Study of Role of Neo-Adjuvant Chemo-Radiotherapy in Colorectal Malignancy

Venugopala, K (2010) Study of Role of Neo-Adjuvant Chemo-Radiotherapy in Colorectal Malignancy. Masters thesis, Madurai Medical College, Madurai.


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INTRODUCTION: Adenocarcinoma of the colon and rectum is one among most common site of new cancer cases and deaths in both men (following prostate and lung/bronchus) and women (following breast, cervix and lung/bronchus). The lifetime risk for developing invasive colorectal cancer increases with age, with more than 90% of new cases being diagnosed in patients older than 50years. Colorectal cancer occurs in hereditary, sporadic, or familial forms. Hereditary forms of colorectal cancer have been extensively described and are characterized by family history, young age at onset, and the presence of other specific tumors and defects. Familial adenomatous polyposis (FAP) and hereditary nonpolyposis colorectal cancer (HNPCC) have been the subject of many recent investigations that have provided significant insights into the pathogenesis of colorectal cancer. Sporadic colorectal cancer occurs in the absence of family history, generally affects an older population (60 to 80 years of age) , and usually presents as an isolated colon or rectal lesion. Genetic mutations associated with the cancer are limited to the tumor itself, unlike hereditary disease, in which the specific mutation is present in all cells of the affected individual. Nevertheless, the genetic of colorectal cancer initiation and progression proceed along very similar pathway in both hereditary and sporadic forms of the disease. Cancers arising in the distal 15cms of the large bowel share many of the genetic, biologic, and morphologic characteristics of colon cancers. However, the unique anatomy of the rectum, with its retroperitoneal location in the narrow pelvis and proximity to the urogenital organs, autonomic nerves, and anal sphincters, make surgical access relatively difficult. In addition, precise dissection in appropriate anatomic planes is essential because dissection medial to the endopelvic fascia in vesting the mesorectum may doom the patient to local recurrence of the disease, and dissection laterally to the avascular anatomic space risks injury to the mixed autonomic nerve, causing impotence in men and bladder dysfunction in both sexes. Furthermore, the biologic properties of the rectum, combined with its anatomic distance from the small intestine afforded by it retroperitoneal pelvic location, provides an opportunity for treatment by radiation therapy. AIM OF THE STUDY: 1. To evaluate the usefulness of Neoadjuvant chemo-radiotherapy in colorectal carcinoma. 2. To improve the rates of surgeries feasible following neoadjuvant therapy. MATERIAL AND METHODS: This study has been conducted in the Department of Surgery, Govt. Rajaji hospital, Madurai during 2008-2009. Patients admitted in general surgery units, surgical gastroenterology & surgical oncology department were selected. All these patients were subjected to detailed history, thorough clinical examination of the abdomen, digital rectal examination, proctoscopy, and scopy guided biopsy was taken for Histopathological examination. All these patient had base line biochemical investigation done and included Blood- Hb%, TC, DC, sugar, urea, creatinine, Urine – sugar, albumin, microscopy Liver function test Ultrasonography Double contrast Barium enema when warranted Computed Tomogram plain and contrast enhanced, Magnetic Resonance Imaging when feasible. All patients were counselled with regards to treatment side effects, possible outcome with and without the preoperative chemo-radiotherapy, the side effects during the course. The patients were counselled with regards to Colostomy. During the counselling session, a previous Ostomate was included. Indications for neoadjuvant therapy, basing a difference between the absolute and relative one were explained. Dosages of drugs and radiation were taken care. Comparing indicatively of clinical and diagnostic data before neoadjuvant therapy and before surgery was done. Patients were staged according to the TNM classification system using clinical and radiological data. CONCLUSION: Goals of Neoadjuvant are varied, has advantages over adjuvant therapy Neoadjuvant therapy may be considered a rational approach for treatment of curative Rectal cancer. Volumetric reduction of neoplasia, mesorectum and lateral pelvic nodes was evident in 90% of the patients There was 25% improved surgical feasablity for a sphincter saving procedure in the study. There was a definite reduction of side effect on close organ, mainly on small bowel, which are not displaced into pelvis by post-operative adhesions. There was no local recurrence in patients who underwent surgery during the 2 year follow up period. All Non-Metastatic patients are candidates for pre operative neoadjuvant therapy. Patient selection by detailed pre-op staging very important. Radiation total dose/fraction/fields are not uniformly agreed upon. Neoadjuvant therapy needed in many cases.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Neo-Adjuvant Chemo-Radiotherapy ; Colorectal Malignancy.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 02 Jun 2018 15:54
Last Modified: 02 Jun 2018 15:54

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