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Preliminary results of preoperative 5-fluorouracil, low-dose leucovorin, and concurrent radiation therapy for clinically resectable T3 rectal cancer

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Diseases of the Colon & Rectum

Abstract

PURPOSE: We report the downstaging, sphincter preservation, acute toxicity, and preliminary local control and survival results of preoperative 5-fiuorouracil (5-FU), low-dose leucovorin (LV), and concurrent radiation therapy followed by postoperative LV/5-FU for treatment of patients with clinically resectable T3 rectal cancer. MATERIALS AND METHODS: A total of 32 patients received two monthly cycles of preoperative LV/5-FU (bolus daily×5). Radiation therapy (5,040 cGy) began concurrently on day 1. Postoperatively, patients received a median of two monthly cycles of LV/5-FU (range, 0–10). RESULTS: The complete response rate was 9 percent pathologic and 13 percent clinical, for a total of 22 percent. Total Grade 3+ acute toxicity during the preoperative combined modality segment was 25 percent (8/32). Of the 20 patients who were thought to initially require an abdominoperineal resection and for whom the intent of treatment was sphincter preservation, 17 (85 percent) were able to undergo sphincter-preserving surgery. With a median follow-up of 22 (3–59) months, none have developed local failure, and the three-year actuarial diseasefree survival rate was 60 percent. CONCLUSION: Our data reveal encouraging downstaging, sphincter preservation, and acute toxicity with this regimen. Additional follow-up is needed to assess the long-term local control and survival rates.

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Authors and Affiliations

  1. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York

    Alison Grann M.D., Bruce D. Minsky M.D. & Joanne Bass-Loeb M.P.H.

  2. Gastrointestinal Oncology Section, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York

    Leonard Saltz M.D., David P. Kelsen M.D., Nancy Kemeny M.D. & David Ilson M.D.

  3. Colorectal Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York

    Alfred M. Cohen M.D., Jose G. Guillem M.D. & Philip B. Paty M.D.

Authors
  1. Alison Grann M.D.
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  2. Bruce D. Minsky M.D.
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  3. Alfred M. Cohen M.D.
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  4. Leonard Saltz M.D.
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  5. Jose G. Guillem M.D.
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  6. Philip B. Paty M.D.
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  7. David P. Kelsen M.D.
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  8. Nancy Kemeny M.D.
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  9. David Ilson M.D.
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Grann, A., Minsky, B.D., Cohen, A.M. et al. Preliminary results of preoperative 5-fluorouracil, low-dose leucovorin, and concurrent radiation therapy for clinically resectable T3 rectal cancer. Dis Colon Rectum 40, 515–522 (1997). https://doi.org/10.1007/BF02055370

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  • DOI: https://doi.org/10.1007/BF02055370

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