Evaluate the results of concomitance chemoradiotherapy postoperative treatment for rectal cancer in stage II-III At K Hospital from 2012 to 2016 Speaker: Le Thi Huyen Sam HaiPhong, 11/2017.

RESEARCH QUESTION Colorectal cancer is one of the fif common types of cancer. Colorectal stage I after surgery for local recurrence rate <10% While stage II for recurrence rate on the spot: 15-35%   And stage III for local recurrence rate: 45-65%.

RESEARCH QUESTION Concomitance chemoradiotherapy postoperative is putted into practice for many years on over the world and Vietnam Many reseachers on the world proved effect of this regimen but in VietNam did not. So we conducted this topic with objective: Evaluate the results of Concomitance chemoradiotherapy supplement the treatment of rectal cancer after surgery phase II-III, and analyze some factors that affect the outcome of treatment.

OBJECTIVES AND RESEARCH METHODS 36 patients with rectal cancer who received postoperative II-III surgery were then treated with concurrent chemoradiotherapy Standard selection Diagnosis of rectal cancer. Evaluation of phase II-III (T3-4N0M0; There are no contraindications to chemotherapy and radiation therapy. Patients fully attended the treatment. PS 0-1 full status . Fully monitored live death status. Have full information. Exclusion c rectal cancer stage I, IV; Pathology: not epithelial carcinoma; Patients with other cancers; Do not fully participate in treatment. Other diseases: kidney failure, heart failure, liver failure

OBJECTIVES AND RESEARCH METHODS 2. Research methodology - Study description retrospective. - Sample: convenient accumulation. - Sample size: n = 36 - Data collection based on medical records. Data is processed by software spss 20.0 3. Location and time of study Time and place: from January 2012 to May 2016 at K Hospital.

OBJECTIVES AND RESEARCH METHODS 4. research content General features Age Job Geography Prehistoric Disease detection time. clinical- subclinical Characteristics Reason for hospitalization clinical symptoms: systemic symptoms functional symptoms physical symptoms Histopathology, CT- ... Stage of disease Treatment results Functional response Response entity Lifetime extra Toxicity of hematopoietic system Toxic with liver and kidney Toxicity outside hematopoietic system

REGIMENS Methodology: Postoperative colorectal cancer patients in Phase II-III were included in the study. Assess patients before concurrent chemoradiation therapy: clinical examination: information on the age, disease stage, tumor location, type of Pathology , differentiation; CT-scan / MRI sub-frame; Serum CEA levels. Radiotherapy at the same time: Radiotherapy: 46-54 Gy, dose 2 Gy / day x 5 days / week. Compound: Capecitabine 825 mg / m 2 twice daily, taken continuously in the days of radiation therapy. Following concurrent chemoradiation therapy, patients were treated with chemotherapy supplemented with Xelox regimen

REGIMENS Result evaluation: At the end of treatment, patients were re-evaluated by clinical examination, taking C.T.Scan / MRI sub-frame, quantifying serum CEA levels compared with pretreatment results. Survival follow-up evaluation:overall survival, progression – free survival, and survival were associated with a number of prognostic factors.

RESULTS AND DISCUSSION Table 1.1. Age distribution of the study group Age group n % < 30 1 2.8 30-40 2 5.6 40-50 8 22.2 50-60 12 33.3 60-70 11 30.6 70≤ Total 36 100

RESULTS AND DISCUSSION Gender male female Figure 1.1. Gender distribution of patient research groups

Table 1.2. Characteristics of the tumor   n % Tumor location high 6 16.7 medium 12 33.3 low 18 50.0 total 36 100.0 Tumor Size < 1/3 perimeter 1 2.8 1/3 – 2/3 perimeter 24 66.6 2/3 – 3/4 perimeter 11 30.6 100 General situation rough 16 44.4 Ulcers 8 22.2 Rough and ulcers infectious tumor Total

Table 1.3. CEA level before surgery RESULTS AND DISCUSSION Table 1.3. CEA level before surgery CEA n % ≤5 ng/ml 26 72.2 >5 ng/ml 10 27.8 Total 36 100.0

RESULTS AND DISCUSSION Mucky AC low Differentiation AC medium diferentiation AC high diferentiation Figure 1.2. Classification of histopathology of the tumor

RESULTS AND DISCUSSION Table 1.4. Stage of disease Stage   n % pT T2 4 11.1 T3 13 36.1 T4a 18 50.0 T4b 1 2.8 pN N0 26 72.2 N1 6 16.7 N2 II 27 75.0 III 9 25.0 Total 36 100

RESULTS AND DISCUSSION Table 1.5 Monitoring information Status n % Have information 36 100 loss of information Alive Recurrent, metastatic 30 7 83,3 19,4 Dead 6 16,7 Average tracking time 36,5 ± 1,9 Longest tracking time 42 The shortest tracking time

RESULTS AND DISCUSSION Overvall survival Time n % After 1 year 33 90,4 After 2 years 32 86,1 After 3 years 30 72,2 OS years Rate month

RESULTS AND DISCUSSION PFS Time n % After 1 year 33 91,1 After 2 years 32 86,6 After 3 years 29 67,6 PFS rate years month

RESULTS AND DISCUSSION OS Folowing T,N OS OS rate rate Month Month

OS folowing stage desease RESULTS AND DISCUSSION OS folowing stage desease OS Stage II Stage III StageII rate Month

Side effects Most patients have toxicity of 0.1. After treatment 13.9% of patients had hemoglobin level 2 toxicity; 25% of patients with hypopituitarism; 22.3% of patients with neutropenia grade 1, 2; There are no patients with neutropenia at 3.4. The rates of creatinine and ALT (levels 1 and 2) were 36.1% and 27.8%, respectively.

Side effects Other undesirable effects (stomatitis, diarrhea, anal pain) were at grade 1, 2 with a low rate of 8.3%; 16.7%; 8.3%; corresponding. Two patients with bowel obstruction accounted for 5.6%. No patient has ulcer in the perineal area, intestinal perforation, narrowing of the mouth. Symptoms on the genitourinary system - level 1 only: cystitis 13.9%; 5.6% vaginitis. There were 30.6% of patients with hand-foot syndrome and at grade 1. None of the patients had a degree of toxicity of 3.4

CONCLUDE A study of 36 patients with rectal cancer in stage T3-4N1-2M0 treated with accelerated dose of 46-54 Gy with Capecitabine after surgery at Hospital K from 2012 to 2016 showed that: The rate of OS and PFS at 3 years is 72.2% and 67.6% respectively. OS at 3 years for tumor stage T2-3 and T4 respectively 77.9% and 71.1%; for node N0; N1; N2 is 84%; 74.1 and 62.8%; For Phase II and III, 84% and 68.6%, respectively. The side effects of the regimen were mostly levels 1, 2 and no patients were interrupted.

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