title: Induction chemotherapy with capecitabine and oxaliplatin followed by chemoradiotherapy before total mesorectal excision in patients with locally advanced rectal cancer.
abstract: BACKGROUND
  Preoperative chemoradiation in patients with locally advanced rectal cancer has no impact on overall survival (OS) and distant recurrences. The aim of the study was to evaluate local downstaging, toxicity and long-term outcome in patients with locally advanced rectal cancer after induction therapy with capecitabine and oxaliplatin (CAPEOX) followed by radiotherapy concomitant with capecitabine [chemoradiotherapy (CRT)] before total mesorectal excision (TME).
  
  
  METHODS
  Patients with T4 tumors, all T3N+ tumors or T3 tumors involving or with a distance ≤1 mm to the mesorectal fascia were included. Patients were planned for two cycles of CAPEOX followed by radiotherapy concomitant with capecitabine. TME was carried out 6 weeks after the completion of CRT.
  
  
  RESULTS
  Of 84 consecutively admitted patients starting induction CAPEOX, 77 patients underwent surgery. R0 resection was seen in 94% and T downstaging in 69%. In the intention-to-treat group, pathological complete response was seen in 23%. Five-year disease-free survival (DFS) and OS were 63% [95% confidence interval (CI), 52.2% to 73.7%] and 67% (95% CI, 56.1% to 77.3%), respectively. Grade 3/4 toxicity was seen in 18%, and four deaths occurred within 2 months of therapy.
  
  
  CONCLUSIONS
  Induction chemotherapy before CRT and surgery showed a high local control rate and promising long-term outcome as OS and DFS.
authors.affiliation: Departments of Oncology. Electronic address: j.schou@dadlnet.dk.
authors.forename: J V
authors.initials: JV
authors.lastname: Schou
authors.affiliation: Departments of Oncology.
authors.forename: F O
authors.initials: FO
authors.lastname: Larsen
authors.affiliation: Departments of Radiology.
authors.forename: L
authors.initials: L
authors.lastname: Rasch
authors.affiliation: Departments of Pathology, Herlev Hospital, Copenhagen, Denmark.
authors.forename: D
authors.initials: D
authors.lastname: Linnemann
authors.affiliation: Departments of Pathology, Herlev Hospital, Copenhagen, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Langhoff
authors.affiliation: Departments of Pathology, Herlev Hospital, Copenhagen, Denmark.
authors.forename: E
authors.initials: E
authors.lastname: Høgdall
authors.affiliation: Departments of Oncology.
authors.forename: D L
authors.initials: DL
authors.lastname: Nielsen
authors.affiliation: Departments of Oncology.
authors.forename: K
authors.initials: K
authors.lastname: Vistisen
authors.affiliation: Departments of Oncology.
authors.forename: A
authors.initials: A
authors.lastname: Fromm
authors.affiliation: Departments of Oncology.
authors.forename: B V
authors.initials: BV
authors.lastname: Jensen
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000069287:Capecitabine; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D008297:Male; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil