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REKTUM (Općenito (prevencija (biopsija (kome, interval), Aspirin, Vit D,…

- - - - nasljeđe
        
        2 bolesti
        
        Lynch
        
        geni
        
        povezane još 2 bolesti
      - Upalne bolesrti
      - prehrana
  - - - rektum
        
        bolovi, stolica
      - proximalni dio
        
        asimtomatski, opstukcija, anemija
  - - - rigidna
      - flexibilna
  - - - kome
      - interval
  - - - CRM
        
        CRM measured at the closest distance of the tumor to the mesorectal fascia. Involved CRM: within 1mm of mesorectal fascia; or, for lower third rectal tumors, within 1 mm from levator muscle; or, for anal canal lesions, invasion into or beyond the intersphincteric plane oBolus 5-FU/leucovorin/RT is an option
        
        https://www.google.ba/search?q=crm+rectal+cancer&tbm=isch&source=lnms&sa=X&ved=0ahUKEwistcWQ26LaAhUMBMAKHQ3cCZkQ_AUICigB&biw=1229&bih=548&dpr=1.56#imgrc=WKSPT2i4PCaCdM:
- - - - http://imedex.com/gi-malignancies-debate-conference/archive/2015/agenda.asp
    - - master
        
        http://www.primeoncology.org/online-education/solid-tumor/masterclass-colorectal-cancer-japan-2017-slides/
- - - - vrste
        
        kurativni
        
        palijativni
        
        lokalni
        
        anus preter
        
        ileotransverzostomija
        
        presadnice
        
        metastazektomija
      - TME
    - - adj
        
        RT
        
        Švedska, preop RT vs OP, LR 27vs11%, OS 74vs64%
        
        R01, adj RT, LR s 25 na 15%
        
        RT
        
        doza
        
        AE
        
        polje
        
        Tretman
        
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        fizičari
        
        boost
        
        imobilizacija
        
        kemoth
        
        KT adj
        
        dokazi, nema ih
        
        GITSG (kako je prošla KT), **zamjerka-korišten Semustin (može uzrokavati leukemjije), 10y krt 45vs 27%
        
        EORTC 22921, T3, 4/Nx 4 grane (preop RT, KRT, OP pa obs vs post op KT), nema benefita u OS-u (ima trend), **ALI samo 40% prmilo
        
        Italijsnka, neg
        
        PROCTOR, CRONICLE-zatvorene zbo malog odaziva
        
        PEGI
        
        dokazi, ALI kod FOLOX-a radi
        
        ADORE, 80 pts, 5FU RT adj Mayo vs Oxali, DFS delta (veći u st III nego u II)
        
        AIO4, PETAC6, NSA C07, MOSAIC-HR 0.80
        
        PAN u Mo
        
        Axel, voditi kao kolon kancer-T3, T4, N+
        
        meta analiza, Peterson, DFS HR 0.75, OS HR 0.83
        
        KRT
        
        adj
        
        NCCTCG 79-47-51
        
        https://www.google.ba/search?q=NCCTG+79-47-51&source=lnms&tbm=isch&sa=X&ved=0ahUKEwit45CQ6sTZAhXE-6QKHVD0CpoQ_AUICygC&biw=1229&bih=607#imgrc=acr5G2-XpA5aSM:
        
        GITSG, postavila temelje KRT kao standarda, 1985, 4 grupe (OP pa obs, KRT, RT, KT), adj KRT -5y- SS LR 11%, OS 60%, ostale grane KT i RT nSS LR, OS- LR20%, OS 50%
        
        TOTALNA NEO (KRT -op, cCR-FU
        
        studije
        
        Habr -Gama (100 pts cCR)
        
        http://sci-hub.tw/10.1097/DCR.0b013e3182a25c4e
        
        MSKCC
        
        PROSPECT, f3, predop FOLFOX vs 5FU -op-KT (prema želji MD-a
        
        RAPIDO, kt-krt-op
        
        w and w
        
        NCCN
        
        In those patients who achieve a complete clinical response with no evidence of residual disease on digital rectal examination, rectal MRI, and direct endoscopic evaluation, a “watch and wait”, nonoperative management approach may be considered in centers with experienced multidisciplinary teams. The degree to which risk of local and/or distant failure may be increased relative to standard surgical resection has not yet been adequately characterized. Decisions for nonoperative management should involve a careful discussion with the patient of his/ her risk tolerance
        
        neoadj
        
        preop KRT vs postop KRT
        
        Njemačka Sojer, 400 pts, T3-4, preop vs postop, neadekvatna RT (veći recidiv) ili ako nisu primili 30% recidi, ** kritike 18% T1-2, 5% samo primilo adj RT, pCR 8%
        
        SS, LR 13vs6%, AE G3-4=40vs27%, sfinkter preservacija 20vs40%
        
        nSS, OS, DFS
        
        NSA R-03, T3-4, N+, poor acural, 5yDFS SS65vs53%, nSS OS i DFS, pCR 15%
        
        shotr kurs
        
        studije
        
        Dutch trial, st O-IV, 1800 pts, preop RT pa TME vs TME, 11vs6% LR kod st III
        
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        Poljska, 316 pts, T3-4, cilj ciše od 15% sfinkter prezervacija (**NIJE DOBAR ENDPOINT-OVISI O KIRURGU), NIJE DIZAJNIRANA DA POKAŽE RAZLIKU, pre RT25Gy vs 50Gy5FU pa OP, nema razlike u OS, pCR 16vs1, poz RR bolji u CRT 4vs13%, pT1-2 -40% (NISU TREBALI preop th)
        
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        Australijska studija, 300 pts, KRT vs SCRT, p cilj više od 10% LR s SC, nisu uspjeli 4vs7%, pCR 15 vs1%, regionalni rekurence 3vs13
        
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        Švedska, preop RT vs OP, LR 27vs11%, OS 74vs64%
        
        1 more item...
        
        MRC-C7, preop RT vs postop KRT selktivna- bolji LR 4vs11%, DFS 77vs70%-SS za preop RT, OS 70%=
        
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        preop KRT pa postop KT
        
        Njemačka Rodel, KRT (5fu ili 5FU/Oy) OP pa adj (5fu ili FOLFOX), SS DFS 68vs64% (HR0.79, CI -98), OS nSS
        
        EXPERT, CAPOX pa KRT pa OP pa adj KT (kape, kapox, capoy+cet), pCR 18%
        
        FOWARC, 1200 pts, predop FOLFOX vs 5FU-RT pa postop
        kt, pCR 15 vs 28%, povećanje AEFOLFOX i
        
        općenito
        
        Indikacije
        
        T3, T4- srednji, donji rektum
        
        T3, T4, N+ bilo koja lokacija
        
        6 tj OP
        
        6vs 12 tj
        
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        komparacija OS SC vs standard
        
        5y 65% (Poljska, Dutch, Švedska), 70% (C-07, Austraslak) vs 75% (njemačka, R-03)
        
        neo KT+RT+/- Ox
        
        5 trialova
        
        SAN (STAR-01, ACORD12, NSA R-04) PETAC CAO
        
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        neoadj RT vs KRT
        
        EORTC 22921, T3, 4/Nx 4 grane (preop RT, KRT, OP pa obs vs post op KT), nema benefita u OS-u (ima trend), samo 43% primilo adj KT
        
        Francuska, bolja LR za KRT 8vs16%, bez impakta na OS, više AE s KRT