Neoadjuvant capecitabine-based chemoradiotherapy followed by total mesorectal excision for locally advanced resectable rectal cancer

ABSTRACT

Twenty three patients with respectable clinical stages II and III cancer rectum entered the study. All patients received concurrent chemoradiotherapy [CRT] based on capecitabine orally at a dose of 825 mg/m2 twice a day throughout the concurrent radiotherapy [RT] course. A radiation dose of 45 Gy was given to the posterior part of the pelvis to include the tumor, the mesorectum, followed by a boost of 5.4 Gy limited to the tumor and corresponding mesorectum with a 2 cm margin. A total mesorectal excision [TME] surgery was performed after a rest period of 6-7 weeks from completion of the preoperative chemo-irradiation. Acute toxicities of concurrent chemo-radiotherapy were reversible and controllable. Grade 3 leucopenia was noted in one patient only. Acute cystitis, moderate grade, was developed in 3 patients. Neurological symptoms were noted in 3 patients. Bleeding during operation occurred in 8.7% of patients. One patient who showed clinical leakage failed conservative management and required surgical re-intervention. Downstaging rate for T-stage was 69.5% [16/23 patients]. This rate was higher for N-stage constituting 84.2% [16/ 19 patients as 4 patients were NO]. There was no increase in T- and/or N-stage [upstaging] recorded in this study. Complete pathological response was recorded in 2 patients only [8.7%]. Sphincter-conserving surgery was successfully performed in 2 of 7 patients who were considered for abdomino-perineal resection before chemo-irradiation [28.6%]. After a median follow up period of 24 months, overall survival rate was 90.9% [20/22]. Distant failure was higher than local recurrence [13.6% Vs 9.1% respectively]. In conclusion; preoperative concurrent capecitabine and radiotherapy is considered to be a safe procedure and well-tolerated in patients with clinical stages II and III resectable rectal cancer treated with TME surgery. Successful high rate of sphincter-sparing procedure to some patients with low cancer rectum is possible after preoperative concurrent capecitabine and radiotherapy. Preoperative concurrent capecitabine and radiotherapy may reduce recurrence and improve survival rates