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

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Authors and Affiliations

  1. Department of Radiooncology Kiel/Luebeck, University of Kiel, Kiel, Germany

    Kathrin Dellas & Jürgen Dunst

  2. Department of Radiooncology Kiel/Luebeck, University of Luebeck, Luebeck, Germany

    Jürgen Dunst

  3. Department of Surgery, Paul-Gerhard-Stiftung, Wittenberg, Germany

    Johannes Buller, Gregor Jürgen Görtz & Helmut Zühlke

  4. Coordination Center for Clinical Trials, Halle (Saale), Germany

    Michael Richter

  5. Prosper Hospital Recklinghausen, Recklinghausen, Germany

    Thomas Höhler

  6. Department of Medical Oncology, Tumor Biology Center Freiburg, Freiburg, Germany

    Dirk Arnold

  7. Department of Surgery, University of Luebeck, Luebeck, Germany

    Tobias Keck

Authors
  1. Kathrin Dellas
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  2. Johannes Buller
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  3. Gregor Jürgen Görtz
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  4. Michael Richter
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  5. Thomas Höhler
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  9. Helmut Zühlke
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Correspondence to Kathrin Dellas.

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Dellas, K., Buller, J., Görtz, G.J. et al. Analysis of Bevacizumab-based Preoperative Radiochemotherapy in Patients with Locally Advanced Rectal Cancer on Surgery-associated Spectrum of Complications. Ann Surg Oncol 21, 1352–1360 (2014). https://doi.org/10.1245/s10434-013-3412-9

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  • DOI: https://doi.org/10.1245/s10434-013-3412-9

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