International Journal of Radiation Oncology*Biology*Physics
Poster Viewing AbstractEarly Results of Neoadjuvant Hyperfractionated Accelerated Radiotherapy (HART) with Concurrent and Postoperative Chemotherapy for Locally Advanced Rectal Cancer
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Purpose/Objective(s)
Neoadjuvant chemoradiotherapy is increasingly used in the management of locally advanced rectal cancer. The purpose of this study is to evaluate the feasibility and toxicity of a regimen comprising HART (1.5 Gy b.i.d.) with concomitant continuous infusion (CI) 5-fluorouracil (5-FU), delayed surgery (4-8 weeks after RT), and adjuvant 5-FU plus folinic acid (FA) for locally advanced rectal cancer.
Materials/Methods
Between October 2007 and March 2009, thirty eligible patients (19 male, 11 female) aged 30-70 (median 53) with cT3-4 or node positive rectum adenocarcinoma were entered into the study. The clinical stages were determined by colonoscopy, positron emission tomography-CT and pelvic diffusion-weighted magnetic resonance. Following HART (42 Gy/1.5 Gy/18 days) with concurrent CI 5-FU (325 mg/m2/day), patients were referred to surgery with total mesorectal excision within 4 to 8 weeks. After the
Results
Of thirty eligible entered into the study, all have completed HART without any interruption. Five patients did not receive CI 5-FU for one week. One patient was not referred to surgery due to early distant omental metastasis. Grade 3-4 toxicity included 2 patients with leucopenia, and 6 patients with abdominal cramp and tenesmus. Sixteen patients received postoperative 4 cycles 5FU-FA. One patient died due to sepsis during the postoperative adjuvant chemotherapy period. Two out of 16 patients
Conclusions
The HART regimen with concurrent CI 5-FU, delayed surgery, and adjuvant 5-FU-FA has been well tolerated. It may improve both local control and complete pathologic response rates. Comparative studies are required to determine whether this regimen offers any survival advantage over conventionally fractionated neoadjuvant treatments. Longer follow-up period is needed in order to assess any late side effects.
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Author Disclosure: Z. Almac, None; M. Fayda, None; O. Asoglu, None; S. Saglam, None; S. Yucel, None; H. Acun, None; E. Saglam, None; A. Kizir, None; H. Camlıca, None; E.N. Oral, None.