Radiat Oncol J.  2018 Mar;36(1):17-24. 10.3857/roj.2017.00185.

Preoperative short course radiotherapy with concurrent and consolidation chemotherapies followed by delayed surgery in locally advanced rectal cancer: preliminary results

• Aghili M
• Sotoudeh S
• Ghalehtaki R
• Babaei M
• Farazmand
• Fazeli MS
• Keshvari A
• Haddad P
• Farhan F

• KMID: 2418881
• DOI: http://doi.org/10.3857/roj.2017.00185

Abstract

PURPOSE
This study aimed to assess complications and outcomes of a new approach, that is, combining short course radiotherapy (SRT), concurrent and consolidative chemotherapies, and delayed surgery.
MATERIALS AND METHODS
In this single arm phase II prospective clinical trial, patients with T3-4 or N+ M0 rectal adenocarcinoma were enrolled. Patients who received induction chemotherapy or previous pelvic radiotherapy were excluded. Study protocol consisted of three-dimensional conformal SRT (25 Gy in 5 fractions in 1 week) with concurrent and consolidation chemotherapies including capecitabine and oxaliplatin. Total mesorectal excision was done at least 8 weeks after the last fraction of radiotherapy. Primary outcome was complete pathologic response and secondary outcomes were treatment related complications.
RESULTS
Thirty-three patients completed the planned preoperative chemoradiation and 26 of them underwent surgery (24 low anterior resection and 2 abdominoperineal resection). Acute proctitis grades 2 and 3 were seen in 11 (33.3%) and 7 (21.2%) patients, respectively. There were no grades 3 and 4 subacute hematologic and non-hematologic (genitourinary and peripheral neuropathy) toxicities and perioperative morbidities such as anastomose leakage. Grade 2 or higher late toxicities were observed among 29.6% of the patients. Complete pathologic response was achieved in 8 (30.8%) patients who underwent surgery. The 3-year overall survival and local control rates were 65% and 94%, respectively.
CONCLUSION
This study showed that SRT combined with concurrent and consolidation chemotherapies followed by delayed surgery is not only feasible and tolerable without significant toxicity but also, associated with promising complete pathologic response rates.

Keyword

Combined modality therapy; Conformal radiotherapy; Rectal cancer; Iran; Consolidation chemotherapy; Anticancer drug combination; XELOX

MeSH Terms

Adenocarcinoma
Antineoplastic Combined Chemotherapy Protocols
Arm
Capecitabine
Combined Modality Therapy
Consolidation Chemotherapy*
Drug Therapy
Humans
Induction Chemotherapy
Iran
Proctitis
Prospective Studies
Radiotherapy*
Radiotherapy, Conformal
Rectal Neoplasms*
Capecitabine