Neoadjuvant chemoradiotherapy with 5-fluorouracil by bolus.
BACKGROUND
Neoadjuvant chemoradiotherapy (CT-RT) with continuous infusion (c.i.) 5-fluorouracil (5-FU) before resection of high-risk rectal cancer improves overall survival (OS) and pelvic control. Since the presence of cardiomiopathy may contraindicate c.i. of 5-FU, an alternative regimen of 5-FU CT-RT was prospectively studied in these patients.


METHODS
From October 2000 to December 2006, patients with clinical stage T3 or T4, or node-positive disease were assigned according to their cardiological status to receive weekly 5-FU bolus administration during radiotherapy (RT). The preoperative treatment consisted of 5,040 cGy, delivered infractions of 180 cGy per day, five days per week, and 5-FU, given in 15 minutes at a dose of 450 mg/m2 of body surface area weekly during all radiotherapy. Surgery was performed six weeks after the completion of CT-RT. The primary endpoint was disease-free survival (DFS).


RESULTS
Fifty-one patients received preoperative CH-RT. The 2-year OS rate was 92.3% and the 3-year DFS was 87.5%. The five-year cumulative incidence of local relapse was 3.9%. Grade 3 acute toxic effects occurred in 19.6% of the patients; worsening of patient's cardiopathy was never reported.


CONCLUSIONS
Patients with cardiopathy developed similar local control and DFS, toxicity and OS with 5-FU administered weekly by bolus as those reported by literature data.
Pasetto
Lara Maria
LM
Istituto Oncologico Veneto, IRCCS, Medical Oncology 2, Padova, Italy. laramary@libero.it
Sinigaglia
Giulietta
G
Basso
Umberto
U
Cocchio
Silvia
S
Compostella
Alessia
A
Pucciarelli
Salvatore
S
Friso
Maria Luisa
ML
Rugge
Massimo
M
Toppan
Paola
P
Agostini
Marco
M
Monfardini
Silvio
S
D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects; D009202:Cardiomyopathies / Q000150:complications; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D020360:Neoadjuvant Therapy; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery
D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil