- 作者：Leire Arbea ; M.D.&lowast ; ; larbea@unav.es ; Rafael Martí ; nez-Monge ; M.D.&lowast ; ; Juan A. Dí ; az-Gonzá ; lez ; M.D.&lowast ; ; Marta Moreno ; M.D.&lowast ; ; Javier Rodrí ; guez ; M.D.&lowast ; ; Jose Luis Herná ; ndez ; M.D.&dagger ; ; Jesú ; s Javier Sola ; M.D.&Dagger ; ; Luis Isaac Ramos ; M.D.&lowast ; ; Jose Carlos Subtil ; M.D.§ ; ; Jorge Nuñ ; ez ; M.D.鈥?/sup> ; Ana Chopitea ; M.D.&lowast ; ; Mauricio Cambeiro ; M.D.&lowast ; ; Miren Gaztañ ; aga ; M.D.&lowast ; ; Jesú ; s Garcí ; a-Foncillas ; M.D.&lowast ; ; Javier Aristu ; M.D.&lowast ;
- 关键词：Locally advanced rectal cancer ; Intensity-modulated radiation therapy ; Capecitabine ; Oxaliplatin ; Pathological response
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2012
- 期刊代码：136_03603016
- 类别：med
- 出版时间：1 June, 2012
- 卷：83
- 期：2
- 页码：587-593
- 文件大小：234 K
Purpose
To validate tolerance and pathological complete response rate (pCR) of a 4-week preoperative course of intensity-modulated radiation therapy (IMRT) with concurrent capecitabine and oxaliplatin (CAPOX) in patients with locally advanced rectal cancer.Methods and Materials
Patients with T3 to T4 and/or N+ rectal cancer received preoperative IMRT (47.5 Gy in 19 fractions) with concurrent capecitabine (825 mg/m2 b.i.d., Monday to Friday) and oxaliplatin (60 mg/m2 on Days 1, 8, and 15). Surgery was scheduled 4 to 6 weeks after the completion of chemoradiation. Primary end points were toxicity and pathological response rate. Local control (LC), disease-free survival (DFS), and overall survival (OS) were also analyzed.
Results
A total of 100 patients were evaluated. Grade 1 to 2 proctitis was observed in 73 patients (73%). Grade 3 diarrhea occurred in 9%of the patients. Grade 3 proctitis in 18%of the first 50 patients led to reduction of the dose per fraction to 47.5 Gy in 20 treatments. The rate of Grade 3 proctitis decreased to 4%thereafter (odds ratio, 0.27). A total of 99 patients underwent surgery. A pCR was observed in 13%of the patients, major response (96-100%of histological response) in 48%, and pN downstaging in 78%. An R0 resection was performed in 97%of the patients. After a median follow-up of 55 months, the LC, DFS, and OS rates were 100%, 84%, and 87%, respectively.
Conclusions
Preoperative CAPOX-IMRT therapy (47.5 Gy in 20 fractions) is feasible and safe, and produces major pathological responses in approximately 50%of patients.