Neoadjuvant chemoradiation with concomitant boost radiotherapy associated to capecitabine in rectal cancer patients
Open Access
- 14 May 2014
- journal article
- Published by Springer Science and Business Media LLC in International Journal of Colorectal Disease
- Vol. 29 (7), 835-842
- https://doi.org/10.1007/s00384-014-1879-x
Abstract
The primary end-points were complete pathological response and local control. Secondary end-points were survivals, anal sphincter preservation, and toxicity profile. Patients with T3/T4 and or N+ rectal cancer (n = 65) were treated with preoperative concomitant boost radiotherapy (55 Gy/25 fractions) associated to concurrent chemotherapy with oral capecitabine. All patients completed the programmed treatment. The complete pathological response was achieved by 17 % of the patients. Anal sphincter preservation surgery was possible for 86 % of the patients with low rectal cancer (≤5 cm from the anal verge). The T-stage and N-stage downstaging were achieved by 40 and 58 % of the patients, respectively. Circumferential radial margin was involved (close/positive) in eight patients. After a median follow-up of 26 months, local and distant recurrence occurred in two and 11 patients, respectively. The 3-year overall survival and disease-free survival were 86.8 and 81 %, respectively. Non-hematological ≥ grade 3 toxicities were observed in 15 % of the patients. On univariate analysis N-downstaging and positive circumferential radial margin were significantly associated with worse overall survival (p = 0.003 and p = 0.023, respectively), disease-free survival (p = 0.001 and p = 0.036, respectively), and metastasis-free survival (MFS) (p = 0.001 and p = 0.038, respectively).On multivariate analysis, the N-downstaging were significantly associated with better overall survival (OS) (p = 0.022). Our data support the efficacy of preoperative treatment for rectal cancer in terms of local outcomes. Radiation treatment intensification may have a biological rationale; longer follow-up is needed.Keywords
This publication has 37 references indexed in Scilit:
- Escalated radiation dose alone vs. concurrent chemoradiation for locally advanced and unresectable rectal cancers: results from phase II randomized studyInternational Journal of Colorectal Disease, 2013
- Multicenter phase II clinical trial of preoperative capecitabine with concurrent radiotherapy in patients with locally advanced rectal cancerClinical and Translational Oncology, 2012
- Concomitant boost radiotherapy and multidrug chemotherapy in the neoadjuvant treatment of locally advanced rectal cancer: Results of a phase II studyActa Oncologica, 2011
- Preoperative Multimodality Therapy Improves Disease-Free Survival in Patients With Carcinoma of the Rectum: NSABP R-03Journal of Clinical Oncology, 2009
- Locally Advanced Rectal Cancer: What Is the Evidence for Induction Chemoradiation?The Oncologist, 2007
- Preoperative Radiotherapy With or Without Concurrent Fluorouracil and Leucovorin in T3-4 Rectal Cancers: Results of FFCD 9203Journal of Clinical Oncology, 2006
- Chemotherapy with Preoperative Radiotherapy in Rectal CancerThe New England Journal of Medicine, 2006
- Preoperative Radiochemotherapy and Sphincter-Saving Resection for T3 Carcinomas of the Lower Third of the RectumAnnals of Surgery, 2001
- Efficacy of intravenous continuous infusion of fluorouracil compared with bolus administration in advanced colorectal cancer. Meta-analysis Group In Cancer.Journal of Clinical Oncology, 1998
- Improved Survival with Preoperative Radiotherapy in Resectable Rectal CancerThe New England Journal of Medicine, 1997