This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Chau, I. Articles by Oates, J. Search for Related Content PubMed PubMed Citation Articles by Chau, I. Articles by Oates, J. Social Bookmarking                            What's this?

Neoadjuvant Capecitabine and Oxaliplatin Followed by Synchronous Chemoradiation and Total Mesorectal Excision in Magnetic Resonance Imaging–Defined Poor-Risk Rectal Cancer

From the Departments of Medicine, Diagnostic Imaging, Radiotherapy, Histopathology, and Computing and Information, Royal Marsden Hospital, London and Surrey, United Kingdom.

Address reprint requests to David Cunningham, MD, Department of Medicine, Royal Marsden Hospital, Downs Rd, Sutton, Surrey, United Kingdom SM2 5PT; e-mail: david.cunningham{at}icr.ac.uk

PURPOSE: To evaluate neoadjuvant capecitabine/oxaliplatin before chemoradiotherapy (CRT) and total mesorectal excision (TME) in newly diagnosed patients with magnetic resonance imaging (MRI) –defined poor-risk rectal cancer.

PATIENTS AND METHODS: MRI criteria for poor-risk rectal cancer were tumors within 1 mm of mesorectal fascia (ie, circumferential resection margin threatened), T3 tumors at or below levators, tumors extending 5 mm into perirectal fat, T4 tumors, and T1-4N2 tumors. Patients received 12 weeks of neoadjuvant capecitabine/oxaliplatin followed by concomitant capecitabine and radiotherapy. TME was planned 6 weeks after CRT. Postoperatively, patients received another 12 weeks of capecitabine.

RESULTS: Between November 2001 and August 2004, 77 eligible patients were recruited. After neoadjuvant capecitabine/oxaliplatin, the radiologic response rate was 88%. In addition, 86% of patients had symptomatic responses in a median of 32 days (ie, just over one cycle of capecitabine/oxaliplatin). After CRT, the tumor response rate was increased to 97%. Three patients remained inoperable. Sixty-seven patients proceeded to TME, and all but one patient had R0 resection. Pathologic complete response was observed in 16 patients (24%; 95% CI, 14% to 36%), and in an additional 32 patients (48%), only microscopic tumor foci were found on surgical specimens. Four deaths occurred during neoadjuvant capecitabine/oxaliplatin therapy as a result of pulmonary embolism, ischemic heart disease, sudden death with history of chest pain, and neutropenic colitis.

CONCLUSION: Capecitabine/oxaliplatin before synchronous CRT and TME results in substantial tumor regression, rapid symptomatic response, and achievement of R0 resection.

Supported by an education grant from Sanofi-Aventis.

Presented in part at the 39th Annual Meeting of the American Society of Clinical Oncology, Chicago, IL, May 31-June 3, 2003; and the 2nd Annual Gastrointestinal Cancers Symposium, Miami, FL, January 27-29, 2005.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				C. Fernandez-Martos, C. Pericay, J. Aparicio, A. Salud, M. Safont, B. Massuti, R. Vera, P. Escudero, J. Maurel, E. Marcuello, et al. Phase II, Randomized Study of Concomitant Chemoradiotherapy Followed by Surgery and Adjuvant Capecitabine Plus Oxaliplatin (CAPOX) Compared With Induction CAPOX Followed by Concomitant Chemoradiotherapy and Surgery in Magnetic Resonance Imaging-Defined, Locally Advanced Rectal Cancer: Grupo Cancer de Recto 3 Study J. Clin. Oncol., February 10, 2010; 28(5): 859 - 865. [Abstract] [Full Text] [PDF]

				N. Damjanov, J. Weiss, and D. G. Haller Resection of the Primary Colorectal Cancer Is Not Necessary in Nonobstructed Patients with Metastatic Disease Oncologist, October 1, 2009; 14(10): 963 - 969. [Abstract] [Full Text] [PDF]

				B D P O'NEILL, G SALERNO, K THOMAS, D M TAIT, and G BROWN MR vs CT imaging: low rectal cancer tumour delineation for three-dimensional conformal radiotherapy Br. J. Radiol., June 1, 2009; 82(978): 509 - 513. [Abstract] [Full Text] [PDF]

				F. G. M. Taylor, R. I. Swift, L. Blomqvist, and G. Brown A Systematic Approach to the Interpretation of Preoperative Staging MRI for Rectal Cancer Am. J. Roentgenol., December 1, 2008; 191(6): 1827 - 1835. [Abstract] [Full Text] [PDF]

				M. Braendengen, K. M. Tveit, A. Berglund, E. Birkemeyer, G. Frykholm, L. Pahlman, J. N. Wiig, P. Bystrom, K. Bujko, and B. Glimelius Randomized Phase III Study Comparing Preoperative Radiotherapy With Chemoradiotherapy in Nonresectable Rectal Cancer J. Clin. Oncol., August 1, 2008; 26(22): 3687 - 3694. [Abstract] [Full Text] [PDF]

				S. H. Lee, K. C. Lee, J. H. Choi, J. H. Oh, J.-H. Baek, S. H. Park, and D. B. Shin Chemoradiotherapy Followed by Surgery in Rectal Cancer: Improved Local Control Using a Moderately High Pelvic Radiation Dose Jpn. J. Clin. Oncol., February 8, 2008; (2008) hym164v1. [Abstract] [Full Text] [PDF]

				R. Glynne-Jones and M. Harrison Locally Advanced Rectal Cancer: What Is the Evidence for Induction Chemoradiation? Oncologist, November 1, 2007; 12(11): 1309 - 1318. [Abstract] [Full Text] [PDF]

				I Craven, J Haselden, K E Miller, G V Miller, I Bradford, and D Sebag-Montefiore Omission of concurrent chemoradiation after a response to neoadjuvant chemotherapy in locally advanced rectal cancer with a synchronous liver metastasis: a note of caution Br. J. Radiol., October 1, 2007; 80(958): e257 - e259. [Abstract] [Full Text] [PDF]

				P Sanghera, K Ho, T Muscroft, and A Hartley Neoadjuvant chemotherapy enables R0 resection of locally advanced rectal cancer in a patient with a previously irradiated pelvis Br. J. Radiol., August 1, 2007; 80(956): e170 - e172. [Abstract] [Full Text] [PDF]

				M. Bellomi, G. Petralia, A. Sonzogni, M. G. Zampino, and A. Rocca CT Perfusion for the Monitoring of Neoadjuvant Chemotherapy and Radiation Therapy in Rectal Carcinoma: Initial Experience Radiology, August 1, 2007; 244(2): 486 - 493. [Abstract] [Full Text] [PDF]

				C. Rodel, T. Liersch, R. M. Hermann, D. Arnold, T. Reese, M. Hipp, A. Furst, N. Schwella, M. Bieker, G. Hellmich, et al. Multicenter Phase II Trial of Chemoradiation With Oxaliplatin for Rectal Cancer J. Clin. Oncol., January 1, 2007; 25(1): 110 - 117. [Abstract] [Full Text] [PDF]

				R J Heald, B. D P O'Neill, B. Moran, G. Brown, A. W Darzi, A. C Wotherspoon, D. Cunningham, and D. M Tait MRI in predicting curative resection of rectal cancer: new dilemma in multidisciplinary team management. BMJ, October 14, 2006; 333(7572): 808 - 808. [Full Text]

				R. Glynne-Jones and D. Sebag-Montefiore Role of Neoadjuvant Chemotherapy in Rectal Cancer: Interpretation of the EXPERT Study J. Clin. Oncol., October 1, 2006; 24(28): 4664 - 4665. [Full Text] [PDF]

				I. Chau, D. Cunningham, D. Tait, and G. Brown In Reply J. Clin. Oncol., October 1, 2006; 24(28): 4665 - 4666. [Full Text] [PDF]

				J.-F. Bosset, L. Collette, G. Calais, L. Mineur, P. Maingon, L. Radosevic-Jelic, A. Daban, E. Bardet, A. Beny, J.-C. Ollier, et al. Chemotherapy with Preoperative Radiotherapy in Rectal Cancer N. Engl. J. Med., September 14, 2006; 355(11): 1114 - 1123. [Abstract] [Full Text] [PDF]

				F. A. Calvo, F. J. Serrano, J. A. Diaz-Gonzalez, M. Gomez-Espi, E. Lozano, R. Garcia, D. de la Mata, J. A. Arranz, P. Garcia-Alfonso, G. Perez-Manga, et al. Improved incidence of pT0 downstaged surgical specimens in locally advanced rectal cancer (LARC) treated with induction oxaliplatin plus 5-fluorouracil and preoperative chemoradiation Ann. Onc., July 1, 2006; 17(7): 1103 - 1110. [Abstract] [Full Text] [PDF]