Induction Chemotherapy With Capecitabine And Oxaliplatin (CAPOX) Followed By Concomitant Chemoradiotherapy Before Surgical Resection In Patients With Locally Advanced Rectal Cancer

摘要

Background: Concomitant chemoradiotherapy (CRT) followed by total mesorectal excision (TME) is standard treatment for locally advanced rectal cancer. Induction chemotherapy has the advantage of earlier administration of systemic therapy and may improve distant control. Purpose: The purpose of the current study was to assess the efficacy and toxicity of induction chemotherapy (CAPOX) followed by concomitant CRT before surgery in patients with locally advanced rectal cancer. Patients and Methods: A total of 31 patients with locally advanced rectal cancer were randomly assigned to induction CAPOX followed by concomitant capecitabine-RT and surgery, then the patients were received an additional 4 cycles adjuvant capecitabine . The primary end point was assessment of pathological complete response (pCR) and the feasibility of surgical resection with sphincter preservation. Results : All patients underwent surgery with sphincter preservation procedure represented in 64.5% of patients. Complete resection (R0) was recorded in 93.5%, T downstaging in 61.3 % and N downstaging in 51.6%. Pathological complete response was recorded in 19.4 %. Two-year OS and DFS rates were 83 % and 67.4%, respectively. Diarrhea was the most common grade 3/4 toxicity seen during the induction and concomitant CRT phases. Conclusions: Our results demonstrated that, induction CAPOX followed by capecitabine-RT is feasible with tolerable toxicity and results in encouragingly high rates of pCR, R0 resection, sphincter preservation and tumor downstaging in patients with locally advanced rectal cancer. Additional studies of this approach to examine more optimal regimens are warranted.