Published online Jan 15, 2018. doi: 10.4251/wjgo.v10.i1.40
Peer-review started: September 7, 2017
First decision: October 9, 2017
Revised: November 26, 2017
Accepted: December 4, 2017
Article in press: December 4, 2017
Published online: January 15, 2018
Processing time: 129 Days and 20.1 Hours
To evaluate the efficacy and tolerability of neoadjuvant hyperfractionated accelerated radiotherapy (HART) and concurrent chemotherapy in patients with locally advanced infraperitoneal rectal cancer.
A total of 30 patients with histopathologically confirmed T2-3/N0+ infraperitoneal adenocarcinoma of rectum cancer patients received preoperative 42 Gy/1.5 Gy/18 days/bid radiotherapy and continuous infusion of 5-fluorouracil (325 mg/m2). All patients were operated 4-8 wk after neoadjuvant concomitant therapy.
In the early phase of treatment, 6 patients had grade III-IV gastrointestinal toxicity, 2 patients had grade III-IV hematologic toxicity, and 1 patient had grade V toxicity due to postoperative sepsis during chemotherapy. Only 1 patient had radiotherapy-related late side effects, i.e., grade IV tenesmus. Complete pathological response was achieved in 6 patients (21%), while near-complete pathological response was obtained in 9 (31%). After a median follow-up period of 60 mo, the local tumor control rate was 96.6%. In 13 patients, distant metastasis occurred. Disease-free survival rates at 2 and 5 years were 63.3% and 53%, and corresponding overall survival rates were 70% and 53.1%, respectively.
Although it has excellent local control and complete pathological response rates, neoadjuvant HART concurrent chemotherapy appears to not be a feasible treatment regimen in locally advanced rectal cancer, having high perioperative complication and intolerable side effects. Effects of reduced 5-fluorouracil dose or omission of chemotherapy with the aim of reducing toxicity may be examined in further studies.
Core tip: This study includes a first phase II study evaluating neoadjuvant hyperfractionated accelerated radiotherapy plus concomitant infusional 5-fluorouracil (5-FU) chemotherapy in locally advanced rectal cancer (not resectable cancer). This regimen may allow clinicians to design other neoadjuvant hyperfractionated accelerated radiotherapies. This study showed excellent local control but high rate of perioperative complications. Decreasing or modifying the 5-FU dose could provide better local control.