Objective: Since sperm abnormalities are known to be a major reason for recurrent pregnancy loss (RPL), any defects in DNA structure and chromatin condensation can place embryos at risk in the early stage of development and implantation. As antioxidants such as vitamin C may play a protective role against the destruction of protamine genes in sperm chromatin, this study was conducted to evaluate the effects of vitamin C on chromatin and the expression of protamine genes in the male partners of couples with RPL. Methods: Twenty male partners of couples with RPL were selected as the intervention group and received vitamin C supplementation (250 mg daily for 3 months). Healthy fertile men (n=20) were included as controls. Sperm chromatin, DNA integrity, and the expression levels of protamine genes were evaluated before and after treatment. Results: Significant differences were found in sperm morphology, protamine deficiency, and apoptosis between the two groups and before and after vitamin C administration. A significant change was found in mRNA levels of PRM1, PRM2, and the PRM1/PRM2 ratio after treatment. Conclusion Daily oral administration of vitamin C may improve human sperm parameters and DNA integrity by increasing protamine gene expression levels in the male partners of couples with RPL. The beneficial effects of vitamin C supplementation as an antioxidant for the male partners of couples with RPL could lead to improved pregnancy outcomes in these cases.

Purpose: Treatment outcomes of locally advanced rectal cancer have improved significantly in recent decades. This retrospective study aimed to assess the efficacy of neoadjuvant chemoradiotherapy (nCRT) followed by surgery in patients with T4 rectal cancer and the different outcomes between T4a and T4b patients. Materials and Methods: A total of 60 clinically T4 rectal cancer patients who underwent nCRT were included in the analysis. Patient characteristics, treatment regimens, down-staging rates, pathological response, and overall survival (OS) were evaluated. Results: Both T4a and T4b patients experienced down-staging following nCRT (36.6% and 6.2% respectively; p = 0.021). T4a patients exhibited a higher rate of pathological complete response (pCR) than T4b patients (13.3% in T4a vs. 0% in T4b; p = 0.122). After a median follow-up of 36 months, the OS and recurrence-free survival (RFS) of T4a patients were significantly higher compared to T4b patients (hazard ratio [HR] = 2.52, 95% confidence interval [CI] 1.05–6.05, p = 0.038 for OS; HR = 2.32, 95% CI 1.09–4.92, p = 0.025 for RFS). Conclusion This study provides valuable insights into the effectiveness of nCRT in T4 rectal cancer patients. Although down-staging was observed in both T4a and T4b subgroups, achieving a pCR remains a challenge, particularly in T4b patients. Further research is needed to optimize treatment strategies and enhance pCR rates in T4 rectal cancer patients to improve oncologic outcomes.

Purpose: Treatment outcomes of locally advanced rectal cancer have improved significantly in recent decades. This retrospective study aimed to assess the efficacy of neoadjuvant chemoradiotherapy (nCRT) followed by surgery in patients with T4 rectal cancer and the different outcomes between T4a and T4b patients. Materials and Methods: A total of 60 clinically T4 rectal cancer patients who underwent nCRT were included in the analysis. Patient characteristics, treatment regimens, down-staging rates, pathological response, and overall survival (OS) were evaluated. Results: Both T4a and T4b patients experienced down-staging following nCRT (36.6% and 6.2% respectively; p = 0.021). T4a patients exhibited a higher rate of pathological complete response (pCR) than T4b patients (13.3% in T4a vs. 0% in T4b; p = 0.122). After a median follow-up of 36 months, the OS and recurrence-free survival (RFS) of T4a patients were significantly higher compared to T4b patients (hazard ratio [HR] = 2.52, 95% confidence interval [CI] 1.05–6.05, p = 0.038 for OS; HR = 2.32, 95% CI 1.09–4.92, p = 0.025 for RFS). Conclusion This study provides valuable insights into the effectiveness of nCRT in T4 rectal cancer patients. Although down-staging was observed in both T4a and T4b subgroups, achieving a pCR remains a challenge, particularly in T4b patients. Further research is needed to optimize treatment strategies and enhance pCR rates in T4 rectal cancer patients to improve oncologic outcomes.

Purpose: Treatment outcomes of locally advanced rectal cancer have improved significantly in recent decades. This retrospective study aimed to assess the efficacy of neoadjuvant chemoradiotherapy (nCRT) followed by surgery in patients with T4 rectal cancer and the different outcomes between T4a and T4b patients. Materials and Methods: A total of 60 clinically T4 rectal cancer patients who underwent nCRT were included in the analysis. Patient characteristics, treatment regimens, down-staging rates, pathological response, and overall survival (OS) were evaluated. Results: Both T4a and T4b patients experienced down-staging following nCRT (36.6% and 6.2% respectively; p = 0.021). T4a patients exhibited a higher rate of pathological complete response (pCR) than T4b patients (13.3% in T4a vs. 0% in T4b; p = 0.122). After a median follow-up of 36 months, the OS and recurrence-free survival (RFS) of T4a patients were significantly higher compared to T4b patients (hazard ratio [HR] = 2.52, 95% confidence interval [CI] 1.05–6.05, p = 0.038 for OS; HR = 2.32, 95% CI 1.09–4.92, p = 0.025 for RFS). Conclusion This study provides valuable insights into the effectiveness of nCRT in T4 rectal cancer patients. Although down-staging was observed in both T4a and T4b subgroups, achieving a pCR remains a challenge, particularly in T4b patients. Further research is needed to optimize treatment strategies and enhance pCR rates in T4 rectal cancer patients to improve oncologic outcomes.

Purpose: Treatment outcomes of locally advanced rectal cancer have improved significantly in recent decades. This retrospective study aimed to assess the efficacy of neoadjuvant chemoradiotherapy (nCRT) followed by surgery in patients with T4 rectal cancer and the different outcomes between T4a and T4b patients. Materials and Methods: A total of 60 clinically T4 rectal cancer patients who underwent nCRT were included in the analysis. Patient characteristics, treatment regimens, down-staging rates, pathological response, and overall survival (OS) were evaluated. Results: Both T4a and T4b patients experienced down-staging following nCRT (36.6% and 6.2% respectively; p = 0.021). T4a patients exhibited a higher rate of pathological complete response (pCR) than T4b patients (13.3% in T4a vs. 0% in T4b; p = 0.122). After a median follow-up of 36 months, the OS and recurrence-free survival (RFS) of T4a patients were significantly higher compared to T4b patients (hazard ratio [HR] = 2.52, 95% confidence interval [CI] 1.05–6.05, p = 0.038 for OS; HR = 2.32, 95% CI 1.09–4.92, p = 0.025 for RFS). Conclusion This study provides valuable insights into the effectiveness of nCRT in T4 rectal cancer patients. Although down-staging was observed in both T4a and T4b subgroups, achieving a pCR remains a challenge, particularly in T4b patients. Further research is needed to optimize treatment strategies and enhance pCR rates in T4 rectal cancer patients to improve oncologic outcomes.

Purpose: Treatment outcomes of locally advanced rectal cancer have improved significantly in recent decades. This retrospective study aimed to assess the efficacy of neoadjuvant chemoradiotherapy (nCRT) followed by surgery in patients with T4 rectal cancer and the different outcomes between T4a and T4b patients. Materials and Methods: A total of 60 clinically T4 rectal cancer patients who underwent nCRT were included in the analysis. Patient characteristics, treatment regimens, down-staging rates, pathological response, and overall survival (OS) were evaluated. Results: Both T4a and T4b patients experienced down-staging following nCRT (36.6% and 6.2% respectively; p = 0.021). T4a patients exhibited a higher rate of pathological complete response (pCR) than T4b patients (13.3% in T4a vs. 0% in T4b; p = 0.122). After a median follow-up of 36 months, the OS and recurrence-free survival (RFS) of T4a patients were significantly higher compared to T4b patients (hazard ratio [HR] = 2.52, 95% confidence interval [CI] 1.05–6.05, p = 0.038 for OS; HR = 2.32, 95% CI 1.09–4.92, p = 0.025 for RFS). Conclusion This study provides valuable insights into the effectiveness of nCRT in T4 rectal cancer patients. Although down-staging was observed in both T4a and T4b subgroups, achieving a pCR remains a challenge, particularly in T4b patients. Further research is needed to optimize treatment strategies and enhance pCR rates in T4 rectal cancer patients to improve oncologic outcomes.