Optimal treatment options for patients with rectal cancer and low risk of progression

Objective. To determine the optimal indications for various treatment options in patients with low-risk rectal cancer depending on local invasion and negative prognostic factors. Material and methods. The study included 227 patients with T1—2N0M0 and T3aN0M0 rectal cancer. Fifty-two (22.9%) ones underwent surgical treatment alone, 81 (35.7%) — neoadjuvant radiotherapy alone, 94 (41.4%) — neoadjuvant irradiation with polyradiomodification. Radiotherapy was administered over five days (single focal dose 5 Gy, total focal dose 25 Gy). The second treatment option included irradiation and polyradiomodification: local microwave hyperthermia, intrarectal administration of biopolymer composition with metronidazole, and oral administration of Capecitabine at a daily dose of 2.0 g/m2 for 2 weeks. Surgery was performed 6—8 weeks after irradiation. Results. For T1sm1—2N0M0 rectal cancer, surgical treatment is indicated, including transanal endoscopic surgery or rectal resection. Radiotherapy is not necessary. In T1sm3—T2N0M0 rectal cancer, recurrence rate after surgical treatment was 6.4% (3 out of 47) and did not differ from recurrence rate (6.5%, 2 out of 31) after neoadjuvant irradiation alone. There were no recurrences in 24 patients after polyradiomodification. Neoadjuvant irradiation alone is ineffective for T3aN0M0 rectal cancer. Recurrences were detected in 2 (4.9%) out of 49 patients. Only polyradiomodification was able to improve treatment outcomes. None out of 94 patients had recurrences, and 88.3% of them underwent sphincter-sparing treatment. Conclusion. Optimal treatment option for patients with low risk of progression is determined by local tumor spread. Polyradiomodification ensures high local control and maximum preservation of the affected organ.