Application of oxaliplatin combined with capecitabine in preoperative concurrent chemoradiotherapy for locally advanced rectal cancer

doi:10.3877/cma.j.issn.1674-0785.2019.12.001

Abstract

Abstract:

Objective

To assess the efficacy and safety of oxaliplatin combined with capecitabine in preoperative concurrent chemoradiotherapy for high-risk locally advanced rectal cancer.

Methods

We retrospectively screened patients with locally advanced adenocarcinoma of the rectum (T3 or T4 with any N, or any T with node positivity) in Peking University Cancer Hospital and Institute from March 2018 to February 2019. The eligible patients had at least one of the following high-risk factors: very low cancer, clinical T4b, mesorectal fascia involvement, positive extramural venous invasion, and lateral lymph node involvement. The patients received preoperative intensity-modulated radiotherapy (95% planning gross tumor volume 50.6 Gy/95% planning target volume 41.8 Gy/22 f/30 d, a single fraction per day) with concurrent oxaliplatin 85 mg/m² at d1 per two weeks and capecitabine 825 mg/m² twice daily for 5 days per week. The primary outcome was complete response (clinical and pathologic complete response) rate. Secondary outcomes included adverse reactions, postoperative complications, R0 resection rate, anus-preserving operation rate, down-staging rate, tumor regression grade (TRG), local recurrence rate, and distant metastasis rate.

Results

In total, 63 patients were included in the analysis. Among them, 63 (100%) completed all radiotherapy doses, and 50 (79.37%) received all three cycles of chemotherapy. There were no cases of grade 4 adverse reactions, and grade 3 adverse reactions occurred in 5 (7.94%) cases. Of 46 patients who underwent surgery, the R0 resection rate was 100%, and the anus-preserving operation rate was 73.91% (36/46). The complete response rate was 34.92% (22/63). The T and N down-staging rates were 82.61% (38/46) and 95.65% (44/46), respectively. The percentages of cases with TRG 0, 1, and 2 were 30.43% (14/46), 45.65% (21/46), and 23.91% (11/46), respectively. Postoperative complications occurred in 6 cases, all of which were relieved by conservative treatments. The median follow-up time was 7.2 months. There was no death or local recurrence during follow-up, and 4 (6.35%, 4/63) cases had distant metastasis.

Conclusion

For patients with high-risk locally advanced rectal cancer, oxaliplatin combined with capecitabine in concurrent chemoradiotherapy has good short-term efficacy and acceptable adverse reactions, which may be a better candidate for neoadjuvant therapy.

Key words: Rectal neoplasms, Antineoplastic combined chemotherapy protocols, Oxaliplatin, Capecitabine

Chen Shi, Yangzi Zhang, Jianhao Geng, Yong Cai, Yongheng Li, Weihu Wang. Application of oxaliplatin combined with capecitabine in preoperative concurrent chemoradiotherapy for locally advanced rectal cancer[J]. Chinese Journal of Clinicians(Electronic Edition), 2019, 13(12): 881-887.

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References 25

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临床特征		数据
性别［例（%）］		?
?	男	45（71.43）
?	女	18（28.57）
年龄［岁，M（Q_R）］		57（40~70）
肿瘤病理及分化［例（%）］		?
?	高分化腺癌	4（6.35）
?	中分化腺癌	44（69.84）
?	低分化腺癌	6（9.52）
?	印戒细胞癌	2（3.17）
?	腺癌	7（11.11）
临床T分期［例（%）］		?
?	T2	1（1.58）
?	T3	44（69.84）
?	T4	18（28.57）
临床N分期［例（%）］		?
?	N0	2（3.17）
?	N1	10（15.87）
?	N2	51（80.95）
高危因素［例（%）］		?
?	极低位	35（55.56）
?	cT4b	11（17.46）
?	侧方淋巴结阳性	38（60.32）
?	MRF阳性	29（46.03）
?	EMVI阳性	24（38.10）
?	同时具有2个及以上高危因素	40（63.49）
ECOG评分［例（%）］		?
?	0分	46（73.02）
?	1分	17（26.98）

临床特征		数据
性别［例（%）］		?
?	男	45（71.43）
?	女	18（28.57）
年龄［岁，M（Q_R）］		57（40~70）
肿瘤病理及分化［例（%）］		?
?	高分化腺癌	4（6.35）
?	中分化腺癌	44（69.84）
?	低分化腺癌	6（9.52）
?	印戒细胞癌	2（3.17）
?	腺癌	7（11.11）
临床T分期［例（%）］		?
?	T2	1（1.58）
?	T3	44（69.84）
?	T4	18（28.57）
临床N分期［例（%）］		?
?	N0	2（3.17）
?	N1	10（15.87）
?	N2	51（80.95）
高危因素［例（%）］		?
?	极低位	35（55.56）
?	cT4b	11（17.46）
?	侧方淋巴结阳性	38（60.32）
?	MRF阳性	29（46.03）
?	EMVI阳性	24（38.10）
?	同时具有2个及以上高危因素	40（63.49）
ECOG评分［例（%）］		?
?	0分	46（73.02）
?	1分	17（26.98）

手术情况		数据
放疗-手术间隔［d，M（Q_R）］		77（56~99）
手术方式［例（%）］		?
?	直肠癌低位前切除术	31（67.39）
?	腹会阴联合切除术	12（26.09）
?	经肛门局部切除术	3（6.52）
手术保肛［例（%）］		34（73.91）
低位手术保肛［例（%）］		12（54.55）
R0切除［例（%）］		46（100）

手术情况		数据
放疗-手术间隔［d，M（Q_R）］		77（56~99）
手术方式［例（%）］		?
?	直肠癌低位前切除术	31（67.39）
?	腹会阴联合切除术	12（26.09）
?	经肛门局部切除术	3（6.52）
手术保肛［例（%）］		34（73.91）
低位手术保肛［例（%）］		12（54.55）
R0切除［例（%）］		46（100）

手术并发症		例（%）
吻合口瘘/出血		2（4.35）
盆腔感染/脓肿		1（2.17）
肠梗阻		1（2.17）
会阴伤口感染		2（4.35）
肺部感染		1（2.17）
新发房颤		1（2.17）
并发症治疗		?
?	保守治疗	6/6（100）
?	手术治疗	0/6（0）

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