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Start Over Creator Svoboda, M.

4. Možnosti predikcie rezistencie k neoadjuvantnej konkomitantnej chemorádioterapii u pacientov s karcinómom konečníka

Creator:
Garajová, Ingrid, Svoboda, M., Kocáková, Ilona, Fabian, Pavel, Kocák, Ivo, Vyzula, Rostislav, and Slabý, Ondřej
Type:
model:article, article, Text, and TEXT
Subject:
adenokarcinom--farmakoterapie--chirurgie--radioterapie, antimetabolity antitumorózní--terapeutické užití, chemoterapie adjuvantní, deoxycytidin--analogy a deriváty--terapeutické užití, fluorouracil--analogy a deriváty--terapeutické užití, lidé, neoadjuvantní terapie, prognóza, radioterapie adjuvantní, nádory rekta--farmakoterapie--chirurgie--radioterapie, výsledek terapie, and nádorové biomarkery--analýza
Language:
Czech, Slovak, and English
Description:
Neoadjuvant concomitant chemoradiotherapy has become a standard treatment of locally advanced rectal adenocarcinomas (LARA). It leads to shrinkage of the tumor mass and subsequently to an increase in complete resections (R0 resections), increasing a feasibility of sphincter-sparing intervention avoiding colostomy. It is based on concurrent application of fluoropyrimidines (5-fluorouracil, capecitabine) and radiotherapy (45 - 50,4 Gy). It shows less acute toxicity and improves local control rate in comparison to adjuvant treatment. Unfortunately, neoadjuvant chemoradiotherapy is not beneficial for all patients. The treatment response ranges from a complete pathological remission (pCR, ypT0ypN0) to a resistance. It is reported that cca 15 percent of patients with advanced rectal cancer show pCR which is indicative of improved long-term prognosis. DESIGN: The following is a review of the significance of neoadjuvant concomitant chemoradiotherapy in the treatment algorithm of patients with LARA and summary of potentional clinical-pathological and molecular markers of response prediction to neoadjuvant therapy. The most important clinical studies concern serum tumor markers levels, clinical lymph node classification. The components of the carcinogenic pathways are explored, including oncogenes, tumor supressor genes, microsatellite instability (MSI) and potentional markers involved in apoptosis, angiogionesis, proliferation as well as metastasis and invasion, are reviewed. Finally, the role of specific enzymes associated with the metabolism of fluoropyrimidines are examined. CONCLUSIONS: No one marker has been consistently identified as clinically applicable. Studies designed to determine the potentional markers are hampered by various techniques as well as tumor heterogenity and recent scientific approach--studying individual molecular markers. Gene expression profiling analysis of multiple genes from the same tumor is becoming reality. We suppose that this assessment will lead in future in finding combination of markers for predicting prognosis and response to therapy in rectal cancer., Garajová Ingrid, Svoboda M., Slabý O., Kocáková L., Fabian P., Kocák I., Vyzula R., and Lit.: 71
Rights:
http://creativecommons.org/publicdomain/mark/1.0/ and policy:public