Pre-operative chemoradiotherapy in locally advanced rectal cancer: Capecitabine versus Capox
Abstract
Introduction: Pre-operative chemoradiotherapy is considered a standard approach for TNM stage II-III rectal cancer. The aim of this study was to investigate the effectiveness and toxicity of pre-operative chemoradiation in this setting.
Methods: Between January 2007 and January 2011, patients received 5 weeks of treatment with radiotherapy 50.4/54 Gy/25 or 30 fractions with concurrent capecitabine 850 mg/m2 twice daily 5 days per week (CAP) or radiotherapy 50.4/54 Gy/25 fractions with capecitabine 850 mg/m2 twice daily 5 days per week and oxaliplatin 50 mg/m(2) once weekly (CAPOX). Histopathologic tumor regression (TRG) was determined by the amount of viable tumor versus fibrosis. Toxicity was monitored according to the Common Toxicity Criteria of the National Cancer Institute.
Results: Seventy six patients were included (median age 68.3 years [range 45-88], 67% male). Median tumor distance from anal verge was 7cm (range 2-13). CAP treatment was performed in 67% and CAPOX in 33% of patients. Pathologic complete response was achieved in 13,2%. T- and N- downstaging rates were 52.6%, 65.8%, respectively. Grade 3 toxicity was documented in less than 10% of patients and no grade 4 toxicity was observed.
Conclusions: This study suggests that there is no major benefit from adding oxaliplatin to preoperative chemoradiotherapy with capecitabine.
Keywords: rectal cancer, chemoradiotherapy, downstaging, capecitabine, oxaliplatin
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