TITLE:
Radio-Chemotherapy in Pre-Operative Rectal Adenocarcinoma at Dalal Jamm Hospital, Senegal
AUTHORS:
Mouhamadou Bachir Ba, Fatimatou Néné Sarr, Adja Coumba Diallo, Maimouna Mané, Pape Massamba Diéne, Papa Macoumba Gaye
KEYWORDS:
Cancer, Rectum, Radiotherapy, Senegal
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.12 No.4,
April
29,
2021
ABSTRACT: Background: Radiation therapy is an essential treatment for rectal cancer. In 2018, Senegal
experienced a transition from two-dimensional to three-dimensional radiotherapy
(RC3D). We are evaluating for the first time the impact of this RC3D in the
treatment of rectal cancer in Senegal. Objective: To describe the epidemiological, clinical and diagnostic
profile of rectum cancer in Senegal, to list the different radiotherapy
techniques used, to evaluate the response as well
as the outcome of patients. Method: We conducted a retrospective descriptive study on preoperative
radio-chemotherapy of rectal adenocarcinoma at the Dalal Jamm University
Hospital in Dakar from July 2018 to June 2020. Results: The 42 patients
included, including 18 men and 24 women (Sex Ratio: 0.75), had an average age
of 55.9 years. We found a family history of CRC (Colorectal cancer) in 7 cases
and smoking in 5 cases. The clinical signs were dominated by rectal bleeding,
noted in 92.8% of cases, with or without pain, and changes in transit in 57.1%
and 50% respectively. The tumor was perceptible on digital rectal examination
(DRE) in 76.1%. All patients had undergone endoscopy, which revealed a budding
aspect in 69% of cases. The preferred location was the lower rectum (59.5%).
The predominant histological type was liberkhunian adenocarcinoma (85.7%). T3
and T4 tumors accounted for 30.9% and 21.4% of cases respectively and stage III
was predominant, 69%. The aim of radiotherapy was curative in 33 patients and
palliative in 9 patients. Curative radiotherapy was preoperative in 29 patients
and adjuvant in 2 patients. RC3D was the technique used in all our patients and
the total dose of 50.4 Gy in 28 sessions of 5 days per week was the most used
(69%). The incidents noted during radiotherapy were 12 cases of
radiodermatitis, 15 cases of diarrhea, and no severe toxicity was noted.
Thirty-one patients underwent surgery, 16 with anterior resection of the rectum
and 3 with total proctectomy; the sphincter preservation rate was 61.2%. The
surgical resection was carcinological (R0) in 26 patients and microscopically
incomplete (R1) in 5 patients. Post-operative evaluation of the pathological
specimen showed a complete histological response in 21% of cases. The evolution
was marked by a progressive disease in 4 cases, local recurrence in 3 cases,
metastatic recurrence in 4 cases, death in 8 cases and remission in 23 cases. The average follow-up of our
patients was 17.3 months. Conclusion: Rectal cancer is diagnosed
late in Senegal; surgery remains the cornerstone of treatment. Radiotherapy
increases the resectability and local control.