Generally, Treating Locally Advanced Rectal Cancer Includes
1664 WordsMay 14, 20177 Pages
Generally, treating locally advanced rectal cancer includes radiotherapy (RT), chemotherapy (CT), chemoradiotherapy (CRT), surgery, and subsequent incorporation of molecularly targeted agents. With multimodality treatment, local recurrence rates became less than 10% with the predominant mode of failure is the development of distant metastases (30–35%). Therefore, the addition of induction CT is not aimed to improve local efficacy, but to better control distant disease [1, 2].
The adjuvant treatment of rectal cancer has been shown to be inferior to the neoadjuvant RT/CRT for a variety of endpoints [3, 4]. Approximately 50% of patients did not receive the planned adjuvant CT dose commonly due to toxicity and patient refusal [5-7].
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A 20% pCR was reported with 3-year progression free survival (PFS) and overall survival (OS) were 68% and 83%, respectively .
On the basis of these encouraging results, this phase II trial was designed to evaluate the efficacy and safety of this approach using CAPOX as induction CT with preoperative concomitant CRT with capecitabine followed by surgery and adjuvant CT in treating stages II & III rectal cancer patients.
This is a prospective phase II single arm study performed at Clinical Oncology Department, Tanta University hospital, throughout the period between June 2013 and December 2015. Thirty-one patients with locally advanced rectal adenocarcinoma were enrolled with a minimum follow-up period of 6 months.
All patients were informed of the nature of the study and had consented for admission into the study.
Eligibility criteria included (a) age 18 to 70 years; (b) histopathologically confirmed rectal adenocarcinoma; (c) T3‐4 N0 or any T N+ve; (d) Eastern Cooperative Oncology Group (ECOG) performance status ≤2; (e) adequate bone marrow reserve (hemoglobin ≥10 mg/dl, platelet count ≥100,000/mm3, leuocytic count ≥4,000/mm3); (f) adequate renal function tests (serum creatinine ≤1.5 mg/dl, calculated creatinine clearance ≥50 mg/min); (g) adequate liver function tests (transaminase levels ≤3 times the upper normal limit, serum bilirubin ≤1.5 mg/dl).
The exclusion criteria included: