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Neoadjuvant oxaliplatin and 5-fluorouracil with concurrent radiotherapy in patients with locally advanced rectal cancer: a singleinstitution experience

Radioterapia neoadiuvante associata ad oxaliplatino e 5-fluorouracile in pazienti affetti da tumore rettale localmente avanzato: l’esperienza di un singolo centro

  • Abdominal Radiology / Radiologia Addominale
  • Published:
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Abstract

Purpose

The aim of this study was to evaluate the rate of pathological response (PR), disease control and safety of neoadjuvant chemotherapy using oxaliplatin (OX) and 5-fluorouracil (5-FU) with concurrent radiotherapy for treating locally advanced rectal cancer.

Materials and methods

Between November 2002 and December 2010, 90 patients with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy (CRT) were retrospectively analysed. All patients underwent preoperative radiotherapy (45 Gy in 1.8-Gy fractions) with concurrent OX (80 mg/m2 i.v., day 1) and a 120-h continuous infusion of 5-FU (1,000 mg/m2 per day). Surgery was performed within 6 weeks after completion of CRT treatment.

Results

Complete pathological response was obtained in six patients (6.7%), and 39 (43.3%) had their disease downstaged. The median follow-up period was 4.7 years (6 months to 9 years). Local recurrence occurred in two patients (2.2%), one of whom developed also liver metastases. Distant metastases not associated with local relapse occurred in 23 (25.6%) patients. Overall (OS) and disease-free (DFS) survival were 62.9% and 52.8%, respectively. CRT was well tolerated, with only one grade 3 (1.2%) haematological toxicity (neutropaenia).

Conclusions

Neoadjuvant systemic chemotherapy based on OX and 5-UC associated with radiotherapy is well tolerated, with good results in terms of pathological response, disease control and survival, in rectal cancer patients.

Riassunto

Obiettivo

Lo scopo di questo studio è quello di valutare la risposta patologica (PR), il controllo di malattia e la sicurezza del trattamento chemioterapico basato sull’uso di oxaliplatino e 5-fluorouracile in associazione alla radioterapia nel trattamento del tumore del retto localmente avanzato.

Materiali e metodi

Sono stati analizzati retrospettivamente, nel periodo compreso tra novembre 2002 e dicembre 2010, 90 pazienti affetti da tumore del retto localmente avanzato sottoposti a radio-chemioterapia (CRT) pre-operatoria. Tutti i pazienti hanno ricevuto una radioterapia pre-operatoria (45 Gy in 1,8 Gy per frazione) associata ad oxaliplatino (80 mg/m2 endovena, giorno 1) ed un’infusione continua di 120 ore di 5-fluorouracile (1000 mg/m2 al giorno). La chirurgia è stata eseguita entro 6 settimane dal completamento del trattamento CRT.

Risultati

In 6 pazienti è stata ottenuta una risposta patologica completa (6,7%), in 39 pazienti (43,3%) è stata evidenziata una riduzione dello stadio iniziale di malattia. Il follow-up mediano è stato di 4,7 anni (da 6 mesi a 9 anni). Due pazienti hanno sviluppato una ricaduta locale (2,2%), uno ha sviluppato anche metastasi epatiche. Ventitre pazienti (25,6%) hanno presentato metastasi a distanza non associate a recidiva locale. La sopravvivenza globale (OS) e la sopravvivenza libera da malattia (DFS) sono state rispettivamente del 62,9% e 52,8%. La CRT è stata ben tollerata infatti un solo paziente (1,2%) ha sviluppato una tossicità ematologica (neutropenia) di grado 3.

Conclusioni

Nei pazienti affetti da tumore del retto, la chemioterapia pre-operatoria, basata sull’uso dell’oxaliplatino ed il 5-fluoruracile ed associata alla radioterapia, è ben tollerata con buoni risultati in termini di risposta patologica, controllo di malattia e sopravvivenza.

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References/Bibliografia

  1. Ferlay J, Bray F, Sankila R et al (1999) Cancer incidence, mortality and prevalence in the European Union. IARC Press, Lyon

    Google Scholar 

  2. Jemal A, Siegel R, Ward E (2009) Cancer statistics. CA Cancer J Clin 59:225–249

    Article  PubMed  Google Scholar 

  3. Jessup JM, Stewart AK, Menck HR et al (1998) The National Cancer Database Report on patterns of care for adenocarcinoma of the rectum 1985–1995. Cancer 83:2408

    Article  PubMed  CAS  Google Scholar 

  4. Capirci C, Rampin L, Erba PA et al (2007) Sequential FDG-PET/CT reliably predicts response of locally advanced rectal cancer to neo-adjuvant chemo-radiation therapy. Eur J Nucl Med Mol Imaging 34:1583–1593

    Article  PubMed  CAS  Google Scholar 

  5. Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative radiochemotherapy for rectal cancer. N Engl J Med 351:1731–1740

    Article  PubMed  CAS  Google Scholar 

  6. Valentini V, Coco C, Cellini N et al (2001) Ten years of preoperative chemoradiation for extraperitoneal T3 rectal cancer: acute toxicity, tumor response, and sphincter preservation in three consecutive studies. Int J Radiat Oncol Biol Phys 51:371–383

    Article  PubMed  CAS  Google Scholar 

  7. Capirci C, Rubello D, Chierichetti F et al (2006) Long-term prognostic value of 18F-FDG PET in patients with locally advanced rectal cancer previously treated with neoadjuvant radiochemotherapy. AJR Am J Roentgenol 187:W202–W208.7

    Article  PubMed  Google Scholar 

  8. Bosset JF, Collette L, Calais G et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355:1114–1123

    Article  PubMed  CAS  Google Scholar 

  9. Gérard JP, Conroy T, Bonnetain F et al (2006) Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3–4 rectal cancers: results of FFCD 9203. J Clin Oncol 24:4620–4625

    Article  PubMed  Google Scholar 

  10. Ishii Y, Hasegawa H, Endo T et al (2010) Medium-term results of neoadjuvant systemic chemotherapy using irinotecan, 5-fluorouracil, and leucovorin in patients with locally advanced rectal cancer. Eur J Surg Oncol 36:1061–1065

    Article  PubMed  CAS  Google Scholar 

  11. Wong SJ, Winter K, Meropol NJ et al (2012) Radiation Therapy Oncology Group 0247: a randomized phase II study of neoadjuvant capecitabine and irinotecan or capecitabine and oxaliplatin with concurrent radiotherapy for patients with locally advanced rectal cancer. Int J Radiat Oncol Biol Phys 82:1367–1367

    Article  PubMed  CAS  Google Scholar 

  12. Belluco C, De Paoli A, Canzonieri V et al (2011) Long-term outcome of patients with complete pathologic response after neoadjuvant chemoradiation for cT3 rectal cancer: implications for local excision surgical strategies. Ann Surg Oncol 18:3686–3693

    Article  PubMed  Google Scholar 

  13. de Campos-Lobato LF, Stocchi L, da Luz Moreira A et al (2010) Downstaging without complete pathologic response after neoadjuvant treatment improves cancer outcomes for cIII but not cII rectal cancers. Ann Surg Oncol 17:1758–1766

    Article  PubMed  Google Scholar 

  14. Dunst J, Debus J, Rudat V et al (2008) Neoadjuvant capecitabine combined with standard radiotherapy in patients with locally advanced rectal cancer: mature results of a phase II trial. Strahlenther Onkol 184:450–456

    Article  PubMed  Google Scholar 

  15. Koukourakis GV, Zacharias G, Tsalafoutas J et al (2010) Capecitabine for locally advanced and metastatic colorectal cancer: a review. World J Gastrointest Oncol 2:311–321

    Article  PubMed  Google Scholar 

  16. Aschele C, Cionini L, Lonardi S (2011) Primary tumor response to preoperative chemoradiation with or without oxaliplatin in locally advanced rectal cancer: pathologic results of the STAR-01 randomized phase III trial. J Clin Oncol 29:2773–2780

    Article  PubMed  CAS  Google Scholar 

  17. Gérard JP, Azria D, Gourgou-Bourgade S (2010) Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer: results of the phase III trial ACCORD 12/0405-Prodige 2. J Clin Oncol 28:1638–1644

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Radiotherapy Unit, University of Florence, Viale Morgagni 85, 50134, Florence, Italy

    D. Greto, F. Paiar, A. Galardi, M. Mangoni, B. Agresti, D. Franceschini, V. Scotti, B. Detti & G. Biti

  2. Department of Surgery, University of Florence, Viale Morgagni 85, 50134, Florence, Italy

    F. Tonelli & A. Valeri

  3. Department of Pathology, University of Florence, Viale Morgagni 85, 50134, Florence, Italy

    L. Messerini

  4. Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Center, Scientific Institute of Tuscany, Florence, Italy

    C. Saieva

  5. Radiotherapy Unit, IFCA, University of Florence, Florence, Italy

    L. Livi & P. Bonomo

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  1. D. Greto
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  2. F. Paiar
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  15. G. Biti
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Correspondence to D. Greto.

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Greto, D., Paiar, F., Saieva, C. et al. Neoadjuvant oxaliplatin and 5-fluorouracil with concurrent radiotherapy in patients with locally advanced rectal cancer: a singleinstitution experience. Radiol med 118, 570–582 (2013). https://doi.org/10.1007/s11547-012-0909-4

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  • DOI: https://doi.org/10.1007/s11547-012-0909-4

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