NEOADJUVANT CHEMOTHERAPY BEFORE, CONCURRENTLY WITH AND AFTER RADIOTHERAPY FOR LOCALLY ADVANCED RECTAL CANCER

Purpose:Neoadjuvantchemoradiotherapy (CRT) has a major impact in the local control of locally advanced rectal cancer (LARC). However, distant metastases is still a major challenge. One approach to address this issue is early administration of systemic chemotherapy. The purpose of this phase II study is to evaluate the feasibility and efficacy of short course of induction chemotherapy in LARC patients treated with standard preoperative CRT. Methods and Mareials: Sixty-four patients with LARC were treated with two cycles of XELOX (capecitabine 1000 mg/m2 bid on days 1?14 and oxaliplatin 130 mg/m2 on day 1). One cycle of XELOX is given before CRT, while the second one is given in the resting period before surgery. During chemoradiation, blous 5-Fluorouracil 425 mg/m2 was dministered in the first 4 days and last 3 days of radiatation (50.4 Gy over 6 weeks ). Surgery was recommended 6 to 8 weeks after completion of CRT, followed by 4 four cycles of adjuvat XELOX. Results: Fifty-six patients underwent surgery; The pathological complete recponse (pCR) rate was seen in 16 (28.6%) patients, R0 resection was achieved in 54 (94.6%) patients. Tumor and nodal downstaging were observed in 40 (71.4%) and 25 (44.6 %) patients, respectively. Sphincter preservation was achieved in 44(78.6%) patients. Three year disease-free survival was 70.3 %, and overall survival was 82.8%. Conclusion: one cycle of XELOX before and after radiotherapy concurrent with 5-flourouracil for LARC results in a reasonable pCR, R0 resection and sphincter preservation, with acceptable safety and tolerability.