La radiologia medica

, Volume 118, Issue 4, pp 570–582 | Cite as

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

  • D. Greto
  • F. Paiar
  • C. Saieva
  • A. Galardi
  • M. Mangoni
  • L. Livi
  • B. Agresti
  • D. Franceschini
  • P. Bonomo
  • V. Scotti
  • B. Detti
  • F. Tonelli
  • A. Valeri
  • L. Messerini
  • G. Biti
Abdominal Radiology / Radiologia Addominale

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.

Keywords

Locally advanced rectal cancer Chemoradiotherapy Oxaliplatin 5-Fluorouracil 

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

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.

Parole chiave

Tumore del retto localmente avanzato Radio-chemioterapia Oxaliplatino 5-fluorouracile 

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Copyright information

© Springer-Verlag Italia 2013

Authors and Affiliations

  • D. Greto
    • 1
  • F. Paiar
    • 1
  • C. Saieva
    • 4
  • A. Galardi
    • 1
  • M. Mangoni
    • 1
  • L. Livi
    • 5
  • B. Agresti
    • 1
  • D. Franceschini
    • 1
  • P. Bonomo
    • 5
  • V. Scotti
    • 1
  • B. Detti
    • 1
  • F. Tonelli
    • 2
  • A. Valeri
    • 2
  • L. Messerini
    • 3
  • G. Biti
    • 1
  1. 1.Radiotherapy UnitUniversity of FlorenceFlorenceItaly
  2. 2.Department of SurgeryUniversity of FlorenceFlorenceItaly
  3. 3.Department of PathologyUniversity of FlorenceFlorenceItaly
  4. 4.Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention CenterScientific Institute of TuscanyFlorenceItaly
  5. 5.Radiotherapy Unit, IFCAUniversity of FlorenceFlorenceItaly

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