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Neoadjuvant hyperfractionated accelerated radiotherapy plus concomitant 5-fluorouracil infusion in locally advanced rectal cancer: A phase Ⅱ study

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World Journal of Gastrointestinal Oncology 2018年第1期10卷 40-47页

作者： Zeynep Gural Sezer Saglam Serap Yucel Esra Kaytan-Saglam Oktar Asoglu Cetin Ordu Hediye Acun Rasul Sharifov Semen Onder Ahmet Kizir Ethem N Oral Department of Radiation Oncology Acibadem University Medical Faculty Department of Medical Oncology Istanbul Bilim University Department of Radiation Oncology Istanbul Medical FacultyIstanbul University Department of General Surgery Academia of Clinical Science of Bogazici Department of Medical Biophysics Harran University Medical Faculty Department of Radiology Bezm-i AlemUniversity Department of Pathology Istanbul Medical FacultyIstanbul University

AIM To evaluate the efficacy and tolerability of neoadjuvant hyperfractionated accelerated radiotherapy(HART)and concurrent chemotherapy in patients with locally advanced infraperitoneal rectal cancer. METHODS A total of 30 patients with histopathologically confirmed T2-3/N0+ infraperitoneal adenocarcinoma of rectum cancer patients received preoperative 42 Gy/1.5 Gy/18 days/bid radiotherapy and continuous infusion of 5-fluorouracil(325 mg/m^2). All patients were operated 4-8 wk after neoadjuvant concomitant therapy. RESULTS In the early phase of treatment, 6 patients had grade Ⅲ-Ⅳ gastrointestinal toxicity, 2 patients had grade Ⅲ-Ⅳ hematologic toxicity, and 1 patient had grade Ⅴ toxicity due to postoperative sepsis during chemotherapy. Only 1 patient had radiotherapy-related late side effects, i.e., grade Ⅳ tenesmus. Complete pathological response was achieved in 6 patients(21%), while near-complete pathological response was obtained in 9(31%). After a median follow-up period of 60 mo, the local tumor control rate was 96.6%. In 13 patients, distant metastasis occurred. Disease-free survival rates at 2 and 5 years were 63.3% and 53%, and corresponding overall survival rates were 70% and 53.1%, *** Although it has excellent local control and complete pathological response rates, neoadjuvant HART concurrent chemotherapy appears to not be a feasible treatment regimen in locally advanced rectal cancer, having high perioperative complication and intolerable side effects. Effects of reduced 5-fluorouracil dose or omission of chemotherapy with the aim of reducing toxicity may be examined in further studies.

关键词： hyperfractionated accelerated radiotherapy Rectal cancer Neoadjuvant chemoradiotherapy

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