T3+ and T4 Rectal Cancer Patients Seem to Benefit From the Addition of Oxaliplatin to the Neoadjuvant Chemoradiation Regimen

Background To achieve T-downstaging and better resectability in locally advanced rectal cancer, neoadjuvant radiochemotherapy (RCT) has become the current standard of treatment. A variety of schemes have been used. This study investigates which scheme had the best effect on these parameters. Methods...

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Bibliographic Details
Published in:Annals of surgical oncology 2012-02, Vol.19 (2), p.392-401
Main Authors: Martijnse, Ingrid S., Dudink, Ralph L., Kusters, Miranda, Vermeer, Thomas A., West, Nicholas P., Nieuwenhuijzen, Grard A., van Lijnschoten, Ineke, Martijn, Hendrik, Creemers, Geert-Jan, Lemmens, Valery E., van de Velde, Cornelis J., Sebag-Montefiore, David, Glynne-Jones, Robert, Quirke, Phil, Rutten, Harm J.
Format: Article
Language:English
Subjects:
Adenocarcinoma - mortality
Adenocarcinoma - secondary
Adenocarcinoma - therapy
Adult
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Capecitabine
Chemoradiotherapy
Colorectal Cancer
Deoxycytidine - administration & dosage
Deoxycytidine - analogs & derivatives
Female
Fluorouracil - administration & dosage
Fluorouracil - analogs & derivatives
Follow-Up Studies
Humans
Leucovorin - administration & dosage
Male
Medicine
Medicine & Public Health
Middle Aged
Neoadjuvant Therapy
Neoplasm Staging
Oncology
Organoplatinum Compounds - administration & dosage
Preoperative Care
Prospective Studies
Rectal Neoplasms - mortality
Rectal Neoplasms - pathology
Rectal Neoplasms - therapy
Surgery
Surgical Oncology
Survival Rate
Treatment Outcome
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Summary:Background To achieve T-downstaging and better resectability in locally advanced rectal cancer, neoadjuvant radiochemotherapy (RCT) has become the current standard of treatment. A variety of schemes have been used. This study investigates which scheme had the best effect on these parameters. Methods Our institution is a referral center for locally advanced rectal cancer. Different neoadjuvant radiochemotherapy regimens were administered: long course radiotherapy (RTH), 5-FU and leucovorin (5FUBolus), a combination of capecitabine and oxaliplatin (CORE), and capecitabine only (CAP). Selection of patients for 1 of the regimens was based on hospital policy rather than patient or tumor characteristics. Results The data of 504 consecutive patients ( n  = 181 T3+, n  = 323 T4) without metastatic disease (cM0) who underwent surgery for advanced rectal carcinoma between 1994 and 2010 were reviewed. The RTH, 5FUBolus, CORE, and CAP scheme were administered to 106, 137, 155, and 106 patients, respectively. Odds ratios for downstaging were less effective for RTH, 5FUBolus, and CAP (0.31, 0.44, and 0.31; P  
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-011-1955-1