Chemoradiation with raltitrexed (Tomudex) in preoperative treatment of stage II-III resectable rectal cancer: a phase II study.
OBJECTIVE
To evaluate the impact of preoperative chemoradiation with raltitrexed (Tomudex(1)) on tumor response, sphincter preservation, and toxicity in patients with locally advanced rectal cancer.


METHODS
Between 1998 and 2002, 54 consecutive patients with Stage T3 or T2N+ resectable rectal carcinoma were treated with preoperative chemoradiation, i.v. bolus of raltitrexed on Days 1, 19, and 38 and concurrent 50 Gy external beam radiotherapy. Surgery was performed 6-8 weeks after the end of chemoradiation.


RESULTS
No patients had Grade 4 acute toxicity. Grade 3 acute toxicity occurred in 16.6% of cases and was hematologic in 6 patients and GI in 2. The overall clinical response rate was 88.8%, with a complete response in 5.5%, partial response in 83.3%, and no change in 9.2%. No patient showed disease progression. All patients underwent surgery. Sphincter saving was obtained in 83.3% of patients. No perioperative mortality occurred, and the perioperative morbidity rate was 5.5%. Of 20 resected patients (37%) who were candidates for abdominoperineal resection at diagnosis (anorectal ring distance < or =30 mm), 13 (65%) underwent a sphincter-saving procedure. At pathologic examination, 13 (24%) of 54 patients had a complete pathologic response (pT0) and 10 (18.5%) had rare isolated residual cancer cells (pT, microscopic foci). Overall, 42.5% had major downstaging. The tumor regression grade (TRG), using Mandard's score system, was also applied and was TRG1 in 13 patients, TRG2 in 11, TRG3 in 20, and TRG4 in 10 patients; no patient had TRG5.


CONCLUSIONS
The use of raltitrexed in a neoadjuvant chemoradiation schedule promoted high pathologic tumor downstaging and use of a sphincter-saving procedure. The low toxicity profile supports the rationale to explore raltitrexed combined with other drugs with different biologic targets.
Gambacorta
Maria Antonietta
MA
Department of Radiation Therapy, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Largo A. Gemelli 8, Rome 00168, Italy.
Valentini
Vincenzo
V
Morganti
Alessio Giuseppe
AG
Mantini
Giovanna
G
Miccichè
Francesco
F
Ratto
Carlo
C
Di Miceli
Dario
D
Rotondi
Fabio
F
Alfieri
Sergio
S
Doglietto
Giovan Battista
GB
Vargas
Jose Garcia
JG
De Paoli
Antonino
A
Rossi
Carlo
C
Cellini
Numa
N
D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D005492:Folic Acid / Q000627:therapeutic use; D005500:Follow-Up Studies; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011799:Quinazolines / Q000627:therapeutic use*; D020266:Radiotherapy, Conformal / Q000009:adverse effects; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D013876:Thiophenes / Q000627:therapeutic use*
D000964:Antimetabolites, Antineoplastic; D006397:Hematinics; D011799:Quinazolines; D013876:Thiophenes; D005492:Folic Acid; C068874:raltitrexed; D005472:Fluorouracil