Effect of Tumor Infiltrating Lymphocyte on Local Control of Rectal Cancer after Preoperative Radiotherapy

Objective： To study the effect of tumor infiltrating lymphocytes at cancer nest on local control of rectal cancer after preoperative radiotherapy. Methods： From Jan. 1999 to Oct. 2007, a total of 107 patients with rectal cancer were reviewed. They were treated by preoperative radiotherapy, 30 Gy/10 fractions/12 days. Two weeks later, the patient underwent a surgical operation. Their pathological samples were kept in our hospital before and after radiotherapy. Lymphocyte infiltration （LI） degree, pathologic degradation and fibrosis degree after radiotherapy in paraffin section were evaluated under microscope. Results： After followed-up of 21 months （2-86 months）, a total of 107 patients were reviewed. Univariate analysis showed that lymphocyte infiltration （LI）, fibrosis and pathologic changes after radiotherapy were significant factors on local control. Logistic regression analysis showed that LI after radiotherapy was a significant effect factor on local control. Conclusion： LI, fibrosis and pathologic degradation after radiotherapy are significant for local control of rectal cancer after preoperative radiotherapy. LI after radiotherapy was a significantly prognostic index for local control of rectal cancer after preoperative radiotherapy.

Adjuvant Therapy on Cancer of the Lower Rectum. Evaluation of the Effects of Preoperative Radiotherapy on the Prognosis of Patients with Cancer of the Lower Rectum

Aims: The prognosis on treatment of the cancer of the rectum has not changed in the last fifty years. Survival rates of 50 to 55% seems immutable in several published series. The main cause for those results is the high incidence of recurrence, either local or widespread. Local recurrence is directly related to the number of undifferentiated cells and to the grade of wall invasion. Widespread recurrence depends specifically on the lymphatic and vascular spreading. So any kind of treatment that would diminish the number of undifferentiated cells and the size or the tumor wall penetration would certainly decrease the local recurrence rate, lengthening the interval free from cancer and, perhaps, modifying the long term survival rate. Between 1978 and 2009, a total of 538 patients with adenocarcinoma of the lower rectum (from the pectinate line to 10 cm above) were treated by preoperative radiotherapy. Methodology: The same protocol was used in all the patients – 400 cGy, 200 cGy/day, during 4 consecutive weeks (anterior and posterior pelvic fields) by means of a Linear Megavoltage Accelerator (25 MeV). Surgery was performed 2 months after completion of the radiotherapy. Results: Statistical analysis of the whole group showed that preoperative radiotherapy does decrease frequency of undifferentiated cells. Moreover, the incidence of local recurrence diminished after irradiation by 3.4%. Preoperative radiotherapy reduces tumor volume (ERUS) and wall invasion, as well as the mortality rate due to local recurrence (2.4%) and alters long-term survival rate (80.1%). Conclusion: Preoperative radiotherapy is really effective in reducing the number of undifferentiated cells and in diminishing the tumor volume and the carcinomatous infiltration of the rectal wall.

Research on Using IMRT Plan for Preoperative Rectal Cancer Patients

Aims: Research the possibility of using IMRT for rectal cancer patients in preoperative radiotherapy. Methods and Material: The research object is the preoperative radiotherapy plan for rectal cancer patients. The research group made two plans (IMRT, 3DCRT) for each image series of 34 rectal cancer patients who have received preoperative radiotherapy in Hanoi Oncology Hospital;and then compared the dose distribution on PTV, bladder, intestine, femoral bones, the average MU, and QA results of two types of plan. Results: The 95% isodose line and 50% isodose of IMRT plan are closer than those of 3DCRT plan. The average dose of PTV in IMRT plan and 3DCRT plan are 5006 ± 23 cGy and 5036 ± 42 cGy, respectively. The HTCI and HI values of IMRT and 3D plan are 0.97 ± 0.026 and 5.37 ± 1.32;1.00 ± 0.003 and 7.08 ± 0.88. About the dose of organ at risk: The maximum dose, average dose on the right, left femoral head in the IMRT plan are less than those values in the 3DCRT plan (6.2 Gy, 6 Gy, 7.4 Gy, 9 Gy, respectively). The maximum dose and average dose on the bladder of the IMRT plan are smaller than those values of the 3DCRT plan (5.3 Gy, 1.5 times, respectively). The maximum dose and average dose of intestine in the IMRT plan was less than those values in the 3DCRT plan (4.3 Gy, 1.54 times, respectively). The MU number of IMRT plan is 1.5 times bigger than that of 3DCRT plan. Gamma index of IMRT plan is better than that of 3DCRT plan (99% compared with 97%). Conclusions: Using IMRT plan in preoperative radiotherapy for rectal cancer patients can still ensure covered PTV as well as the 3D PLAN. Furthermore, the dose of PTV in the IMRT plan is more uniform than those in the 3D plan, and the dose effect on the OAR surrounding PTV is much lower than when using the 3D plan. When IMRT plan were used to treat the preoperative rectal cancer patients, the LINAC took more time than when using 3DCRT plan.