A Prospective Study of Preoperative Oxaliplatin and 5-fluorouracil with Concurrent Radiotherapy in Patients with Locally Advanced Rectal Cancer
Michael Chao, Kathryn Field, Ian Jones, Ian Hayes, Mclaughlin Stephen, Faragher Iain, Skinner Iain, Lim Joon Daryl and Gibbs Peter
World Journal of Surgical Medical and Radiation Oncology 2014, 3:3
This study evaluated the efficacy and toxicity of adding oxaliplatin to preoperative chemoradiation with 5-fluorouracil, and the utility of 18FDG Positron Emission Tomography as a tool to predict for pathologic response.
Sixteen patients with locally advanced rectal cancer (T3-T4 and/or N+) received weekly oxaliplatin (50mg/m2) and 5FU (225mg/m2/daily) during radiotherapy to a total dose of 50.4-54Gy. An optional 18FDG Positron Emission Tomography was performed at baseline and 2 weeks into chemoradiation. The percentages of standardized uptake value decrease from baseline to subsequent scans were assessed and correlated with pathologic TNM staging. The main endpoints were efficacy as assessed by pathological complete response, safety, tolerability, and rate of correlation between 18FDG Positron Emission Tomography response and pathological response.
Three patients (19%) achieved pathological complete response. Overall pathological downstaging was seen in 10 patients (63%). R0 resections were achieved in 15 (94%) patients. The most frequent grade 3-4 toxicity was diarrhoea (25%). After a median follow up of 46 months, the local control rate is 100% with 3 deaths occurring from distant metastases. 18FDG Positron Emission Tomography were performed in 9 patients and all 6 patients achieving a response of >40% achieved tumor downstaging.
The addition of oxaliplatin has significant activity with high rates of pathological complete response and locoregional control in locally advanced rectal cancer. However, treatment is also associated with moderate toxicity with grade 3-4 diarrhoea, being of greatest concern. Although 18FDG Positron Emission Tomography predicted for tumor downstaging, it failed to accurately predict for pathological complete response, and further studies in this context are warranted.
rectal cancer, chemotherapy, neoadjuvant, oxaliplatin, radiotherapy.