Sequential short-course radiation therapy and chemotherapy in the neoadjuvant treatment of rectal adenocarcinoma
- PDF / 353,772 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 28 Downloads / 197 Views
RESEARCH
Open Access
Sequential short-course radiation therapy and chemotherapy in the neoadjuvant treatment of rectal adenocarcinoma Angela Y. Jia1, Amol Narang1, Bashar Safar2, Atif Zaheer3, Adrian Murphy4, Nilofer S. Azad4, Susan Gearhart2, Sandy Fang2, Jonathan Efron2, Tam Warczynski2, Amy Hacker-Prietz1 and Jeffrey Meyer1*
Abstract Background: There is continued debate regarding the optimal combinations of radiation therapy and chemotherapy in the preoperative treatment of locally advanced rectal adenocarcinomas. We report our single-institution experience of feasibility and early oncologic outcomes of short-course preoperative radiation therapy (5 Gy X 5 fractions) followed by consolidation neoadjuvant chemotherapy. Methods: We reviewed the records of 26 patients with locally advanced rectal adenocarcinoma. All patients underwent short course radiotherapy (5 Gy X 5 fractions) followed by chemotherapy [either modified infusional and bolus 5-fluorouracail and oxalipatin (mFOLFOX6) or capecitabine and oxaliplatin] prior to consideration for surgery. A full course of chemotherapy was defined as at least 8 weeks of chemotherapy. Results: There were five clinical (c) T2, 16 cT3, and five cT4 rectal tumors, with 88% cN+. Twenty-five patients received a median of 4 cycles (range 3 to 8) of mFOLFOX6 (with one cycle defined as a two-week period); one patient received 3 cycles of capecitabine and oxaliplatin. All patients completed SCRT; 81% completed the full course of neoadjuvant chemotherapy with 19% requiring dose reductions in chemotherapy, most commonly due to neuropathy. Nineteen patients underwent post-treatment endoscopic evaluation, and nine patients were noted to achieve a complete clinical response (CCR). Six of the nine patients who achieved CCR opted for a non-operative approach of watch-and-wait. Twenty patients underwent surgical resection; pathologic complete response was observed in seven (35%) of these twenty. The main radiation-associated toxicity was proctitis with CTCAE Grade 2 proctitis observed in seven patients (27%). Post-operative Clavien-Dindo Grade 3 complications within 30 days of surgery were identified in six patients (30%), with no Grade 4 or 5 adverse events. Median length of hospital stay was 4.5 days (range 2–16 days); three patients were readmitted within a 30 day period. Conclusions: Short course preoperative radiotherapy followed by neoadjuvant chemotherapy was welltolerated and achieved oncologic outcomes that compare favorably with short-course radiation therapy alone or long-course chemoradiotherapy. This regimen is associated with high rates of clinical and pathologic complete response. Keywords: Rectal cancer, Short-course chemoradiotherapy, Watch and wait
* Correspondence: [email protected] 1 Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA Full list of author information is available at the end of the article
© The Author(s). 2019 Open Access This article is distributed under the terms of
Data Loading...
