Preoperative irradiation and fluorouracil chemotherapy for locally advanced rectosigmoid carcinoma: phase I-II study.

Abstract

From June 1988 to July 1991, 20 patients with locally advanced rectal or rectosigmoid cancer were treated prospectively with a strategy of combining preoperative irradiation and fluorouracil chemotherapy before surgical resection. The preoperative radiation dose was 5,000 cGy, and fluorouracil chemotherapy was administered on the first and last 3 days of irradiation in an intravenous bolus dose of 500 mg/m2. In a median follow-up of 25 months, the local regional failure rate was 10%. The 3-year actuarial overall survival and disease-free survival were 92% and 82%, respectively. Twenty percent of the surgical specimens showed no residual tumor, and only 10% showed positive lymph nodes. Significant leukopenia occurred in 10% of patients. Preoperative irradiation and fluorouracil chemotherapy increased surgical downstaging and improved local regional control. The overall toxicity was acceptable. The results of this particular multimodality approach was encouraging and warrant further investigation in phase III trials.

T-Level Downstaging and Complete Pathologic Response After Preoperative Chemoradiation for Advanced Rectal Cancer Result in Decreased Recurrence and Improved Disease-Free Survival

“…The CPR rate of 18 percent in the present study compares favorably with previous studies using preoperative CRT. 8,9,14,16,20,22,23,26 In addition, 41 percent of the patients in our study achieved T-level downstaging. Discrepancies in response rates after preoperative CRT might be attributed to different selection criteria, variation in pretreatment staging, and different treatment approaches.…”

“…7 tive combined modality treatment in the management of rectal cancer (Table 1). [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Preoperative CRT offers several potential advantages. It reduces acute toxicity by avoiding radiation to the neorectum and increases efficacy by irradiating well-oxygenated tissues.…”

Development of In Situ Gelling and Bio Adhesive 5-Fluorouracil Enema

“…5-FU is the main chemotherapeutic agent used for the treatment of colorectal cancer [4]–[6]. It is given intravenously via bolus or continuous infusion in doses ranging from 250 to 1,000 mg/m 2 /day [7]–[10]. 5-FU toxicity is predominantly dependent on the mean serum concentration and typical adverse events include leukopenia, diarrhea, stomatitis, and weight loss [7]–[10].…”

Multimodality approaches for rectal cancer

“…Extrapolating from postoperative data showing the efficacy of radiotherapy in combination with 5-FU based chemotherapy, many institutions routinely use conventional neoadjuvant CMT for locally advanced rectal cancer followed by definitive surgery at least 4 weeks after completion. [55][56][57][58][59] Neoadjuvant CMT has also been shown to be quite effective in sphincter preservation. Using standard fractionation limits the acute side effects of treatment while allowing time for the 5-FU chemotherapy to act as a radiosensitizer.…”