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Sequential short-course radiation therapy and chemotherapy in the neoadjuvant treatment of rectal adenocarcinoma
BACKGROUND: There is continued debate regarding the optimal combinations of radiation therapy and chemotherapy in the preoperative treatment of locally advanced rectal adenocarcinomas. We report our single-institution experience of feasibility and early oncologic outcomes of short-course preoperativ...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6700789/ https://www.ncbi.nlm.nih.gov/pubmed/31426827 http://dx.doi.org/10.1186/s13014-019-1358-1 |
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author | Jia, Angela Y. Narang, Amol Safar, Bashar Zaheer, Atif Murphy, Adrian Azad, Nilofer S. Gearhart, Susan Fang, Sandy Efron, Jonathan Warczynski, Tam Hacker-Prietz, Amy Meyer, Jeffrey |
author_facet | Jia, Angela Y. Narang, Amol Safar, Bashar Zaheer, Atif Murphy, Adrian Azad, Nilofer S. Gearhart, Susan Fang, Sandy Efron, Jonathan Warczynski, Tam Hacker-Prietz, Amy Meyer, Jeffrey |
author_sort | Jia, Angela Y. |
collection | PubMed |
description | BACKGROUND: There is continued debate regarding the optimal combinations of radiation therapy and chemotherapy in the preoperative treatment of locally advanced rectal adenocarcinomas. We report our single-institution experience of feasibility and early oncologic outcomes of short-course preoperative radiation therapy (5 Gy X 5 fractions) followed by consolidation neoadjuvant chemotherapy. METHODS: We reviewed the records of 26 patients with locally advanced rectal adenocarcinoma. All patients underwent short course radiotherapy (5 Gy X 5 fractions) followed by chemotherapy [either modified infusional and bolus 5-fluorouracail and oxalipatin (mFOLFOX6) or capecitabine and oxaliplatin] prior to consideration for surgery. A full course of chemotherapy was defined as at least 8 weeks of chemotherapy. RESULTS: There were five clinical (c) T2, 16 cT3, and five cT4 rectal tumors, with 88% cN+. Twenty-five patients received a median of 4 cycles (range 3 to 8) of mFOLFOX6 (with one cycle defined as a two-week period); one patient received 3 cycles of capecitabine and oxaliplatin. All patients completed SCRT; 81% completed the full course of neoadjuvant chemotherapy with 19% requiring dose reductions in chemotherapy, most commonly due to neuropathy. Nineteen patients underwent post-treatment endoscopic evaluation, and nine patients were noted to achieve a complete clinical response (CCR). Six of the nine patients who achieved CCR opted for a non-operative approach of watch-and-wait. Twenty patients underwent surgical resection; pathologic complete response was observed in seven (35%) of these twenty. The main radiation-associated toxicity was proctitis with CTCAE Grade 2 proctitis observed in seven patients (27%). Post-operative Clavien-Dindo Grade 3 complications within 30 days of surgery were identified in six patients (30%), with no Grade 4 or 5 adverse events. Median length of hospital stay was 4.5 days (range 2–16 days); three patients were readmitted within a 30 day period. CONCLUSIONS: Short course preoperative radiotherapy followed by neoadjuvant chemotherapy was well-tolerated and achieved oncologic outcomes that compare favorably with short-course radiation therapy alone or long-course chemoradiotherapy. This regimen is associated with high rates of clinical and pathologic complete response. |
format | Online Article Text |
id | pubmed-6700789 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-67007892019-08-26 Sequential short-course radiation therapy and chemotherapy in the neoadjuvant treatment of rectal adenocarcinoma Jia, Angela Y. Narang, Amol Safar, Bashar Zaheer, Atif Murphy, Adrian Azad, Nilofer S. Gearhart, Susan Fang, Sandy Efron, Jonathan Warczynski, Tam Hacker-Prietz, Amy Meyer, Jeffrey Radiat Oncol Research BACKGROUND: There is continued debate regarding the optimal combinations of radiation therapy and chemotherapy in the preoperative treatment of locally advanced rectal adenocarcinomas. We report our single-institution experience of feasibility and early oncologic outcomes of short-course preoperative radiation therapy (5 Gy X 5 fractions) followed by consolidation neoadjuvant chemotherapy. METHODS: We reviewed the records of 26 patients with locally advanced rectal adenocarcinoma. All patients underwent short course radiotherapy (5 Gy X 5 fractions) followed by chemotherapy [either modified infusional and bolus 5-fluorouracail and oxalipatin (mFOLFOX6) or capecitabine and oxaliplatin] prior to consideration for surgery. A full course of chemotherapy was defined as at least 8 weeks of chemotherapy. RESULTS: There were five clinical (c) T2, 16 cT3, and five cT4 rectal tumors, with 88% cN+. Twenty-five patients received a median of 4 cycles (range 3 to 8) of mFOLFOX6 (with one cycle defined as a two-week period); one patient received 3 cycles of capecitabine and oxaliplatin. All patients completed SCRT; 81% completed the full course of neoadjuvant chemotherapy with 19% requiring dose reductions in chemotherapy, most commonly due to neuropathy. Nineteen patients underwent post-treatment endoscopic evaluation, and nine patients were noted to achieve a complete clinical response (CCR). Six of the nine patients who achieved CCR opted for a non-operative approach of watch-and-wait. Twenty patients underwent surgical resection; pathologic complete response was observed in seven (35%) of these twenty. The main radiation-associated toxicity was proctitis with CTCAE Grade 2 proctitis observed in seven patients (27%). Post-operative Clavien-Dindo Grade 3 complications within 30 days of surgery were identified in six patients (30%), with no Grade 4 or 5 adverse events. Median length of hospital stay was 4.5 days (range 2–16 days); three patients were readmitted within a 30 day period. CONCLUSIONS: Short course preoperative radiotherapy followed by neoadjuvant chemotherapy was well-tolerated and achieved oncologic outcomes that compare favorably with short-course radiation therapy alone or long-course chemoradiotherapy. This regimen is associated with high rates of clinical and pathologic complete response. BioMed Central 2019-08-19 /pmc/articles/PMC6700789/ /pubmed/31426827 http://dx.doi.org/10.1186/s13014-019-1358-1 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Jia, Angela Y. Narang, Amol Safar, Bashar Zaheer, Atif Murphy, Adrian Azad, Nilofer S. Gearhart, Susan Fang, Sandy Efron, Jonathan Warczynski, Tam Hacker-Prietz, Amy Meyer, Jeffrey Sequential short-course radiation therapy and chemotherapy in the neoadjuvant treatment of rectal adenocarcinoma |
title | Sequential short-course radiation therapy and chemotherapy in the neoadjuvant treatment of rectal adenocarcinoma |
title_full | Sequential short-course radiation therapy and chemotherapy in the neoadjuvant treatment of rectal adenocarcinoma |
title_fullStr | Sequential short-course radiation therapy and chemotherapy in the neoadjuvant treatment of rectal adenocarcinoma |
title_full_unstemmed | Sequential short-course radiation therapy and chemotherapy in the neoadjuvant treatment of rectal adenocarcinoma |
title_short | Sequential short-course radiation therapy and chemotherapy in the neoadjuvant treatment of rectal adenocarcinoma |
title_sort | sequential short-course radiation therapy and chemotherapy in the neoadjuvant treatment of rectal adenocarcinoma |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6700789/ https://www.ncbi.nlm.nih.gov/pubmed/31426827 http://dx.doi.org/10.1186/s13014-019-1358-1 |
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