CHOICE OF THE OPTIMAL METHOD OF TREATMENT OF LOCALLY ADVANCED RECTAL CANCER.

Аннотация

Rectal cancer is one of the most common forms of malignant neoplasms both in the world oncological practice and in Uzbekistan. About 600,000 new cases of this disease are diagnosed annually in the world. Over the past few decades, there has been a steady increase in the incidence of rectal cancer. The data on the relative incidence of this nosology are comparable among Russian and foreign authors according to Siegel R., Miller K., rectal cancer, including anal canal cancer, accounts for about 50% of all colon tumors. In recent years, there has been a tendency towards an increase in the incidence of rectal cancer worldwide, so its share in the structure of oncological morbidity in men is 5.3% and in women 4.4%. Locally advanced rectal cancer is a tumor of limited mobility or immobile with involvement or destruction of its own fascia, without obvious signs of distant metastasis in patients who, due to its spread beyond the organ, cannot undergo radical surgery without a high risk of local relapse in thenear future after surgery. One of theurgent tasks ofmodern oncoproctology is to improve thelong-term results of treatment ofpatients with locally advanced rectal cancer (LARC). Key words: locally advanced rectal cancer, chemoradiation therapy, neoadjuvant chemotherapy, consolidation chemotherapy, induction chemotherapy, SANDWICH therapy, pathomorphism.capecitabine; oxaliplatin. Relevance. In recent years, against the background of an increase in the overall incidence of rectal cancer both in the world and in Russia, the proportion of patients with a locally advanced tumor process at primary treatment is more than 30% [8]. The use of preoperative prolonged chemoradiotherapy (CRT) in combination with fluoropyrimidine drugs, followed by total mesorectumectomy and adjuvant chemotherapy (CT) is the standard of treatment for this group of patients and is included in national recommendations of the USA (NCCN), Western European countries (ESMO) and Russia (AOR). Colorectal cancer accounts for 15% of all cancer cases, and rectal cancer (RC) accounts for 30%. More than 1 million cases of colorectal cancer are registered worldwide every year. In most countries, mortality from RC ranks 5th or 6th [5]. Unfortunately, this goal is not always achievable in the treatment of RC, since the radicalism of the operation is often achieved through extensive resections with the loss of the locking apparatus of the rectum [7]. At the same time, expanding the scope of surgical intervention does not prevent the risk of relapse, which requires combined treatment in various modes. Epidemiology . The highest incidence of rectal cancer is recorded in Japan (Hiroshima: men - 23.3, women - 10.0), the Czech Republic (men - 18, women - 7). High incidence is recorded in New Zealand, North America, Northern and Western Europe. Low incidence is noted in Africa, South and Central America. In Russia, the incidence of rectal cancer is quite high (St. Petersburg: men -13, women -8) [12]. The share of rectal cancer in the structure of morbidity http://www.internationaljournal.co.in/index.php/jasass 505 Volume 15Issue 05, May 2025 Impact factor: 2019: 4.679 2020: 5.015 2021: 5.436, 2022: 5.242, 2023: 6.995, 2024 7.75 from 13 malignant neoplasms in the male population is 5.2%, in women - 4.7%. Among the CIS countries, it was minimal in Armenia, Uzbekistan and Kyrgyzstan (2-3%), and maximal in Moldova (8% in men and 5.2 in women). Rectal cancer in Russia, Belarus, Uzbekistan is in fifth place. On average, in men, rectal cancer in these countries is from 4to 5%. The increase in standardized incidence rates was 12–50% for both sexes in Azerbaijan and Armenia, and for men in Kazakhstan and Belarus. The lowest increase was observed in Uzbekistan (3.3% for men and 4.2% for women). A decrease in standardized incidence rates of rectal cancer was noted inKyrgyzstan (15.9%and -25%). Etiology. Most malignant neoplasms of the rectum develop against the background of adenomatous polyps or adenoma. Polyps are histologically classified as tubular (5% malignancy), villous (40% malignancy), or mixed (20% malignancy)[39]. The degree of intestinal epithelial dysplasia also plays an important role in the etiology of rectal cancer and ranges from 5% malignancy (low grade) to 35% (high grade). The risk ofmalignancy of benign neoplasms also correlates with the size of adenomas: 90% are less than 1 cm in size (1% risk), 10% are more than 1 cm (10% risk). Despite advances in radiation and drug therapy, as well as recent advances in molecular biology of cancer, theleading The surgical method remains the treatment of this pathology [1]. However, despite the abundance ofmodern surgical techniques, many fundamentally new designs of suturing devices and modern high-tech equipment for operating rooms, the improvement of the surgical method from an oncological standpoint has toa certain extent reached its limit, as evidenced by thelack ofsignificant improvements in thelong-term results