Outcome of locally advanced rectal cancer patients treated with radical surgery followed by concurrent capecitabine and radiotherapy / 中华放射肿瘤学杂志

ABSTRACT

Objective To evaluate the toxicities and long-term survival of a pilot study of radical surgery followed by concurrent capecitabine and radiotherapy for stage Ⅱ/Ⅲ rectal cancer patients.Methods From March 1,2005 to December 31,2007,131 pathologically proved stage Ⅱ and Ⅲ rectal cancer patients received radical surgery followed by chemoradiotherapy and adjuvant chemotherapy.Capecitabine was delivered daily in twice,for 2 weeks followed by a 2nd cycle after a rest of 7 days during radiotherapy,with the dosage of 1600 mg/m2/d.Three-dimensional conformal radiotherapy was encouraged to the dose of 50 Gy in 25 fractions,and Oxaliplatin/5-fluorouracil or leucovorin based adjuvant chemotherapy was recommended.Results Grade 3 +4 toxicities during concurrent chemoradiotherapy were observed in 28.2％ of patients.The follow-up rate was 93.9％.The 3-year overall survival (OS),locoregional-free survival and distant metastasis-free survival rates were 85.1％,96.7％ and 79.5％,respectively.Among the 31 patients with relapse,5 had loco-regional recurrence and 28 had distant metastasis.Univariate analysis indicated that patients with low and moderate-low differentiated adenocarcinoma,no adjuvant chemotherapy,stage ⅢC disease or positive lymph node ratio (LNR) more than 30％ had lower OS ( x2 =15.49,15.85,8.80 and 9.76,P ＝ 0.000,0.000,0.011 and 0.002 ).Patients with N2 disease had more loco-regional recurrence.Patients with stage ⅢC,without adjuvant chemotherapy,or LNR more than 30％ were at higher risk of distant metastasis ( x2 =6.51,11.57 and 9.70,P =0.034,0.001 and 0.002 ).However,patients who didn ' t receive adjuvant chemotherapy were likely to have low differentiated adenocarcinoma and T4 stage disease ( x2 =7.20,6.48,P =0.027,0.039).Conclusions After radical surgery and concurrent eapecitabine and radiotherapy for stage Ⅱ/Ⅲ rectal cancer patients,loco-regional recurrence rate is pretty low.Distant metastasis is the main treatment failure.