Abstract
Purpose: To assess the safety and efficacy of oxaliplatin (OXA) plus dual inhibition of thymidilate synthase during preoperative pelvic radiotherapy (RT) in patients with poor prognosis for rectal carcinoma. Methods and Materials: Sixty-three patients with the following characteristics, a clinical (c) stage T4, cN1-2, or cT3N0 of ≤5 cm from the anal verge and/or with a circumferential resection margin (CRM) of ≤5 mm (by magnetic resonance imaging), received three biweekly courses of chemotherapy with OXA, 100 mg/m 2; raltitrexed (RTX), 2.5 mg/m 2 on day 1, and 5-fluorouracil (5-FU), 900 mg/m 2 (31 patients) or 800 mg/m 2 (32 patients); levo-folinic acid (LFA), 250 mg/m 2 on day 2, during pelvic RT (45 Gy). Pathologic response was defined as complete pathological response (ypCR), major (tumor regression grade(TRG) 2 to 3, with ypCRM-ve and ypN-ve) or minor or no response (TRG4 to -5, or ypCRM+ve, or ypN+ve). Adjuvant 5-FU/LFA regimen was given in cases of cT4, ypN+ve, or ypCRM+ve. Results: Overall, neutropenia (40%) and diarrhea (13%) were the most common grade ≥3 toxicities, and tolerability was better with a 5-FU dose reduction. No significant difference in pathologic response was seen according 5-FU dosage: overall, a ypCR was obtained in 24 (39%) patients, and a major response in 20 (32%) patients. The 5-year probability of freedom from recurrence was 80% (95% confidence interval, 68%-92%); it was 56% for the minor/no response group, while it was around 90% for both the ypCR and the major response group. Conclusions: OXA, RTX, and 5-FU/LFA administered during pelvic RT produced promising early and long-term results in rectal carcinoma patients with poor prognosis. The postoperative treatment strategy applied in our study supports the risk-adapted approach in postoperative management.
| Original language | English |
|---|---|
| Pages (from-to) | 670-676 |
| Number of pages | 7 |
| Journal | International Journal of Radiation Oncology Biology Physics |
| Volume | 79 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Mar 1 2011 |
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Keywords
- MRI staging
- Neoadjuvant chemoradiation
- Oxaliplatin
- Rectal cancer
- Thymidilate synthase inhibition
ASJC Scopus subject areas
- Oncology
- Radiology Nuclear Medicine and imaging
- Radiation
- Cancer Research
Cite this
Oxaliplatin plus dual inhibition of thymidilate synthase during preoperative pelvic radiotherapy for locally advanced rectal carcinoma : Long-term outcome. / Avallone, Antonio; Delrio, Paolo; Pecori, Biagio; Tatangelo, Fabiana; Petrillo, Antonella; Scott, Nigel; Marone, Pietro; Aloi, Luigi; Sandomenico, Claudia; Lastoria, Secondo; Iaffaioli, Vincenzo Rosario; Scala, Dario; Iodice, Giovanni; Budillon, Alfredo; Comella, Pasquale.
In: International Journal of Radiation Oncology Biology Physics, Vol. 79, No. 3, 01.03.2011, p. 670-676.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Oxaliplatin plus dual inhibition of thymidilate synthase during preoperative pelvic radiotherapy for locally advanced rectal carcinoma
T2 - Long-term outcome
AU - Avallone, Antonio
AU - Delrio, Paolo
AU - Pecori, Biagio
AU - Tatangelo, Fabiana
AU - Petrillo, Antonella
AU - Scott, Nigel
AU - Marone, Pietro
AU - Aloi, Luigi
AU - Sandomenico, Claudia
AU - Lastoria, Secondo
AU - Iaffaioli, Vincenzo Rosario
AU - Scala, Dario
AU - Iodice, Giovanni
AU - Budillon, Alfredo
AU - Comella, Pasquale
PY - 2011/3/1
Y1 - 2011/3/1
N2 - Purpose: To assess the safety and efficacy of oxaliplatin (OXA) plus dual inhibition of thymidilate synthase during preoperative pelvic radiotherapy (RT) in patients with poor prognosis for rectal carcinoma. Methods and Materials: Sixty-three patients with the following characteristics, a clinical (c) stage T4, cN1-2, or cT3N0 of ≤5 cm from the anal verge and/or with a circumferential resection margin (CRM) of ≤5 mm (by magnetic resonance imaging), received three biweekly courses of chemotherapy with OXA, 100 mg/m 2; raltitrexed (RTX), 2.5 mg/m 2 on day 1, and 5-fluorouracil (5-FU), 900 mg/m 2 (31 patients) or 800 mg/m 2 (32 patients); levo-folinic acid (LFA), 250 mg/m 2 on day 2, during pelvic RT (45 Gy). Pathologic response was defined as complete pathological response (ypCR), major (tumor regression grade(TRG) 2 to 3, with ypCRM-ve and ypN-ve) or minor or no response (TRG4 to -5, or ypCRM+ve, or ypN+ve). Adjuvant 5-FU/LFA regimen was given in cases of cT4, ypN+ve, or ypCRM+ve. Results: Overall, neutropenia (40%) and diarrhea (13%) were the most common grade ≥3 toxicities, and tolerability was better with a 5-FU dose reduction. No significant difference in pathologic response was seen according 5-FU dosage: overall, a ypCR was obtained in 24 (39%) patients, and a major response in 20 (32%) patients. The 5-year probability of freedom from recurrence was 80% (95% confidence interval, 68%-92%); it was 56% for the minor/no response group, while it was around 90% for both the ypCR and the major response group. Conclusions: OXA, RTX, and 5-FU/LFA administered during pelvic RT produced promising early and long-term results in rectal carcinoma patients with poor prognosis. The postoperative treatment strategy applied in our study supports the risk-adapted approach in postoperative management.
AB - Purpose: To assess the safety and efficacy of oxaliplatin (OXA) plus dual inhibition of thymidilate synthase during preoperative pelvic radiotherapy (RT) in patients with poor prognosis for rectal carcinoma. Methods and Materials: Sixty-three patients with the following characteristics, a clinical (c) stage T4, cN1-2, or cT3N0 of ≤5 cm from the anal verge and/or with a circumferential resection margin (CRM) of ≤5 mm (by magnetic resonance imaging), received three biweekly courses of chemotherapy with OXA, 100 mg/m 2; raltitrexed (RTX), 2.5 mg/m 2 on day 1, and 5-fluorouracil (5-FU), 900 mg/m 2 (31 patients) or 800 mg/m 2 (32 patients); levo-folinic acid (LFA), 250 mg/m 2 on day 2, during pelvic RT (45 Gy). Pathologic response was defined as complete pathological response (ypCR), major (tumor regression grade(TRG) 2 to 3, with ypCRM-ve and ypN-ve) or minor or no response (TRG4 to -5, or ypCRM+ve, or ypN+ve). Adjuvant 5-FU/LFA regimen was given in cases of cT4, ypN+ve, or ypCRM+ve. Results: Overall, neutropenia (40%) and diarrhea (13%) were the most common grade ≥3 toxicities, and tolerability was better with a 5-FU dose reduction. No significant difference in pathologic response was seen according 5-FU dosage: overall, a ypCR was obtained in 24 (39%) patients, and a major response in 20 (32%) patients. The 5-year probability of freedom from recurrence was 80% (95% confidence interval, 68%-92%); it was 56% for the minor/no response group, while it was around 90% for both the ypCR and the major response group. Conclusions: OXA, RTX, and 5-FU/LFA administered during pelvic RT produced promising early and long-term results in rectal carcinoma patients with poor prognosis. The postoperative treatment strategy applied in our study supports the risk-adapted approach in postoperative management.
KW - MRI staging
KW - Neoadjuvant chemoradiation
KW - Oxaliplatin
KW - Rectal cancer
KW - Thymidilate synthase inhibition
UR - http://www.scopus.com/inward/record.url?scp=79551487814&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79551487814&partnerID=8YFLogxK
U2 - 10.1016/j.ijrobp.2009.12.007
DO - 10.1016/j.ijrobp.2009.12.007
M3 - Article
C2 - 20472346
AN - SCOPUS:79551487814
VL - 79
SP - 670
EP - 676
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
SN - 0360-3016
IS - 3
ER -