Preoperative concomitant radiotherapy with oral capecitabine in advanced rectal cancer within 6 cm from anal verge.
OBJECTIVE
This study aimed to evaluate the role preoperative chemo-radiotherapy with oral capacitabine for advanced low rectal cancer within 6 cm of anal verge.


METHODS
Twenty-six patients with rectal adenocarcinoma were treated with preoperative radiotherapy, and oral capecitabine administrated at 5 days/week. Conventional abdominoperineal resection (APR) was done in 12 patients, and sphincter-saving resection (SSR) in 14 patients, the mean follow-up was 26.92+/-6.69 months.


RESULTS
Oral capecitabine was well tolerated in all patients; grade 3 toxicity was seen in only one patient (3.85%) in the form of febrile neutropenia, and diarrhea. Clinical response observed in 17 patients (65.38%). There were no intra or postoperative deaths. Pathological down-staging was seen in 16 patients (61.53%) and pathological complete response in three patients (11.54%). There were two disease-linked deaths, one controlled regional recurrence, two evolutive patients (pulmonary metastases), and 22 disease-free patients.


CONCLUSIONS
Preoperative chemo-radiotherapy with oral capecitabine induced significant down-staging. Combining such a regimen with intersphincteric resection led to the achievement of distal and radial negative margins, allowing a low local recurrence rate.
Elshazly
Walid Galal
WG
Colorectal Unit, Surgical Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt. wshazly@hotmail.com
Farouk
Mohmed
M
Samy
Mohmed
M
D000284:Administration, Oral; D000328:Adult; D001003:Anal Canal / Q000473:pathology*; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000069287:Capecitabine; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010349:Patient Compliance; D011300:Preoperative Care; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D016019:Survival Analysis; D016896:Treatment Outcome
D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil