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Adjuvant radiochemotherapy in rectal cancer: analysis of acute and late-onset toxicity

Radioquimioterapia adyuvante en cáncer de recto: análisis de toxicidad aguda y tardía

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Abstract

Objective

To analyse the factors related to the appearance, incidence and severity of toxicity associated with post-operative radiochemotherapy in rectal cancer.

Material and methods

Between January 1994 and September 1997, we prospectively collected the data on 122 patients treated for rectal adenocarcinoma in the B2-C stage. Surgery was followed by radiotherapy and chemotherapy (5-FU plus leucovorin) administered as an alternating, or as a concomitant, scheme. Pelvic volume was treated with a four-portal, or a two-portal, irradiation technique using megavoltage photon beams (60Co or 23 MV photons). Total administered dose was 50 Gy in 1.8–2 Gy fractions. Statistical analysis was performed to identify factors related to the incidence of toxicity, and its severity.

Results

Acute side effects were noted in 98 (80.3%) patients; the most frequent being diarrhea (55%) followed by skin reactions (40.1%). Toxicity occurred following the administration of a mean radiation dose of 26 Gy (range: 8–50 Gy). Grade 3 toxic events were observed in 20.5% of patients. It was necessary to interrupt treatment in 32.8% of patients for a mean period of 8.8 days. There were no grade 4 toxicities or therapy-related deaths. The concomitant scheme of radiochemotherapy (compared to alternating) was the main predictive factor for higher incidence (91.1% versus 74%; p=0.04), higher severity grade 3 (33.3% versus 13%; p=0.014) and early (following 22.7 Gy versus 28.4 Gy, p=0.012) acute toxicity.

With a median follow-up of 68.9 months, late grade 3 toxicity appeared in 13 patients (10.8%), and 10 patients (8.3%) required surgical treatment to resolve an intestinal obstruction. None of the parameters analysed influenced the late-onset toxicity, or the development of small-bowel obstruction.

Conclusions

In our study, the concomitant radiochemotherapy combination scheme was the main predictive factor for acute toxicity, but with no influence on late-onset toxicity. Our overall results were similar to others reported in the literature.

Resumen

|Objetivo

El propósito es estudiar la incidencia e intensidad de la toxicidad inherente al tratamiento radioquimioterápico postquirúrgico en cáncer rectal.

|Material y métodos

Se recogieron prospectivamente los datos de 122 pacientes tratados con intención radical entre enero de 1994 y septiembre de 1997 por un adenocarcinoma rectal en estadio B2-C. La cirugía fue seguida de radio y quimioterapia (5-FU en bolus y leucovorín), administradas siguiendo un esquema alternante o concomitante. El volumen pélvico fue tratado con técnica de dos o cuatro campos hasta una dosis total de 50 Gy (1,8–2 Gy/sesión) mediante fotones de Co-60 o Rx de 23 MV. Se ha realizado un análisis estadístico para la detección de los factores relacionados con la incidencia e intensidad de la toxicidad aparecida.

|Resultados

El 80,3% de los pacientes presentaron efectos agudos, siendo el más frecuente la aparición de diarrea (55%), seguido de epidermitis (40,1%). La toxicidad apareció tras una dosis media de radioterapia de 26 Gy (amplitud 8–50 Gy). Un 20,5% de los casos presentaron toxicidad grado 3. Fue necesario interrumpir temporalmente el tratamiento en un 32,8% de los pacientes (media: 8,8 días). No hubo ningún caso de toxicidad grado 4, ni muertes atribuibles al tratamiento combinado. La secuencia de combinación de radioquimioterapia fue el principal factor determinante de una mayor frecuencia (74% frente al 91,1%, p=0,04), mayor intensidad (13% frente al 33,3%, p=0,014) y más precocidad (tras 28,4 Gy frente a 22,7 Gy, p=0,012) de aparición de toxicidad aguda en el brazo de tratamiento concomitante.

Con una mediana de seguimiento de 68,9 meses. 13 pacientes (10,8%) presentaron toxicidad tardía grado 3, y 10 pacientes (8,3%) requirieron tratamiento quirúrgico para solucionar un cuadro obstructivo adherencial. Ningún parámetro analizado influyó en la aparición de toxicidad tardía de cualquier grado, o en el desarrollo de oclusión intestinal.

|Conclusiones

En nuestro estudio, el índice de toxicidad y su gravedad es similar a la recogida en la literatura, siendo la forma de combinación de la quimioterapia y radioterapia el principal factor predisponente a su aparición durante el tratamiento, pero sin influencia en la toxicidad tardía.

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Correspondence to Javier Valencia Julve.

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Julve, J.V., Jaime, S.P., Orduña, V.A. et al. Adjuvant radiochemotherapy in rectal cancer: analysis of acute and late-onset toxicity. Rev Oncol 6, 150–158 (2004). https://doi.org/10.1007/BF02710116

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  • DOI: https://doi.org/10.1007/BF02710116

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