Gaubtinės ir tiesiosios žarnos vėžio chemoterapijos veiksmingumo įvertinimas

Show simple item record Jančiauskienė, Rasa 2017-08-21T08:07:03Z 2017-08-21T08:07:03Z 2006
dc.description.abstract 1. INTRODUCTION Colon and rectum cancers (CRC) accounted for about 1 million new cases in 2002 (9.4 % of the world total) with about 529,000 deaths and 2.8 million alive with CRC diagnosed within 5 years of diagnosis [Parkin DM et al, 2005]. Recent estimates indicate that in 2004 CRC among the most common incident form of cancer in the Europe was in the second position with more than 380,000 new cases (13.2% of total). CRC was also one of two most common causes of cancer deaths in Europe (203,700 per year) [Boyle P et al, 2005]. A favourable pattern in CRC mortality for both genders was observed in most of western European countries from the 1990s onwards, but CRC mortality rates were still in the upward direction in some eastern European countries [Fernandez E et al, 2005]. For patients diagnosed with CRC during the early 1990s, the EUROCARE study showed that differences in stage at diagnosis were a key explanation for differences in survival between western European countries, and differences in therapy contributed to survival differences between eastern and western European countries [Gatta G et al, 2000]. The number of new cases of CRC in Lithuania is increasing every year. According to the data of Lithuanian Cancer Registry, there were diagnosed 1442 new colorectal cancer cases and 973 deaths in 2004 in Lithuania [The main results of cancer control in Lithuania. Transitional report 2004. Lithuanian Cancer Registry]. CRC is in the third position according new cancer cases and cancer related deaths in Lithuania. The CRC is ranked having moderate prognosis (European average 5-year survival 40-59% for those who were diagnosed during 1990-1994 period) [Coleman M et al, 2003]. But in Lithuania rectal cancer belongs to group of cancers of poor prognosis with 5-year survival less than 40% [Kurtinaitis J. Cancer trends and survival of cancer patients in Lithuania. Research Report Presented for Habilitation. Kaunas, 2003]. During the last 15 years there were a lot of changes at the diagnosis and treatment of CRC in the world: increased the proportion of stage I and II patients due to availibility of endoscopic evaluation, increased resection rate and decreased postoperative mortality, rose the proportion of stage III patients treated with adjuvant chemotherapy and proportion of stage IV patients treated with palliative chemotherapy. This led to an improvement in five year relative survival [Faivre-Finn C et al, 2002]. Although randomized controlled trials consistently show that adjuvant fluorouracil-based chemotherapy improves the survival of stage III colon cancer patients and combination of chemotherapy and radiotherapy improves the survival of stage II and III rectal cancer patients, it is not yet known where this benefit exist in populations underrepresented on clinical trials, particularly the elderly with medical comorbidity. Studies showed that in US about 70% of all CRC patients are older than 65 years, and only 40% of elderly patients are enrolled in clinical trials [Hutchins LF et al,1999]. The aim of the study To evaluate the effectiveness of chemotherapy in colorectal cancer patients. The objectives of the study 1. To compare survival of colorectal cancer patients of Kaunas region who were diagnosed during 1990-1992 and 1995-1997 periods. 2. To evaluate the effectiveness of palliative chemotherapy for colorectal cancer patients of Kaunas region who were diagnosed during 1990-1992 and 1995-1997 periods. 3. To evaluate the effectiveness of adjuvant chemotherapy for colon cancer patients of Kaunas region who were diagnosed during 1990-1992 and 1995-1997 periods. 4. To evaluate the effectiveness of adjuvant chemotherapy for rectal and rectosigmoid cancer patients of Kaunas region who were diagnosed during 1990-1992 and 1995-1997 periods. 5. To assess the use of adjuvant and palliative chemotherapy for Kaunas region colorectal cancer patients at the 1990-1992 and 1995-1997 periods. 6. To evaluate prospectively the effectiveness of hepatic artery infusion in the neoadjuvant setting in patients with metastatic colorectal cancer confined to the liver: response rate, resection rate of liver metastases, time to progression, median survival. 7. To evaluate prospectively the adverse effects of hepatic artery infusion. 8. To evaluate prospectively the impact of other prognostic factors on survival of patients treated with hepatic artery infusion. Scientific novelty of the study Ø Little is known about the adjuvant and palliative chemotherapy effectiveness for colorectal cancer at the population level. Population based studies recording all cases diagnosed in a well defined population represent the only way to assess improvement in the management of colon cancer. Some cancer registries collect detailed data on therapeutic approaches allowing to access information about changes in the management of cancer at the population level. This interest is recent and therefore there is paucity in the literature of reports of this type. The data about treatment are not collected at Lithuanian Cancer Registry. The effectiveness of chemotherapy at the population level were evaluated for the first time in Lithuania. Ø Surgery remains the gold standard treatment for colorectal cancer patients with resectable liver metastases. For patients with non-resectable metastases, improvements in chemotherapy have resulted in significant benefit of survival. However, long-term survival is only exceptionally obtained with chemotherapy alone. Encouraging data are now emerging with the combined use of neoadjuvant chemotherapy and surgery. The long-term remissions observed in unresectable patients treated by this combined approach open new perspectives for category of patients otherwise doomed to a rapid fatal outcome. Resectability is a new endpoint showing curative potential of the treatment compared with classical endpoints of response or progression-free survival that are important if palliation is the aim [Folprecht G et al, 2005]. We evaluated the effectiveness of hepatic artery infusion in the neoadjuvant setting for selected colorectal cancer patients with unresectable metastases confined to the liver. There are only few reports in the literature according the impressive effectiveness of HAI as neoadjuvant treatment method in combination with systemic chemotherapy [Kemeny N et al, 2005; Ducreux M et al, 2005]. We performed multiple catheterisations of hepatic artery and this allowed precisely perfuse all the hepatic tumours. Only a few authors have proposed multiple catheterisations for intraarterial infusion of chemotherapeutic agents for the local treatment of tumours such as pancreatic, uterine, cervical, and breast cancer, but there are no data in the literature about use of multiple catheterisations for the treatment of metastatic colorectal adenocarcinoma confined to the liver. 2. MATERIALS AND METHODS 2.1. Retrospective study Primary data (date of birth, place of residence, date of diagnosis, location of tumour, morphologic verification, stage of disease and TNM classification, date and cause of death) of colorectal cancer patients who were diagnosed in Kaunas region at 1990-1992 and 1995-1997 periods (n=1879) were obtained from population-based cancer registries of Lithuania and Kaunas region. Data about treatment were obtained from archival case histories (from 1990 to 2002) in Kaunas Medical University Hospital and Oncology Hospital, also in Oncology Institute of Vilnius University. During the periods 1990-1992 and 1995-1997 there were diagnosed 1879 new colorectal cancer cases in Kaunas region. Because of unknown status or early deaths from diagnosis (it is usually cases registered through death certificates alone) were excluded 10.2% of patients (table 1). Cancers were classified according to the International Classification of Diseases (ICD), 10th revision. A total of 1688 patients with colorectal cancer (C18, C19 and C20 according ICD-10) were enrolled into analysis. Because of adjuvant and palliative treatment does not differ for rectal and rectosigmoid cancer, these cancers were analysed together. Place of residence was recorded as university hospital town (Kaunas), other urban area (Kėdainiai, Jonava, Raseiniai, Šakiai, Jurbarkas, Kaišiadorys, Prienai, Birštonas, Marijampolė, Alytus, Lazdijai, Vilkaviškis) and rural areas. The main characteristics of enrolled patients are shown in table 2. Diagnosis of advanced disease (stage III + IV + unknown) was made approximately for the same proportion (74.3% and 78.5%, respectively) of patients at the different periods. The status of the patients was validated at 2nd of February 2005. It was found that 28.3% and 28.9% of those in whom CRC diagnosis was made at the periods from 1990 to 1992 and from 1995 to 1997, respectively, were alive (table 3). We identified 227 patients who were treated with chemotherapy. In 1995-1997 increased the proportion of treated males, patients from other urban areas and patients with rectal-rectosigmoid cancer, in palliative setting chemotherapy was administered relatively more frequent than in adjuvant setting (table 4). The combination of 5-fluorouracil and immunomodulators (levamisole or leucovorin) was used relatively rarely at the periods from 1990 to 1992 and from 1995 to 1997: only for 7.4% of those treated in the adjuvant setting and for 8.3 % of those treated in the palliative setting (table 5). In the most majority of case it was administered the 5-fluorouracil alone. Statistical analysis. Data were analysed using Statistical Package for Social Sciences (SPSS), 10th version. Cancer-specific survival was determined by Kaplan-Meier method and distribution compared by the log rank, Breslow and Wilcoxon tests. The difference was denoted significant when p-value was found less than 0.05. In the survival analysis patients were adjusted by sex and age using random sampling (the ratio of treated with palliative chemotherapy versus not tr
dc.language.iso lit
dc.subject Chemoterapija
dc.subject Gaubtinės ir tiesiosios žarnos vėžys
dc.subject Colorectal cancer
dc.subject Chemotherapy
dc.title Gaubtinės ir tiesiosios žarnos vėžio chemoterapijos veiksmingumo įvertinimas
dc.title.alternative The evaluation of chemotherapy effectiveness for colorectal cancer patients
dc.type Daktaro disertacija

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