Chemoradiation effect of combined preoperative intensity-modulated radiotherapy with oral capecitabine in patients with locally advanced mid-low rectal cancer using a simultaneous integrated boost of tomotherapy / 中国综合临床

ABSTRACT

Objective To assess the safety and efficacy of preoperative intensity-modulated radiotherapy(IMRT) with oral capecitabine in patients with locally advanced mid-low rectal cancer using a simultaneous integrated boost (SIB) of tomotherapy.Methods Total 16 patients with resectable locally advanced mid-low rectal cancer (patients with T3 to T4 and/or N ± rectal cancer) were enroll in current study.Patients were received IMRT to 2 dose levels simultaneously (55 and 47.5 Gy in 25 fractions) with concurrent capecitabine 825 mg/m2 twice daily,5 days/week.Total mesorectal excision was performed at 8 to 9 week after the completion of chemoradiation.The primary end point included side effect,the rate of sphinctersparing,postoperative complication and pathological complete response rate (pCR) were observed.Side effects were scored using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0.Results All patients were received chemoradiotion therapy without any break.Tomotherapy showed superiority with respect to target coverage,homogeneity and conformality.Two patients refused to perform radical surgery because of almost complete primary tumor regression and complete symptom relief after neoadjuvant therapy.Fourteen patients underwent surgical resection and 11 patients (78.6％) underwent sphincter-sparing lower anterior resection.Four patients(28.6％) had a pathological complete response.The incidence of grade 1-2 hematologic,gastro-intestinal toxicities were 62.5％ (10/16) and 18.8％ (3/16).The incidence of grade 3 skin toxicities were 68.8％(10/16).Grade Ⅳ side effect was not observed.Surgical complications (incisional infection on thirteen after surgery) were observed in 1 patient.Conclusion Preoperative simultaneous integrated boost of tomotherapy with concurrent oral capecitabine is safe and well tolerated in patients with a promising local control.However,a larger number of patients and a long follow-up are required to assess its potential superiority.