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Objective To evaluate the feasibility and efficacy of chemoradiotherapy for locally advanced (inoperable) rectal cancer. Methods Seventy-six patients with locally advanced (T_4) or recurrent rectal cancer were randomized into two groups of concurrent chemoradiotherapy with either oxaliplatin plus 5-FU (oxaliplatin 130 mg/m~2, day 1,5-FU 350 mg/m~2, day 1 -5 ,LV 200 mg/m~2, day 1 -5, 4 weeks per cycle) or capecitabine (1650 mg/m~2, day 1 -14, 3 weeks per cycle) alone. All patients received pelvic three-dimensional conforrnal radiotherapy (3 DCRT) of 46 -50 Gy in 23 -25 fractions, with a boost of 14 -18 Gy in 7 -9 fractions. Results The median follow-up time was 19 months. The overall response rate was 64% in the oxaliplatin/5-FU group comparing with 58% in the capecitabine group (χ~2 = 0. 08 ,P =0. 772), with the median survival time of 22 months and 18 months (u = 17.71, P = 0. 077), respectively. The overall survival in the two groups was 68% and 63% at 1 year, and 21% and 19% at 2 years, respectively (χ~2 = 0. 97, P = 0. 326). There were no treatment-related deaths or grade 4 toxicities. Neutrocytopenia (39. 5% vs 77.7%, z = -3.97,P =0. 0001), diarrhea (47.4% vs 88.9%, z = -4. 78, P = 0. 0001), nausea and vomiting (68.4% vs 97.2%, z = -3. 17, P = 0. 0001), and neurotoxicity (5.3% vs 66.7%, z= -6.56, P= 0.0001) were more common in the oxaliplatin/5-FU group. Conclusions Concurrent chemoradiotherapy is well-tolerated and effective in patients with locally advanced (inoperable) rectal cancer.
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Objective To evaluate the effect of radiotherapy(RT)combined with arterial infusion chemotherapy(AIC) in the treatment of locally advanced or recurrent rectal cancer. Methods From May.1994 to Dec.2000, 62 patients with locally advanced or recurrent rectal cancer were randomized into two groups: RT alone group(31 patients)and the combined group(RT+AIC, 31 patients). All patients were treated with conventional radiotherapy by 8 18 ?MV X ray to a total dose of D T40 50 ?Gy in 4 to 5 weeks for the resectable disease, or to a dose of 60 70 ?Gy in 6 to 7 weeks for the unresectable disease. However, the combined group received concurrent arterial infusion chemotherapy by DDP 70?mg/m 2 and 5 FU 600 ?mg/m 2 in 2 3 cycles. Results The response rates were 83.9% and 54.8% in combined group and RT alone group, respectively (P
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Objective To investigate the down stage effect and long-term results of preoperative chemoradiotherapy for locally advanced lower rectal adenocarcinoma. Methods From Jan. 1989 to Jul 1999, 103 patients suffering from lower rectal carcinoma were treated. Criteria entry: 1. Distance between anal verge and centre of tumor 4-8?cm(median 6.2?cm), 2. Uncertainty in decision of preservation of anus before admission, 3. Lesion belonged to locally advanced type, 4. definitive pathology, clinical stage and presence of objective observation of tumor extent, 5. Performance status proposed by Eastern Cooperative Oncology Group 0-2, 6. Age0.05), 25.5% and 48.5% (P
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0.05). ConclusionsConventional radiotherapy plus three dimensional conformal radiotherapy combined with chemotherapy may significantly improve the survival rate and reduce the distant metastasis rate of locally advanced or recurrent rectal cancer.