Colorectal Cancer

Annals of Surgical Oncology

, Volume 21, Issue 4, pp 1352-1360

Analysis of Bevacizumab-based Preoperative Radiochemotherapy in Patients with Locally Advanced Rectal Cancer on Surgery-associated Spectrum of Complications

  • Kathrin DellasAffiliated withDepartment of Radiooncology Kiel/Luebeck, University of Kiel Email author 
  • , Johannes BullerAffiliated withDepartment of Surgery, Paul-Gerhard-Stiftung
  • , Gregor Jürgen GörtzAffiliated withDepartment of Surgery, Paul-Gerhard-Stiftung
  • , Michael RichterAffiliated withCoordination Center for Clinical Trials
  • , Thomas HöhlerAffiliated withProsper Hospital Recklinghausen
  • , Dirk ArnoldAffiliated withDepartment of Medical Oncology, Tumor Biology Center Freiburg
  • , Tobias KeckAffiliated withDepartment of Surgery, University of Luebeck
  • , Jürgen DunstAffiliated withDepartment of Radiooncology Kiel/Luebeck, University of KielDepartment of Radiooncology Kiel/Luebeck, University of Luebeck
  • , Helmut ZühlkeAffiliated withDepartment of Surgery, Paul-Gerhard-Stiftung

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Abstract

Background

Preoperative radiochemotherapy (RCT) is a standard of care for patients with locally advanced rectal cancer (LARC; stages II and III). Results of our phase II study (BevXelOx-RT) have shown that this regimen is feasible but without a significant improvement of pathological complete response. Whether preoperatively administered bevacizumab, due to its specific toxicity profile, leads to increased rates of surgical complications is currently a subject for debate. This analysis focusses on the surgery-associated spectrum of complications.

Methods

Data from 62 patients with rectal cancer (uT3-4; N0/1, M0) of the phase II trial were analyzed. Patients received radiotherapy (50.4/1.8 Gy fractions), simultaneous bevacizumab 5 mg/kg (d1, d15, d29), and capecitabine 825 mg/m2 twice daily (d1–14, d22–35), oxaliplatin 50 mg/m2 (d1, d8, d22, d29). Four to six weeks after RCT, surgical resection was performed.

Results

Overall, 69/69 patients underwent surgery, and 66 (95.7 %) patients had R0 resection. Surgery was mainly conducted (in 66 %) by highly experienced surgeons (>20 resections of rectal cancer/year) with differences between the institutions due to the operative procedures but without effects on the rate of R0 resection or complications. The average duration of surgery was 239 min (±10). Frequency of multivisceral resections (11 %), intraoperative (8 %) and postoperative (43 %) complications were all in the expected range. In particular, we did not observe an increased rate of postoperative bleedings (3 %). The postoperative mortality rate was 0 %.

Conclusions

Quantity and the kind of surgery-associated spectrum of complications followed by a preoperative bevacizumab-containing RCT regimen in patients with LARC were in line with comparable trials of bevacizumab-based approaches.