Five fractions of radiation therapy followed by 4 cycles of FOLFOX chemotherapy as preoperative treatment for rectal cancer
| Autor: | James W. Fleshman, Parag J. Parikh, Joel Picus, Elisa H. Birnbaum, Robert J. Myerson, Steven Sorscher, Bashar Safar, Andrea Wang-Gillam, Michael Naughton, A. Craig Lockhart, Jeffrey R. Olsen, Rama Suresh, Steven C. Hunt, Benjamin R. Tan, Ira J. Kodner, Caron Rigden, Feng Gao, Matthew G. Mutch, Lannis Hall |
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| Rok vydání: | 2013 |
| Předmět: |
Male
Cancer Research medicine.medical_specialty Neoplasm Residual Organoplatinum Compounds Colorectal cancer Pyridines medicine.medical_treatment Leucovorin Anal Canal Preoperative care Drug Administration Schedule Article FOLFOX Antineoplastic Combined Chemotherapy Protocols Preoperative Care medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies Neoplasm Staging Chemotherapy Radiation business.industry Rectal Neoplasms Dose fractionation Middle Aged medicine.disease Surgery Oxaliplatin Radiation therapy Regimen Oncology Female Dose Fractionation Radiation Fluorouracil business Organ Sparing Treatments medicine.drug |
| Zdroj: | International journal of radiation oncology, biology, physics. 88(4) |
| ISSN: | 1879-355X |
| Popis: | Preoperative radiation therapy with 5-fluorouracil chemotherapy is a standard of care for cT3-4 rectal cancer. Studies incorporating additional cytotoxic agents demonstrate increased morbidity with little benefit. We evaluate a template that: (1) includes the benefits of preoperative radiation therapy on local response/control; (2) provides preoperative multidrug chemotherapy; and (3) avoids the morbidity of concurrent radiation therapy and multidrug chemotherapy.Patients with cT3-4, any N, any M rectal cancer were eligible. Patients were confirmed to be candidates for pelvic surgery, provided response was sufficient. Preoperative treatment was 5 fractions radiation therapy (25 Gy to involved mesorectum, 20 Gy to elective nodes), followed by 4 cycles of FOLFOX [5-fluorouracil, oxaliplatin, leucovorin]. Extirpative surgery was performed 4 to 9 weeks after preoperative chemotherapy. Postoperative chemotherapy was at the discretion of the medical oncologist. The principal objectives were to achieve T stage downstaging (ypTcT) and preoperative grade 3+ gastrointestinal morbidity equal to or better than that of historical controls.76 evaluable cases included 7 cT4 and 69 cT3; 59 (78%) cN+, and 7 cM1. Grade 3 preoperative GI morbidity occurred in 7 cases (9%) (no grade 4 or 5). Sphincter-preserving surgery was performed on 57 (75%) patients. At surgery, 53 patients (70%) had ypT0-2 residual disease, including 21 (28%) ypT0 and 19 (25%) ypT0N0 (complete response); 24 (32%) were ypN+. At 30 months, local control for all evaluable cases and freedom from disease for M0 evaluable cases were, respectively, 95% (95% confidence interval [CI]: 89%-100%) and 87% (95% CI: 76%-98%). Cases were subanalyzed by whether disease met requirements for the recently activated PROSPECT trial for intermediate-risk rectal cancer. Thirty-eight patients met PROSPECT eligibility and achieved 16 ypT0 (42%), 15 ypT0N0 (39%), and 33 ypT0-2 (87%).This regimen achieved response and morbidity rates that compare favorably with those of conventionally fractionated radiation therapy and concurrent chemotherapy. |
| Databáze: | OpenAIRE |
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