Klinikai és hisztopatológiai eredmények előrehaladott rectumtumorok neoadjuváns kezelése után

2/nap 5-FU es 20 mg/m 2 /nap leucovorin kemoterapia, az utobbi időben kiegeszitve celzott an a makroszkopos tumorra biztonsagi zonaval 3x1,8 Gy előrehozott boost besugarzassal. Restaging vizsgalatokat kovetően atlagosan 8 hett el az onkologiai kezeles utan vegeztuk a műteteket. 38 (57%) elulső rectumreszekcio tortent kett ős stapler technikaval, 18 (27%) abdominoperinealis rectumexstirpaciot, 7 Hartmann-műtetet, illetve 4 per anum exciziot vegeztunk. A patologiai feldolgozas a preoperativ staginghez kepest 6 esetben (11%) teljes ( P T 0 N 0 ) remissziot, 43%-ban parcialis remissziot mutatott . A regresszios gradiens alapjan TRG 1 11%, TRG 2 25%, TRG 3 32,2%, TRG 4 26,8%, TRG 5 5% volt. Reoperaciot igenylő morbiditas 5,9% volt. Varratelegtelenseg nem fordult elő. Az onkologiai es sebeszi kezelesnek mortalitasa nem volt. A hosszuidejű neoadjuvans onkologiai kezeles az esetek tobbsegeben a rectumdaganat stadiumat csokkenti, ezzel emeli a reszekabilitast es a jobb eletminőseget jelentő reszekcios műtetek aranyat. Magyar Onkologia 54:129–135, 2010 Kulcsszavak: rectumcarcinoma, neoadjuvans radio-kemoterapia The role of the surgical intervention is decisive in treating colorectal tumors. The neo-adjuvant radiochemotherapy has improved the effi cacy of the treatment of advanced rectum tumors. In order to decrease the size and stage of advanced rectal carcinoma and to increase the rate of resecability, we introduced neoadjuvant radio-chemotherapy. We carried out neo-adjuvant and surgical treatment in case of 67 patients with rectal adenocarcinoma (T 2–4 N 1–2 M 0 ) between June 1, 2005 and July 31, 2008. The average age of the patients was 61.2 years, the division according to sex was 44 males/23 females. Regarding the local stage of the rectal process or the proximity to the sphincter, we applied radio-chemotherapy (radiotherapy 25 times altogether 45 Gy and on the fi rst and last week for 5–5 days they received 350 mg/m 2 / day 5-FU and 20 mg/m 2 /day leucovorin chemotherapy, recently complemented with 3x1.8 Gy advanced boost radiation aiming at the macroscopic tumor site with security zone). Patients underwent surgery 8 weeks on average aft er restaging examinations. Thirty-eight patients underwent anterior rectal resection with double stapler procedure; there were 18 abdominoperineal rectal extirpations, 7 Hartmann operations and 4 per anum excisions. Compared to the preoperative staging, the histological evaluation of the resected specimens showed total remission (pT 0 N 0 ) in 11% and partial remission in 43%. The morbidity necessitating reoperation was 5.9%, without mortality and suture insuffi ciency. The long-term neoadjuvant oncological treatment led to down-staging of rectal tumors in most cases and increased the resecability and rate of resection operations. Varga L, Baradnay G, Hőhn J, Simonka Z, Hideghety K, Maraz A, Nikolenyi A, Vereb B, Tiszlavicz L, Nemeth I, Man E, Lazar G. Clinical and histopathological results aft er the neo-adjuvant treatment of advanced rectal tumors. Hungarian Oncology 54:129–135, 2010