Four-Week Neoadjuvant Intensity-Modulated Radiation Therapy With Concurrent Capecitabine and Oxaliplatin in Locally Advanced Rectal Cancer Patients: A Validation Phase II Trial

Arbea, Leire; Martı́nez-Monge, Rafael; Díaz-González, J.A.; Moreno, Marta; Rodríguez, Javier Jacob; Hernández, José L.; Sola, Jesús Javier; Ramos, Luís; Súbtil, José Carlos; Núñez, Jorge; Chopitea, Á.; Cambeiro, Mauricio; Gaztañaga, Miren; Garcı́a-Foncillas, Jesús; Aristu, Javier

doi:10.1016/j.ijrobp.2011.06.2008

Cited by 31 publications

(23 citation statements)

References 33 publications

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“…34 The application of intensity-modulated radiation therapy (IMRT), while not yet standard treatment, may help to reduce this toxicity further without compromising response rates. 25,33,48–50 Similar to previous studies, we did not identify a lower likelihood of pCR in patients who received IMRT relative to standard external beam therapy.…”

Section: Discussionsupporting

confidence: 87%

Predictors of Pathologic Complete Response Following Neoadjuvant Chemoradiotherapy for Rectal Cancer

et al. 2015

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Background Some patients with rectal cancer who receive neoadjuvant chemoradiotherapy (nCRT) achieve a pathologic complete response (pCR) and may be eligible for less radical surgery or non-operative management. The aim of this study was to identify variables that predict pCR after nCRT for rectal cancer and to examine the impact of pCR on postoperative complications. Methods A retrospective review was performed of the NCDB from 2006 to 2011. Patients with rectal cancer who received nCRT followed by radical resection were included in this study. Multivariable analysis of the association between clinicopathologic characteristics and pCR was performed, and propensity-adjusted analysis was used to identify differences in postoperative morbidity between pCR and non-pCR patients. Results A total of 23,747 patients were included in the study. Factors associated with pCR included lower tumor grade, lower clinical T and N stage, higher radiation dose, and delaying surgery by more than 6–8 weeks after the end of radiation, while lack of health insurance was linked with a lower likelihood of pCR. Complete response was not associated with an increased risk of major postoperative complications. Conclusions Several clinical, pathologic, and treatment variables can help to predict which patients are most likely to have pCR after nCRT for rectal cancer. Awareness of these variables can be valuable in counseling patients regarding prognosis and treatment options.

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Section: Discussionsupporting

confidence: 87%

Predictors of Pathologic Complete Response Following Neoadjuvant Chemoradiotherapy for Rectal Cancer

et al. 2015

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“…the results of the former approach have been reported elsewhere. 19 surgery was scheduled 5 to 6 weeks after the completion of CRt.…”

Section: Methodsmentioning

confidence: 99%

Prognosis Factors for Recurrence in Patients With Locally Advanced Rectal Cancer Preoperatively Treated With Chemoradiotherapy and Adjuvant Chemotherapy

Arredondo

Baixauli

Beorlegui

et al. 2013

Diseases of the Colon &Amp; Rectum

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“…As an illustration, death from myocardial infarction and protocol violations requiring chemotherapy dose reduction and/or radiotherapy interruption secondary to severe toxicity have been reported in 32% of patients with locally advanced cancer treated with capecitabine and oxaliplatin concurrently with 3D-CRT [15]. However, using the same chemotherapy regimen, Sola et al reported that pelvic radiation with IMRT for locally advanced rectal cancer was better tolerated with less interruption of the treatment schedule [7]. Thus, bowel sparing and bone marrow sparring through IMRTmay improve patient tolerance to chemoradiation, allowing them to undergo surgery for complete resection and possible cure for their rectal cancer [5], [6].…”

Section: Discussionmentioning

confidence: 99%

“…The reported acute grade 3–4 radiation enteritis and hematologic toxicity range from 3% to 24% and 0 to 3% respectively. The percentage of patients who have radiotherapy treatment break range from 11.1% to 16.2% [7], [18]–[20]. Table 3 summarizes acute toxicity in patients with locally advanced rectal cancer treated with IMRT and chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…Preliminary results with IMRT are encouraging with fewer treatment breaks, less serious toxicities, and less hospitalization in patients with rectal cancer undergoing chemoradiation with various chemotherapy regimens [6]. In addition to reduced toxicity, an excellent pathological response rate and complete resection rate are reported following chemoradiation with IMRT in patients with locally advanced rectal cancer [7]. Thus, the potential advantage in normal tissue sparing that is associated with IMRT may allow elderly patients to receive curative treatment despite the presence of age-associated co-morbidities.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of Image-Guided Radiotherapy for Elderly Patients with Locally Advanced Rectal Cancer

et al. 2013

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PurposeThe study aims to assess the tolerance of elderly patients (70 years or older) with locally advanced rectal cancers to image-guided radiotherapy (IGRT). A retrospective review of 13 elderly patients with locally advanced rectal cancer who underwent preoperative chemoradiation using IGRT was performed. Grade 3–4 acute toxicities, survival, and long-term complications were compared to 17 younger patients (<70 years) with the same disease stage.ResultsGrade 3–4 hematologic toxicities occurred in 7.6% and 0% (p = 0.4) and gastrointestinal toxicities, and, in 15.2% and 5% (p = 0.5), of elderly and younger patients, respectively. Surgery was aborted in three patients, two in the elderly group and one in the younger group. One patient in the elderly group died after surgery from cardiac arrhythmia. After a median follow-up of 34 months, five patients had died, two in the elderly and three in the younger group. The 3-year survival was 90.9% and 87.5% (p = 0.7) for the elderly and younger group respectively. Two patients in the younger group developed ischemic colitis and fecal incontinence. There was no statistically significant difference in acute and late toxicities as well as survival between the two groups.Conclusions and Clinical RelevanceElderly patients with locally advanced rectal cancers may tolerate preoperative chemoradiation with IGRT as well as younger patients. Further prospective studies should be performed to investigate the potential of IGRT for possible cure in elderly patients with locally advanced rectal cancer.

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Four-Week Neoadjuvant Intensity-Modulated Radiation Therapy With Concurrent Capecitabine and Oxaliplatin in Locally Advanced Rectal Cancer Patients: A Validation Phase II Trial

Cited by 31 publications

References 33 publications

Predictors of Pathologic Complete Response Following Neoadjuvant Chemoradiotherapy for Rectal Cancer

Predictors of Pathologic Complete Response Following Neoadjuvant Chemoradiotherapy for Rectal Cancer

Prognosis Factors for Recurrence in Patients With Locally Advanced Rectal Cancer Preoperatively Treated With Chemoradiotherapy and Adjuvant Chemotherapy

Feasibility of Image-Guided Radiotherapy for Elderly Patients with Locally Advanced Rectal Cancer

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