Fundamental research on the extraction of a high-risk group in rectal cancer, and the adjuvant treatment of the surgically treated rectal cancer.

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For the purpose to improve the prognosis of rectal cancer patients, we have continued efforts to prevent both pelvic and distant recurrence, and to treat the recurrent cases. To prevent local recurrence, the neo-adjuvant treatment combined radiation and chemotherapy with surgery has been used in our institute for 15 years. And the regional and systemic chemotherapy was performed to treat more extended disease. We evaluated the clinical results of these treatments, and investigated the more improving points fundamentally and clinically. and the following knowledge was acquired. 1.70 patients with middle or lower rectal cancer was undergone preoperative radiotherapy which was delivered 20Gy / 4 times / one week. The chemotherapy, named PMC (pharmacokinetic modulating chemotherapy) which uses UFT together to 5FU continuous infusion was performed preoperatively every week before an operation to randomized 35 cases of them (radiation-alone group vs. neo-chemoadjuvant group). The rate of a p … More ositive lymph node metastases decreased from 40% to 23%, and down-staging was found in the neo-chemoadjuvant group. The pelvic recurrence was not found till in this period. 2. The regional PMC using hepatic arterial infusion after resection of colorectal liver metastases enabled to decrease the prevalence of lung metastasis significantly. Cumulative 5-year survival rate after hepatectomy in PMC group (59%) was significantly higher in control group (27%). 3. Fundamentally, we proved the mechanism which PMC takes effect. It was shown that PMC effects on the cell cycle also at a G2-/M checkpoint in a target of the fluorouracil based chemotherapy which has been effected at G1-/G0 checkpoint. By using the neo-adjuvant treatment, the sphincter preservationoperation has been performed to 91% of a rectal cancer case, and the pelvic recurrence case is not found till present. In conclusion, our treatment modalities could improve the prognosis of rectal cancer patients with higher quality of life. Less