Improved incidence of pT0 downstaged surgical specimens in locally advanced rectal cancer (LARC) treated with induction oxaliplatin plus 5-fluorouracil and preoperative chemoradiation
2006; Elsevier BV; Volume: 17; Issue: 7 Linguagem: Inglês
10.1093/annonc/mdl085
ISSN1569-8041
AutoresFelipe A. Calvo, Javier Serrano, Juan A. Díaz-González, M. Gómez-Espí, E. Bayo Lozano, Rafael Pérez García, Dolores de la Mata, José Ángel Arranz, Pilar García‐Alfonso, G. Pérez-Manga, E. Álvarez,
Tópico(s)Colorectal and Anal Carcinomas
ResumoPurpose: To compare efficacy in terms of pathologic response in LARC patients treated with preoperative chemoradiation, with or without a short-intense course of induction oxaliplatin.Patients and Methods: From 05/98 to 10/02, 114 patients were treated with preoperative chemoradiation (4500–5040 cGy + oral Tegafur 1200 mg/day) for cT3-4N+/xM0 rectal cancer. Starting 05/01, 52 consecutive patients additionally received induction FOLFOX-4, oxaliplatin (85 mg/m2 iv d1), 5-FU (400 mg/m2 iv bolus d1) and 600 mg/m2 iv continuous infusion in 22 h with leucovorin (200 mg iv) d1 and d2, every 15 days (2 cycles), followed by the previously described Tegafur chemoradiation regime. Surgery was performed in 5–6 weeks. Pathological assessment investigated post-treatment T and N status in the rectal wall and peri-rectal tissues.Results: Patients, tumor and treatment characteristics were comparable between groups. Incidence of pT0 specimens was significantly increased by induction FOLFOX-4 (P = 0.006). Total T and N downstaging were 58% versus 75% and 42% versus 40%, respectively (P = ns). T downstaging of ≥2 categories was significantly superior in FOLFOX-4 group (P = 0.029).Conclusions: Short-intense induction FOLFOX-4 significantly improves pathologic complete response in LARC patients treated with tegafur-sensitized preoperative chemoradiation. The 44% rate of pT0-1 specimens observed in the oxaliplatin group should impulse innovative surgical approaches to promote ano-rectal sphincter conserving protocols.
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