Neoadjuvant chemotherapy and preoperative chemoradiotherapy in resectable carcinoma of the rectum

• Autores: Ruth Vera García, Javier Arellano Aburto, Juan José Valerdi Álvarez, Martín Tejedor, Juan José Albistur Tomé, Juan Ignacio Arrarás Urdániz, Fernando Arias de la Vega
• Localización: Revista de oncología: Publicación oficial de la Federación de Sociedades Españolas de Oncología y del Instituto Nacional de Cancerología de México, ISSN 1575-3018, Vol. 5, Nº. 8, 2003, págs. 465-470
• Idioma: inglés
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• Resumen

  • The effectiveness of neoadjuvant chemotherapy (Mayo clinic schedule) and continuous oral chemotherapy (tegafur 400 mg and folinic acid 15 mg every 12 hours) administered during preoperative radiotherapy (4,500 cGy over 5 weeks) were studied in 53 patients with surgically-resectable rectal adenocarcinoma. Toxicities of <= grade II were lower with neoadjuvant chemotherapy while the chemoradiotherapy had higher toxicity rates including grade III diarrhoea (4%), grade III mucositis (4%), and grade III-IV neutropenia (9%). Symptom improvement ocurred in 38% of patients after neoadjuvant chemotherapy coparative with 55% following the first week of chemoradiotherapy. Surgery was curative in 97% of the patients: abdominoperineal amputation in 24 patients (47%) and conservative surgery in 28 (53%). Down-staging ocurred in 24 patients (46%), and 7 patients (14%) showed pathological complete response. Overvall survival at 5 years, with a median follow-up of 50 months, was 70% (cancer-specific survival was 75%) with significant differences recorded between N+ and N0 patients (56% and 76%, respectively; p<0.001), and between T-0-1-2 and T3 patients (73% and 56%, respectively; p<0.001). Only 2 patients (3%) had local relapse. In conclusion, this treatment scheme was well tolerated and had high rate of local control and long-term times.