2. 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.

3. 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: %.

4. 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.

5. 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

6. 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.

7. 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

8. 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: 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

9. 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.

10. 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

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

12. Table 1.2. Characteristics of the tumorn %
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

13. 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

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

15. 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

16. 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

17. 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

18. 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

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

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

21. 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.

22. 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

23. CONCLUDE
A study of 36 patients with rectal cancer in stage T3-4N1-2M0 treated with accelerated dose of 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.

24. Thanks you very much for your attention!