title: Evaluation of short-course radiotherapy followed by neoadjuvant bevacizumab, capecitabine, and oxaliplatin and subsequent radical surgical treatment in primary stage IV rectal cancer.
abstract: BACKGROUND
  To evaluate the efficacy and tolerability of preoperative short-course radiotherapy followed by capecitabine and oxaliplatin treatment in combination with bevacizumab and subsequent radical surgical treatment of all tumor sites in patients with stage IV rectal cancer.
  
  
  METHODS
  Adults with primary metastasized rectal cancer were enrolled. They received radiotherapy (5 × 5 Gy) followed by bevacizumab (7.5 mg/kg, day 1) and oxaliplatin (130 mg/m(2), day 1) intravenously and capecitabine (1000 mg/m(2) twice daily orally, days 1-14) for up to six cycles. Surgery was carried out 6-8 weeks after the last bevacizumab dose. The percentage of radical surgical treatment, 2-year survival and recurrence rates, and treatment-related toxicity was evaluated.
  
  
  RESULTS
  Of 50 included patients, 42 (84%) had liver metastases, 5 (10%) lung metastases, and 3 (6%) both liver and lung metastases. Radical surgical treatment was possible in 36 (72%) patients. The 2-year overall survival rate was 80% [95% confidence interval (CI) 66.3%-90.0%]. The 2-year recurrence rate was 64% (95% CI 49.8%-84.5%). Toxic effects were tolerable. No treatment-related deaths occurred.
  
  
  CONCLUSIONS
  Radical surgical treatment of all tumor sites carried out after short-course radiotherapy, and bevacizumab-capecitabine-oxaliplatin combination therapy is a feasible and potentially curative approach in primary metastasized rectal cancer.
authors.affiliation: Department of Surgery. Electronic address: t.h.van.dijk@umcg.nl.
authors.forename: T H
authors.initials: TH
authors.lastname: van Dijk
authors.affiliation: Department of Medical Oncology.
authors.forename: K
authors.initials: K
authors.lastname: Tamas
authors.affiliation: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen.
authors.forename: J C
authors.initials: JC
authors.lastname: Beukema
authors.affiliation: Department of Surgery, University Hospital Maastricht.
authors.forename: G L
authors.initials: GL
authors.lastname: Beets
authors.affiliation: Department of Clinical Oncology, Leiden University Medical Center.
authors.forename: A J
authors.initials: AJ
authors.lastname: Gelderblom
authors.affiliation: Department of Hepato-pancreato-biliary Surgery, University of Groningen, University Medical Center Groningen.
authors.forename: K P
authors.initials: KP
authors.lastname: de Jong
authors.affiliation: Department of Pathology, University Medical Center St Radboud, Nijmegen.
authors.forename: I D
authors.initials: ID
authors.lastname: Nagtegaal
authors.affiliation: Department of Surgery, Catharina Hospital, Eindhoven.
authors.forename: H J
authors.initials: HJ
authors.lastname: Rutten
authors.affiliation: Department of Surgery, Leiden University Medical Center, The Netherlands.
authors.forename: C J
authors.initials: CJ
authors.lastname: van de Velde
authors.affiliation: Department of Surgery.
authors.forename: T
authors.initials: T
authors.lastname: Wiggers
authors.affiliation: Department of Medical Oncology.
authors.forename: G A
authors.initials: GA
authors.lastname: Hospers
authors.affiliation: Department of Surgery.
authors.forename: K
authors.initials: K
authors.lastname: Havenga
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000068258:Bevacizumab; D000069287:Capecitabine; D017024:Chemotherapy, Adjuvant; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D019583:Dose Fractionation, Radiation; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012007:Rectum / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000068258:Bevacizumab; D000069287:Capecitabine; D005472:Fluorouracil
keywords: bevacizumab; neoadjuvant chemotherapy; preoperative radiotherapy; rectal cancer; stage IV