1;107(13):1719–30.
- 14. Garcia-Aguilar J, Renfro LA, Chow OS, Shi Q, Carrero XW,
Lynn PB, Thomas CR, Chan E, Cataldo PA, Marcet JE, Medich
DS, Johnson CS, Oommen SC, Wolff BG, Pigazzi A, McNevin
SM, Pons RK, Bleday R. Organ preservation for clinical T2N0
distal rectal cancer using neoadjuvant chemoradiotherapy and
local excision (ACOSOG Z6041): results of an open-label, single-
arm, multi-institutional, phase 2 trial. Lancet Oncol. 2015
Nov 1;16(15):1537–46.
- 15. Shaikh I, Askari A, Ourû S, Warusavitarne J, Athanasiou T,
Faiz O. Oncological outcomes of local excision compared with
radical surgery after neoadjuvant chemoradiotherapy for rectal
cancer: a systematic review and meta-analysis. Int J Colorectal
Dis. 2015 Jan 1;30(1):19–29.
- 16. Long-Term Survival After Transanal Excision of T1 Rectal
Can... : Diseases of the Colon & Rectum [Internet]. [cited 2024
Jan 7]. Available from: https://journals.lww.com/dcrjournal/abstract/
2009/04000/long_term_survival_after_transanal_excision_
of_t1.4.aspx
- 17. Zhifei Sun , Mohamed A Adam, Jina Kim, Daniel P Nussbaum,
Ehsan Benrashid, Christopher R Mantyh, John Migaly Determining
the optimal timing for initiation of adjuvant chemotherapy
after resection for Stage II and III colon cancer. Dis Colon
Rectum. 2016;59(2):87-93.
- 18. Cercek A, Garcia-Aguilar J. Rectal cancer: neoadjuvant therapy.
In: Steele SR, Hull TL, Read TE, Saclarides TJ, Senagore
AJ, Whitlow CB, eds. The ASCRS Textbook of Colon and Rectal
Surgery. 3rd ed. New York: Springer; 2016:481-494.
- 19. USA National İnstuties of Healty Guide for Grants and Contracts
- Vol. 19, No. 28 - July 27, 1990.
- 20.Rolf Sauer, Torsten Liersch, Susanne Merkel, Rainer Fietkau,
Werner Hohenberger, Clemens Hess, Heinz Becker, Hans-Rudolf
Raab, Marie Therese Villanueva, Helmut Witzigmann,
Christian Wittekind, Tim Beissbarth, and Claus Rödel ,Preoperative
versus postoperative chemoradiotherapy for rectal cancer.
N Engl J Med. 2004;351:1731-1740.
- 21. Smith FM, Wiland H, Mace A, Pai RK, Kalady MF. Clinical criteria
underestimate complete pathological response in rec tal
cancer treated with neoadjuvant chemoradiotherapy. Dis Colon
Rectum. 2014;57(3):311-315.
- 22. Sammour T, Price BA, Krause KJ, Chang GJ. Nonoperative
management of “watch and wait” for rectal cancer with com
plete clinical response after neoadjuvant chemoradiotherapy:
a critical appraisal. Ann Surg Oncol. 2017;24:1904-1915. doi:
10.1245/s10434-017-5841-3.
- 23. Habr-Gama A, Perez RO, Nadalin W, Sabbaga J, Ribeiro U,
Silva e Sousa AH, Campos FG, Kiss DR, Gama-Rodrigues J.
Operative versus nonoperative treatment for stage 0 distal rectal
cancer following chemoradiation therapy: long-term results.
Ann Surg. 2004 Oct;240(4):711–7; discussion 717-718.
- 24. Angelita Habr-Gama , Rodrigo O Perez, Gregory Wynn, John
Marks, Hermann Kessler, Joaquim Gama-Rodrigues.Complete
clinical response after neoadjuvant chemoradiation therapy for
distal rectal cancer: characterization of clinical and endoscopic
findings for standardization. Dis. Colon Rectum 53, 1692–1698
(2010).
- 25. Angelita Habr-Gama , Guilherme Pagin São Julião , Bruna
Borba Vailati , Jorge Sabbaga , Patricia Bailão Aguilar , Laura
Melina Fernandez , Sergio Eduardo Alonso Araújo , Rodrigo
Oliva Perez, Organ preservation in cT2N0 rectal cancer after
neoadjuvant chemoradiation therapy: the impact of radiation
therapy dose-escalation and consolidation chemotherapy. Ann.
Surg. 269, 102–107 (2019).
- 26. Påhlman L, Bohe M, Cedermark B, Dahlberg M, Lindmark G,
Sjödahl R, Öjerskog B, Damber L, Johansson R. The Swedish
rectal cancer registry. Br J Surg. 2007 Oct 1;94(10):1285–92.
- 27. Dulk M den, Putter H, Collette L, Marijnen CAM, Folkesson J,
Bosset JF, Rödel C, Bujko K, Påhlman L, Velde CJH van de.
The abdominoperineal resection itself is associated with an adverse
outcome: The European experience based on a pooled
analysis of five European randomised clinical trials on rectal
cancer. Eur J Cancer. 2009 May 1;45(7):1175–83.
- 28. Lujan J, Valero G, Biondo S, Espin E, Parrilla P, Ortiz H. Laparoscopic
versus open surgery for rectal cancer: results of a
prospective multicentre analysis of 4,970 case. Surg Endosc.
2013 Jan 1;27(1):295–302.
- 29. College of American Pathologists (CAP). Protocol for the Examination
of Specimens from Case with Primary Carcinoma
of the Colon and Rectum. Based on AJCC/UICC TNM, 7th
edition. ColonRectum 3.1.0.0 cap.org http://webapps.cap.
org/apps/ docs/committees/cancer/cancer_protocols/2009/
Colon_09protocol.pdf (2011).
- 30. Royal College of Pathologists. Standards and datasets for
reporting cancers. Dataset for histopathological reporting
of colorectal cancer. 2017. https://www.rcpath.org/uploads/
assets/c8b61ba0- ae3f-43f1-85ffd3ab9f17cfe6/G049-dataset-
forhistopathological-reporting-of-colorectal-cancer.pdf.