Helical Tomotherapy Combined with Capecitabine in the Preoperative Treatment of Locally Advanced Rectal Cancer

• Published in: BioMed research international 2014-01, Vol.2014 (2014), p.1-12
• Main Authors: Huang, Ming-Yii, Chen, Chin-Fan, Huang, Chun-Ming, Tsai, Hsiang-Lin, Yeh, Yung-Sung, Ma, Cheng-Jen, Wu, Chan-Han, Lu, Chien-Yu, Chai, Chee-Yin, Huang, Chih-Jen, Wang, Jaw-Yuan
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biomedical research; Capecitabine; Colorectal cancer; Combined Modality Therapy; Deoxycytidine - administration & dosage; Deoxycytidine - analogs & derivatives; Female; Fluorouracil - administration & dosage; Fluorouracil - analogs & derivatives; Humans; Male; Middle Aged; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Neoplasm Staging; Preoperative Care; Radiotherapy; Radiotherapy, Intensity-Modulated; Rectal Neoplasms - drug therapy; Rectal Neoplasms - mortality; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; Treatment Outcome
• ISSN: 2314-6133; 2314-6141
• DOI: 10.1155/2014/352083

The aim of this study was to evaluate the efficacy of helical tomotherapy plus capecitabine as a preoperative chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC). Thirty-six LARC patients receiving preoperative CRT were analyzed. Radiotherapy (RT) consisted of 45 Gy to the regional lymph nodes and simultaneous-integrated boost (SIB) 50.4 Gy to the tumor, 5 days/week for 5 weeks. Chemotherapy consisted of capecitabine 850 mg/m2, twice daily, during the RT days. Patients underwent surgery 6–8 weeks after completion of CRT. Information was collected for patient characteristics, treatment response, and acute and late toxicities. Grade 3/4 (G3+) toxicities occurred in 11.1% of patients (4/36). Sphincter preservation rate was 85.2% (23/27). Five patients (14.3%) achieved pathological complete response. Tumor, nodal, and ypT0-2N0 downstaging were noted in 60% (21/35), 69.6% (16/23), and 57.1% (20/35). Tumor regression grade 2~4 was achieved in 28 patients (80%). After a median follow-up time of 35 months, the most common G3+ late morbidity was ileus and fistula (5.7%, 2/35). The study showed that capecitabine plus helical tomotherapy with an SIB is feasible in treatment of LARC. The treatment modality can achieve a very encouraging sphincter preservation rate and a favorable ypT0-2N0 downstaging rate without excessive toxicity.