Hypofractionated accelerated radiotherapy, cytoprotection and capecitabine in the treatment of rectal cancer: a feasibility study.
BACKGROUND
This is a report on the feasibility and efficacy of hypofractionated accelerated radiotherapy combined with amifostine cytoprotection (hypoARC) and capecitabine in the treatment of rectal adenocarcinoma.


METHODS
Twenty-seven patients (pts) received pre- (14 pts) or postoperative (13 pts) conformal radiotherapy with 10 consecutive fractions of 3.4 Gy in 12 days, supported with subcutaneously administered high-dose amifostine (up to 1000 mg) and capecitabine (daily dose of 600 mg/m2 twice a day, 5 days per week for 4 weeks). Ten additional patients with inoperable tumors received a higher dose (15 fractions of 3.4 Gy) as a radical intervention and 5 received a lower dose for palliation.


RESULTS
Chemotherapy-related toxicity was minimal and radiation grade 2 diarrhoea and proctitis was noted in 3/42 and 4/42 cases, respectively. No peri- or postoperative complications were noted in patients receiving pre-operative radiochemotherapy. Significant tumor regression was confirmed in post- RT CT-imaging and major histological responses were noted in 85% of cases treated before surgery. Late toxicity (median follow-up 26 months) was negligible. The 2-year local relapse-free survival was 85-90% in patients treated with pre- or postoperative radiotherapy and 35% in patients with inoperable tumors.


CONCLUSIONS
Capecitabine-based hypoARC is feasible with only minimal early and late toxicity and encouraging efficacy.
Koukourakis
Michael I
MI
Department of Radiotherapy-Oncology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece. targ@her.forthnet.gr
Simopoulos
Constantinos
C
Pitiakoudis
Michael
M
Lyratzopoulos
Nikolaos
N
Romanidis
Konstantinos
K
Giatromanolaki
Alexandra
A
Polychronidis
Alexandros
A
Kouklakis
George
G
Sivridis
Efthimios
E
Minopoulos
George
G
Manolas
Konstantinos
K
D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004999:Amifostine / Q000009:adverse effects / Q000627:therapeutic use*; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects / Q000627:therapeutic use*; D000069287:Capecitabine; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D019583:Dose Fractionation, Radiation; D004305:Dose-Response Relationship, Drug; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011837:Radiation-Protective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D055815:Young Adult
D000964:Antimetabolites, Antineoplastic; D011837:Radiation-Protective Agents; D003841:Deoxycytidine; D000069287:Capecitabine; D004999:Amifostine; D005472:Fluorouracil