Abstract
Aim — Background
In local advanced rectal cancer at clinical stages IIa-IIIc, chemoradiotherapy precedes total mesorectal resection. If there is a high risk of local recurrence or an attempt to convert a transabdominal resection to intervention for sphincter preservation, preoperative combined chemoradiotherapy with 3D conformal external beam radiotherapy and concurrent chemotherapy is recommended; this can downstage an unresectable cancer to one that is resectable.
Objectives — Methods
Twelve patients with stage IIa-IIIc rectal cancer received preoperative 3D conformal EBRT and chemotherapy. Three patients received four cycles of adjuvant chemotherapy with bolus 5-FU 225mg/m2, continuous infusion during the first and fifth weeks of radiotherapy, and nine patients were treated with Capecitabine 825mg/m2 twice daily, per os (tb xeloda) 5 days/week. CT-simulation equation and 3D conformal treatment planning was performed during the days of radiotherapy with 5-FU(iv 225mg/m2). The total dose was 50.4 Gy of 1.8 Gy/Fr in 28 fractions daily, from Monday to Friday. The pelvis was first irradiated with 25Fr of 45 Gy followed by boost therapy in the tumour mass region with continuous infusions (= complementary tumour dose) of a total dose of 5.4 Gy in 3 fractions, using a linear accelerator with MLC-multileaf collimator. This ensures protection of the organs at risk near the tumour mass, such as the bladder, small bowel, and femur heads.
Results
At 20–30 day follow-up after completion of radiotherapy, nine patients were considered suitable for sphincter preservation surgical intervention. Toxicity was Grade I. Only one patient interrupted radiotherapy because of 5-FU toxicity. In two patients, MRI of the pelvis after chemoradiotherapy showed non-conventional images for sphincter preservation intervention.
Conclusions
Preoperative 3D conformal EBRT, combined with chemotherapy, 5-FU or Capecitabine per os (tb xeloda), in patients with rectal cancer at stages IIa-IIIc, proved a very good therapeutical approach. In this way, it was possible to downstage an unresectable tumour mass into one that was resectable. It is also allowed greater possibilities of sphincter preservation, with minimum toxicity, thereby improving the quality of life in these patients.
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Stylianidou, S. Preoperative chemoradiotherapy in patients with rectal cancer - 3D conformal external beam radiotherapy (EBRT). Hellenic J Surg 85, 175–179 (2013). https://doi.org/10.1007/s13126-013-0032-6
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DOI: https://doi.org/10.1007/s13126-013-0032-6