A phase I trial of preoperative S-1 in combination with oxaliplatin and pelvic radiation for lower rectal cancer with T4 and lateral pelvic lymph node metastasis

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• 作者：Masayuki Ohue ; Tetsuya Hamaguchi…
• 关键词：Lower rectal cancer ; T4 ; Lateral pelvic lymph node metastasis ; S ; 1 ; Oxaliplatin ; Preoperative chemoradiation
• 刊名：International Journal of Clinical Oncology
• 出版年：2015
• 出版时间：April 2015
• 年：2015
• 卷：20
• 期：2
• 页码：338-344
• 全文大小：196 KB
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• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Oncology
  Surgical Oncology
  Radiotherapy
  Diagnostic Radiology
  Internal Medicine
  Pathology
  
• 出版者：Springer Japan
• ISSN：1437-7772

文摘

Background The purpose of this phase I study of the dose escalation of oxaliplatin in combination with oral S-1 and pelvic radiation preoperatively for poor-risk lower rectal cancer was to determine the dose-limiting toxicity (DLT) and recommended dose of oxaliplatin. Methods Patients with cT4 and lateral pelvic lymph node metastasis, and without distant metastasis (cM0), were treated with weekly oxaliplatin, oral S-1 40?mg/m2 twice daily for 5?days a week, and radiation. A total of 5 weekly doses of oxaliplatin were planned. RT was administered to a total dose of 50.4?Gy in 28 fractions. Results We enrolled 11 patients between December 2009 and January 2012. DLTs were observed at dose level 1 (50?mg/m2) in two patients, one of whom experienced grade 3 aspartate aminotransferase elevation and a grade 3 alanine aminotransferase increase, and the other developed grade 4 hypokalemia and a grade 3 alanine aminotransferase increase. Five patients at dose level 2 (60?mg/m2) showed no DLTs. The hematological toxicities in all patients were mild and reversible. One patient showed distant metastasis after chemoradiation. Ten of the 11 patients achieved R0 resection by mesorectal resection and lateral lymph node dissection; three of the 10 underwent combined resection of the other organs. Conclusion This phase I trial of preoperative S-1 in combination with oxaliplatin and radiation for lower rectal cancer with T4 and lateral pelvic lymph node metastasis revealed that the recommended dose of oxaliplatin was 60?mg/m2 weekly.