Araştırma Makalesi
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Rektum Kanserlerinde Sfinkter Koruyu Girişimlerin Neoadjuvan Kemoradyoterapi ile İlişkisi

Yıl 2021, Cilt: 8 Sayı: 2, 97 - 103, 31.08.2021

Öz

Bu çalışma, rektum kanserli hastalarda neoadjuvan kemoradyoterapinin (nKRT) evre gerilemesine ve sfinkter koruyucu cerrahiye olan etkisini ortaya koymak amacıyla yapılmıştır. Neoadjuvan kemoradyoterapi uygulanan distal rektum kanseri olan hastalar çalışmaya alınmıştır. Hastaların verileri retrospektif olarak taranarak özel olarak hazırlanmış veritabanına kaydedilmiştir. Hastalara uygulanan neoadjuvan tedavi protokolleri, neoadjuvan tedaviye bağlı tümör boyutunda küçülme ve evre gerilemesi oranları ile sfinkter koruyucu cerrahi (SKC) oranları belirlenerek literatür eşliğinde değerlendirme yapılmıştır. Alt ve orta rektum kanseri nedeniyle nKRT uygulanan 88 hasta çalışmaya alınmıştır. Hastaların yaş ortalaması 57.6 (21-78), kadın erkek oranı 3/5’di. Neoadjuvan tedavi sonrası ortalama bekleme süresi 6.5 (4-8) haftaydı. Downsizing, downstaging ve sfinkter korunma oranları sırasıyla %80.7, %65.9, %63.6 (alt rektum için %32.5, orta rektum için %89.6) olarak değerlendirildi. Neoadjuvan tedaviye bağlı dört hastada patolojik tam yanıt (pTY) alınmıştı. Hastalardan 47’sine aşağı anterior rezeksiyon, sekizine çok aşağı anterior rezeksiyon ve bir hastaya intersfinkterik rezeksiyon uygulanmıştı. SKC uygulanan 5 hastada ileri derecede inkontinans olduğu (wexner skoru ≥ 9) ve genel olarak hastalarının yaşam kalitesinin bozulmadığı değerlendirildi. Sonuç olarak neoadjuvan tedavi sonrası ‘’downsizing’’ ’’downstaging’’ oranları ve SKC oranlarının literatürle uyumlu olduğu değerlendirildi. Yine literatürde de belirtildiği gibi SKC oranları üzerindeki en etkili faktörler; tümörün seviyesi, anal sfinkter mekanizması ile ilişkisi ve cerrahın tutumu olarak değerlendirildi.

Kaynakça

  • 1. Miles, WE. A Method of Performing Abdomino-Perineal Excision for Carcinoma of the Rectum and of the Terminal Portion of the Pelvic Colon. (1908, Reprinted from LANCET II:1812-1813. 1908) CA Cancer J Clin.1971;21:361-4.
  • 2. Dixon CF. Anterior resection for malignant lesions of the upper part of the rectum and lower part of the sigmoid. Ann Surg. 1948;128:425-42.
  • 3. Goligher JC. Resection with restoration of continuity in the treatment of carcinoma of the rectum and rectosigmoid. Postgrad Med J. 1951;27:568-75.
  • 4. Hermanek P, Gall FP. Safe aboral distance in the sphincterpreserving resection of the rectum. Chirurg. 1981;52:25-9.
  • 5. Pollett WG, Nicholls RJ. The relationship between the extent of distal clearance and survival and local recurrence rates after curative anterior resection for carcinoma of the rectum. Ann Surg. 1983;198:159-63.
  • 6. Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Dutch Colorectal Cancer Group.Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345:638-46.
  • 7. Bosset JF, Calais G, Daban A. Does the addition of chemotherapy to radiation increase acute toxicity in patients with rectal cancer; Report of 22921 EORTC phase 3 trial. J Clin Oncol. 2003;21:294.
  • 8. Braendengen M, Tveit KM, Berglund A, et al. Randomized phase III study comparing preoperative radiotherapy with chemoradiotherapy in nonresectable rectal cancer. J Clin Oncol. 2008;26:3687.
  • 9. Claus Rödel, Peter Martus, Thomas Papadoupolos, et al. Prognostic Significance of Tumor Regression After Preoperative Chemoradiotherapy for Rectal Cancer. J Clin Oncol. 2005; 23: 8688-96.
  • 10. Bosset JF, Calais G, Mineur L, et al. Enhanced Tumorocidal Effect of Chemotherapy With Preoperative Radiotherapy for Rectal Cancer:Preliminary Results—EORTC 22921. J Clin Oncol. 2005; 23:5620-7.
  • 11. Wong RK, Tandan V, De Silva S, Figueredo A. Preoperative radiotherapy and curative surgery for the management of localized rectal carcinoma. Cochrane Database Syst Rev. 2007;(2): CD002102.
  • 12. Bosset JF, Collette L, Calais G, et al. EORTC Radiotherapy Group Trial 22921.Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med. 2006;355:1114-23.
  • 13. CeelenWP, Van Nieuwenhove Y, Fierens K. Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer. Cochrane Database Syst Rev. 2009, Issue 1. Art.No.: CD006041.
  • 14. Bujko K, Nowacki MP, Nasirowska-Guttmejer A, et al. Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapy. Radiother Oncol. 2004;72:15-24.
  • 15. Bujko K, Kepka L, MichalskiW, et al. Does rectal cancer shrinkage induced by preoperative radio(chemo)therapy increase the likelihood of anterior resection? A systematic review of randomised trials. Radiother Oncol. 2006;80:4-12.
  • 16. Swedish Rectal Cancer Trial. Local recurrence rate in a randomized multicentre trial of preoperative radiotherapy compared to surgey alone in resectable rectal carcinoma. Eur J Surg. 1996;162:397-402.
  • 17. Francois Y, Nemoz CJ, Baulieux J, et al. Influence of the interval between preoperative radiation therapy and surgery on dawnstaging and on the rate of sphincter –sparing surgery for rectal cancer: the Lyon R90-01 randomised trial. J Clin Oncol. 1999;17:2396-402.
  • 18. Sauer R. Adjuvant versus neoadjuvant combined modality treatment for locally advanced rectal cancer: first results of the German rectal cancer study (CAO/ARO/AIO-94). Int J radiat Oncol Biol Phys. 2003;57:124-5.
  • 19. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. Colon and Rectum. AJCC Cancer Staging Manual 7th. Printing, 2010, page:143-164.
  • 20. Dworak O, Keilholz L, Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy. Int j Colorectal Dis. 1997; 12: 19-23.
  • 21. Gerard JP, Conroy T, Bonnetain F, ve ark. Preoperative radiotherapy with or without concurrent fluorouraciland leucovorin in t3-4 rectal cancers: results of FFCD 9203. J Clin Oncol. 2006;24:4620-5.
  • 22. www.rtog.org Research Associates Adverse Event Reporting Acute Radiation Morbidity Scoring Criteria.aspx erişim tarihi: ocak 2011
  • 23. www.rtog.org Research Associates Adverse Event Reporting RTOG/EORTC Late Radiation Morbidity Scoring Schema.aspx erişim tarihi: ocak 2011
  • 24. Canda AE, Terzi C, Gorken IB, et al. Effects of preoperative chemoradiotherapy on anal sphincter functions and quality of life in rectal cancer patients. Int J Colorectal Dis. 2010 Feb;25(2):197-204.
  • 25. Lange MM, den Dulk M, Bossema ER, Maas CP, Marijnen CAM, Van De Velde CJH. Risk factors for faecal incontinence after rectal cancer treatment. Br J Surg. 2007;94:1278-84.
  • 26. Pollack J, Holm T, Cedermark B, Holmström B, Mellgren A. Long- term effect of preoperative radiation therapy on anorectal function. Dis Colon Rectum. 2006;49:345-52.
  • 27. Maier AG, Barton PP, Neuhold NR, Herbst F, Teleky BK, Lechner GL. Peritumoral tissue reaction at transrectal US as a possible cause of overstaging in rectal cancer: Histopathologic correlation. Radiology. 1997;203:785-9.
  • 28. Tio TL, Coene PPLO, van Delden OM, Tytgat GNJ. Colorectal carcinoma: Preoperative TNM classification with Endosonography. Radiology. 1991;179:165-70.
  • 29. NCCN Clinical Practice Guidelines in Oncology, Rectal Cancer, V.2.2010. www.nccn.org. Erişim tarihi Mart 2010

Neoadjuvant Chemoradiotherapy and The Sphinchter Sparing Surgery Association in Rectal Cancer

Yıl 2021, Cilt: 8 Sayı: 2, 97 - 103, 31.08.2021

Öz

This study was conducted to reveal the effect of neoadjuant chemoradiotherapy to down-staging and sphincter sparing surgery in rectal cancer. Patients with lower and middle rectum cancer undergoing neoadjuvant chemoradiotherapy were included in the study. The data of the patients were collected retrospectively and recorded in a database. Neoadjuvant treatment protocols applied to the patients, downsizing, downstagings and sphincter sparing surgery rates were determined and evaluation was made in the light of the literature. 88 patients who received neoadjuvant chemoradiotherapy for lower and middle rectal cancer were included in the study. The mean age of the patients was 57.6 (21-78) years, and the ratio of women to men was 3/5. The mean waiting time after neoadjuvant therapy was 6.5 (4-8) weeks. Downsizing, downstaging and sphincter sparing rates were 80.7%, 65.9%, 63.6% (32.5% for the lower rectum, 89.6% for the middle rectum) respectively. The pathological complete response was obtained in four patients. Eight of the patients had undergone very low anterior anterior resection, 47 had low anterior resection and 1 patient had intersphincteric resection. It was evaluated that, 5 patients who underwent sphincter sparing surgery had advanced incontinence score (wexner≥9) and their quality of life was generally not impaired. As a result, the rates of downsizing, downstaging and sphincter-sparing surgery rates after neoadjuvant therapy were evaluated to be compatible with the literature. As stated in the literature, the most effective factors on sphincter sparing surgery rates are; the location of the tumor, its relation with the anal sphincter mechanism and the surgeon's attitude.

Kaynakça

  • 1. Miles, WE. A Method of Performing Abdomino-Perineal Excision for Carcinoma of the Rectum and of the Terminal Portion of the Pelvic Colon. (1908, Reprinted from LANCET II:1812-1813. 1908) CA Cancer J Clin.1971;21:361-4.
  • 2. Dixon CF. Anterior resection for malignant lesions of the upper part of the rectum and lower part of the sigmoid. Ann Surg. 1948;128:425-42.
  • 3. Goligher JC. Resection with restoration of continuity in the treatment of carcinoma of the rectum and rectosigmoid. Postgrad Med J. 1951;27:568-75.
  • 4. Hermanek P, Gall FP. Safe aboral distance in the sphincterpreserving resection of the rectum. Chirurg. 1981;52:25-9.
  • 5. Pollett WG, Nicholls RJ. The relationship between the extent of distal clearance and survival and local recurrence rates after curative anterior resection for carcinoma of the rectum. Ann Surg. 1983;198:159-63.
  • 6. Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Dutch Colorectal Cancer Group.Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345:638-46.
  • 7. Bosset JF, Calais G, Daban A. Does the addition of chemotherapy to radiation increase acute toxicity in patients with rectal cancer; Report of 22921 EORTC phase 3 trial. J Clin Oncol. 2003;21:294.
  • 8. Braendengen M, Tveit KM, Berglund A, et al. Randomized phase III study comparing preoperative radiotherapy with chemoradiotherapy in nonresectable rectal cancer. J Clin Oncol. 2008;26:3687.
  • 9. Claus Rödel, Peter Martus, Thomas Papadoupolos, et al. Prognostic Significance of Tumor Regression After Preoperative Chemoradiotherapy for Rectal Cancer. J Clin Oncol. 2005; 23: 8688-96.
  • 10. Bosset JF, Calais G, Mineur L, et al. Enhanced Tumorocidal Effect of Chemotherapy With Preoperative Radiotherapy for Rectal Cancer:Preliminary Results—EORTC 22921. J Clin Oncol. 2005; 23:5620-7.
  • 11. Wong RK, Tandan V, De Silva S, Figueredo A. Preoperative radiotherapy and curative surgery for the management of localized rectal carcinoma. Cochrane Database Syst Rev. 2007;(2): CD002102.
  • 12. Bosset JF, Collette L, Calais G, et al. EORTC Radiotherapy Group Trial 22921.Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med. 2006;355:1114-23.
  • 13. CeelenWP, Van Nieuwenhove Y, Fierens K. Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer. Cochrane Database Syst Rev. 2009, Issue 1. Art.No.: CD006041.
  • 14. Bujko K, Nowacki MP, Nasirowska-Guttmejer A, et al. Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapy. Radiother Oncol. 2004;72:15-24.
  • 15. Bujko K, Kepka L, MichalskiW, et al. Does rectal cancer shrinkage induced by preoperative radio(chemo)therapy increase the likelihood of anterior resection? A systematic review of randomised trials. Radiother Oncol. 2006;80:4-12.
  • 16. Swedish Rectal Cancer Trial. Local recurrence rate in a randomized multicentre trial of preoperative radiotherapy compared to surgey alone in resectable rectal carcinoma. Eur J Surg. 1996;162:397-402.
  • 17. Francois Y, Nemoz CJ, Baulieux J, et al. Influence of the interval between preoperative radiation therapy and surgery on dawnstaging and on the rate of sphincter –sparing surgery for rectal cancer: the Lyon R90-01 randomised trial. J Clin Oncol. 1999;17:2396-402.
  • 18. Sauer R. Adjuvant versus neoadjuvant combined modality treatment for locally advanced rectal cancer: first results of the German rectal cancer study (CAO/ARO/AIO-94). Int J radiat Oncol Biol Phys. 2003;57:124-5.
  • 19. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. Colon and Rectum. AJCC Cancer Staging Manual 7th. Printing, 2010, page:143-164.
  • 20. Dworak O, Keilholz L, Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy. Int j Colorectal Dis. 1997; 12: 19-23.
  • 21. Gerard JP, Conroy T, Bonnetain F, ve ark. Preoperative radiotherapy with or without concurrent fluorouraciland leucovorin in t3-4 rectal cancers: results of FFCD 9203. J Clin Oncol. 2006;24:4620-5.
  • 22. www.rtog.org Research Associates Adverse Event Reporting Acute Radiation Morbidity Scoring Criteria.aspx erişim tarihi: ocak 2011
  • 23. www.rtog.org Research Associates Adverse Event Reporting RTOG/EORTC Late Radiation Morbidity Scoring Schema.aspx erişim tarihi: ocak 2011
  • 24. Canda AE, Terzi C, Gorken IB, et al. Effects of preoperative chemoradiotherapy on anal sphincter functions and quality of life in rectal cancer patients. Int J Colorectal Dis. 2010 Feb;25(2):197-204.
  • 25. Lange MM, den Dulk M, Bossema ER, Maas CP, Marijnen CAM, Van De Velde CJH. Risk factors for faecal incontinence after rectal cancer treatment. Br J Surg. 2007;94:1278-84.
  • 26. Pollack J, Holm T, Cedermark B, Holmström B, Mellgren A. Long- term effect of preoperative radiation therapy on anorectal function. Dis Colon Rectum. 2006;49:345-52.
  • 27. Maier AG, Barton PP, Neuhold NR, Herbst F, Teleky BK, Lechner GL. Peritumoral tissue reaction at transrectal US as a possible cause of overstaging in rectal cancer: Histopathologic correlation. Radiology. 1997;203:785-9.
  • 28. Tio TL, Coene PPLO, van Delden OM, Tytgat GNJ. Colorectal carcinoma: Preoperative TNM classification with Endosonography. Radiology. 1991;179:165-70.
  • 29. NCCN Clinical Practice Guidelines in Oncology, Rectal Cancer, V.2.2010. www.nccn.org. Erişim tarihi Mart 2010
Toplam 29 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Cerrahi
Bölüm Araştırma Makalesi
Yazarlar

Muharrem Öztaş 0000-0001-6819-6511

İsmail Özerhan Bu kişi benim 0000-0001-5777-8671

Armağan Günal Bu kişi benim 0000-0002-9923-926X

Mehmet Beyzadeoğlu Bu kişi benim 0000-0003-1035-7209

Yusuf Peker 0000-0002-0700-6718

Sadettin Çetiner Bu kişi benim 0000-0002-1517-0112

Yayımlanma Tarihi 31 Ağustos 2021
Gönderilme Tarihi 13 Mayıs 2020
Yayımlandığı Sayı Yıl 2021 Cilt: 8 Sayı: 2

Kaynak Göster

APA Öztaş, M., Özerhan, İ., Günal, A., Beyzadeoğlu, M., vd. (2021). Rektum Kanserlerinde Sfinkter Koruyu Girişimlerin Neoadjuvan Kemoradyoterapi ile İlişkisi. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, 8(2), 97-103.
AMA Öztaş M, Özerhan İ, Günal A, Beyzadeoğlu M, Peker Y, Çetiner S. Rektum Kanserlerinde Sfinkter Koruyu Girişimlerin Neoadjuvan Kemoradyoterapi ile İlişkisi. MMJ. Ağustos 2021;8(2):97-103.
Chicago Öztaş, Muharrem, İsmail Özerhan, Armağan Günal, Mehmet Beyzadeoğlu, Yusuf Peker, ve Sadettin Çetiner. “Rektum Kanserlerinde Sfinkter Koruyu Girişimlerin Neoadjuvan Kemoradyoterapi Ile İlişkisi”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 8, sy. 2 (Ağustos 2021): 97-103.
EndNote Öztaş M, Özerhan İ, Günal A, Beyzadeoğlu M, Peker Y, Çetiner S (01 Ağustos 2021) Rektum Kanserlerinde Sfinkter Koruyu Girişimlerin Neoadjuvan Kemoradyoterapi ile İlişkisi. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 8 2 97–103.
IEEE M. Öztaş, İ. Özerhan, A. Günal, M. Beyzadeoğlu, Y. Peker, ve S. Çetiner, “Rektum Kanserlerinde Sfinkter Koruyu Girişimlerin Neoadjuvan Kemoradyoterapi ile İlişkisi”, MMJ, c. 8, sy. 2, ss. 97–103, 2021.
ISNAD Öztaş, Muharrem vd. “Rektum Kanserlerinde Sfinkter Koruyu Girişimlerin Neoadjuvan Kemoradyoterapi Ile İlişkisi”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 8/2 (Ağustos 2021), 97-103.
JAMA Öztaş M, Özerhan İ, Günal A, Beyzadeoğlu M, Peker Y, Çetiner S. Rektum Kanserlerinde Sfinkter Koruyu Girişimlerin Neoadjuvan Kemoradyoterapi ile İlişkisi. MMJ. 2021;8:97–103.
MLA Öztaş, Muharrem vd. “Rektum Kanserlerinde Sfinkter Koruyu Girişimlerin Neoadjuvan Kemoradyoterapi Ile İlişkisi”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, c. 8, sy. 2, 2021, ss. 97-103.
Vancouver Öztaş M, Özerhan İ, Günal A, Beyzadeoğlu M, Peker Y, Çetiner S. Rektum Kanserlerinde Sfinkter Koruyu Girişimlerin Neoadjuvan Kemoradyoterapi ile İlişkisi. MMJ. 2021;8(2):97-103.