Efficacy and safety of neoadjuvant intensity-modulated radiotherapy with concurrent capecitabine for locally advanced rectal cancer.

Abstract

BACKGROUND:

We previously conducted a prospective phase II clinical trial studying a unique 22-fraction neoadjuvant intensity-modulated radiotherapy with concurrent capecitabine treatment followed by total mesorectal excision for locally advanced rectal cancer.

OBJECTIVE:

The objective of this study was to retrospectively review the efficacy, toxicity, and surgical complications following intensity-modulated radiotherapy in patients who have rectal cancer.

DESIGN:

This was a retrospective study.

SETTING:

Data were gathered from a surgical database.

PATIENTS:

This study included patients who underwent intensity-modulated radiotherapy with gross tumor volume/clinical target volume of 50.6/41.8 Gy in 22 fractions with concurrent capecitabine treatment over a period of 30 days, after which the patients underwent surgery for rectal cancer in Peking University Cancer Hospital (2007-2013).

MAIN OUTCOME MEASURES:

The primary end points were acute toxicity, postoperative complications, and complete response rate.

RESULTS:

A total of 260 patients were included in our analysis. The median age was 55 years (range, 21-87 years), and 68.5% of the patients were male. The yield complete response rate was 18.5% (48/260). There were no grade 4 toxicity and perioperative mortality. The grade 3 toxicity rate was 5.8%, which included diarrhea (4.2%), neutropenia (1.2%), and radiation dermatitis (0.4%). The 30-day postoperative and severe complication (≥grade 3) rates were 23.1% and 2.7%. The anastomotic leakage rate was 3.3% (5/152). Perineal wound complications (29.2%, 28/96) represented the most common problem following abdominoperineal resection. The estimated 3-year local recurrence-free survival, cancer-specific survival, and disease-free survival rates were 94.2% (95% CI, 90.1%-98.3%), 92.2% (95% CI, 87.5%-97.0%), and 81.4% (95% CI, 75.4%-87.4%).

LIMITATION:

The retrospective nature and the single-arm design was the limitation of the study.

CONCLUSION:

The 22-fraction neoadjuvant intensity-modulated radiotherapy regimen used to treat rectal cancer in this study has a high efficacy rate and a low toxicity rate. Further studies are needed to better define the role of intensity-modulated radiotherapy for rectal cancer treatment in a neoadjuvant setting.

• Authors: Lin Wang, Zi-Yu Li, Zhong-Wu Li, Yong-Heng Li, Ying-Shi Sun, Jia-Fu Ji, Jin Gu, Yong Cai
• Journal: Diseases of the colon and rectum (Dis Colon Rectum) Vol. 58 Issue 2 Pg. 186-92 (Feb 2015) ISSN: 1530-0358 [Electronic] United States
• PMID: 25585076 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antimetabolites, Antineoplastic
• Deoxycytidine
• Capecitabine
• Fluorouracil

Topics

• Adenocarcinoma (pathology, therapy)
• Adult
• Aged
• Aged, 80 and over
• Antimetabolites, Antineoplastic (therapeutic use)
• Capecitabine
• Chemoradiotherapy
• Deoxycytidine (analogs & derivatives, therapeutic use)
• Disease-Free Survival
• Female
• Fluorouracil (analogs & derivatives, therapeutic use)
• Humans
• Male
• Middle Aged
• Neoadjuvant Therapy (methods)
• Postoperative Complications
• Radiation Injuries
• Radiotherapy, Intensity-Modulated (methods)
• Rectal Neoplasms (pathology, therapy)
• Rectum (surgery)
• Retrospective Studies
• Treatment Outcome
• Tumor Burden
• Young Adult