Efficacy of Preoperative Capecitabine and Concurrent Radiotherapy in Locally Advanced Rectal Cancer
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- Category: Vol. 78, March 2010
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Efficacy of Preoperative Capecitabine and Concurrent Radiotherapy in Locally Advanced Rectal Cancer,REHAM SAFWAT, KHALED ALSHAHHAT, TAREK ESSAM and HADIER SAFWAT
Abstract
Background: Combined-modality therapy consisting of surgery, radiotherapy, and chemotherapy is the recommended management strategy for patients with stage II and III rectal cancer. Adjuvant radiotherapy has been used to improve the historically high pelvic recurrence rates. Both preoperative and postoperative radiation treatment strategies have been extensively studied. However, the recently published 5-year results of the randomized German CAO/ARO/AIO 94 trial of preoperative vs. Postoperative chemoradiotherapy support a standard preoperative treatment approach. Randomized trials have also demonstrated that the addition of chemotherapy to preoperative radiotherapy significantly enhances tumor down-staging, pathologic response, and local control over radiation alone.
Objective: The aim of the current study is to evaluate the efficacy of preoperative combined RT and capecitabine based chemotherapy on the OS and DFS of patients with transmural or node-positive middle and lower rectal carcinoma who underwent curative resection. Secondary end points were to ascertain the acute toxicity rate, downstaging, and surgical morbidity.
Patients and Methods: Between April 2006 and December 2009, 28 patients with clinical preoperative stage II–III underwent chemoradiotherapy followed by radical surgery for middle and lower rectal adenocarcinoma. The median age was 60 years. And was predominantly male (M: F = 18: 10). The tumor locations (mid-, lower rectum) were 75% and 25%, respectively. All received concurrent Capecitabine which was given at a dose of 900mg/m2 for 5 days per week combined with 50.4Gy of radiotherapy followed by surgery (if resectable). Surgery was attempted 4-8 weeks after completing preoperative CCRT.
Results: All patients completed the planned chemoradio-therapy. The response rate was 89.2%. Twelve patients (42.8%) underwent sphincter-sparing surgery. Seven patients 25% underwent AP resection. 21.4% achieved pathological complete response with either abdomino prineal resecitionor low anterior resecition. The remaining three patients had unresectable disease. The most common toxicity of preoperative treatment was grade. 1-2 diarrhea (28.5%). Grade 3 to 4 toxicity occurred in 7 cases (25%). Three-year actuarial disease-free survival and overall survival rates were (23/28) 82.1% and 92.8% (26/28), respectively. The local failure rate was 14.3%, 5 patients had distant metastases (17.8%). Two patients died (of cancer related causes), 23 are alive and disease free, and three are alive with disease.
Conclusions: Combined preoperative treatment with capecitabine and radiotherapy is an effective treatment for patients with locally advanced rectal cancer that has a man-ageable toxicity, seems to improve the disease-free survival and overall survival of selected patients with rectal cancer. However, a longer follow-up time is required to confirm these results.