title: Phase II trial of preoperative 3D conformal radiotherapy, protracted venous infusion 5-fluorouracil, and weekly CPT-11, followed by surgery for ultrasound-staged T3 rectal cancer.
abstract: OBJECTIVE
  CPT-11 sensitizes tumor cells to radiation and in combination therapy with 5-fluorouracil (5-FU) results in enhanced cytotoxicity to metastatic colorectal cancer. We report the results from a Phase II trial of preoperative radiotherapy (RT), CPT-11, and 5-FU for patients with ultrasound-staged T3 rectal cancer.
  
  
  METHODS
  Between April 1999 and August 2001, 32 patients (21 men, 11 women; median age 52 years, range 40-74) with biopsy-proven adenocarcinoma of the rectum were enrolled in the study. All patients underwent endorectal ultrasonography for staging (uT3N0 = 19; uT3N1 = 13; uT2N1 = 1). RT was prescribed to the draining lymph nodes (45 Gy in 1.8-Gy daily fractions) and tumor (50.4 Gy in 1.8-Gy daily fractions). Patients also received concurrent CPT-11 (50 mg/m(2), Days 1, 8, 15, and 22) and 5-FU (200 mg/m(2) daily, 7 d/wk, Days 1-33). Surgical resection was performed 6-10 weeks after completing chemoradiotherapy.
  
  
  RESULTS
  Acute toxicity was frequently observed, and 18 patients (56%) required either a chemotherapy dose reduction or RT interruption of >3 days. One patient withdrew because of diarrhea and abdominal cramping (Grade III) after 10 days of treatment. Although no Grade IV toxicity was observed, Grade III diarrhea (n = 9, 28%), mucositis (n = 7, 21%), rectal sores (n = 7, 21%), abdominal cramping (n = 3, 9%) were noted. Of the 32 patients who underwent surgery, 12 had a complete pathologic response. Of the 32 patients, the disease of 23 (71%) was downstaged. The average length of hospitalization was between 5 and 12 days, with 1 patient staying 33 days. All patients were followed for disease-free survival.
  
  
  CONCLUSIONS
  Although associated with frequent acute toxicity, the regimen is associated with significant tumor "downstaging." Additional patients and longer follow-up are necessary to define the role of this regimen fully.
authors.affiliation: Department of Radiation Oncology, Stanford University Medical Center, Stanford, CA, USA. dr_vmehta@yahoo.com
authors.forename: Vivek K
authors.initials: VK
authors.lastname: Mehta
authors.forename: Cheryl
authors.initials: C
authors.lastname: Cho
authors.forename: James M
authors.initials: JM
authors.lastname: Ford
authors.forename: C
authors.initials: C
authors.lastname: Jambalos
authors.forename: Joseph
authors.initials: J
authors.lastname: Poen
authors.forename: Albert
authors.initials: A
authors.lastname: Koong
authors.forename: Albert
authors.initials: A
authors.lastname: Lin
authors.forename: J Augusto
authors.initials: JA
authors.lastname: Bastidas
authors.forename: Harvey
authors.initials: H
authors.lastname: Young
authors.forename: Eamonn P
authors.initials: EP
authors.lastname: Dunphy
authors.forename: George
authors.initials: G
authors.lastname: Fisher
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D000077146:Irinotecan; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D020266:Radiotherapy, Conformal / Q000379:methods*; D012004:Rectal Neoplasms / Q000473:pathology / Q000628:therapy*; D014465:Ultrasonics
chemical_list: D000077146:Irinotecan; D005472:Fluorouracil; D002166:Camptothecin