Patients with locally advanced rectal cancer on neoadjuvant treatment with chemo‐radiotherapy in the Instituto Nacional de Cancerología during 2010
Keywords:
Rectal neoplasms, Drug Therapy, Radiotherapy, Combined Modality Therapy, FluorouracilAbstract
Objectives: To describe the sociodemographic and clinical characteristics of a group of patients with locally advanced rectal cancer treated with neoadjuvant chemo‐radiotherapy, and to make a situational diagnosis of the management.
Methods: A case series study was conducted using the clinical information of 41 patients treated in the Instituto Nacional de Cancerología during the year 2010.
Results: The mean age of the patients studied was 61 years, and 60% were male. The Karnofsky functional state was equal or greater than 70%. The neoadjuvant scheme most used was 5‐fluorouracil and leucovorin in boluses, concomitant with radiotherapy. Of the 41 patients, 30 completed the treatment with good tolerance; 21 required surgery, with preservation of the sphincter in 10 of them; 18 achieved a pathological response; 14, partial and 4, complete.
Conclusion: The patients with locally advanced rectal cancer who received neoadjuvant treatment with chemo‐radiotherapy in the Instituto Nacional de Cancerología during the year 2010 were, mainly males with a good functional state. The principal chemotherapy scheme employed was 5‐fluorouracil and leucovorin in boluses, due to which resectability of the tumour, preservation of the sphincter, and a pathological response in approximately half of the patients, was achieved.
Author Biographies
Giovanna Rivas, Instituto Nacional de Cancerología
Grupo de Oncología Clínica, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia
Universidad El Bosque, Bogotá, D. C., Colombia
Fabio Olivella, Instituto Nacional de Cancerología
Grupo de Oncología Clínica, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia
Universidad El Bosque, Bogotá, D. C., Colombia
José Carreño, Instituto Nacional de Cancerología
Grupo de Investigación Clínica Instituto Nacional de Cancerología, Bogotá, D. C., Colombia
Viviana Rodríguez, Universidad El Bosque
Grupo de Epidemiología Clínica, Universidad El Bosque, Bogotá, D. C., Colombia
References
Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. GLOBOCAN 2008 v 2.0. Cancer Incidence and Mortality World‐ wide: IARC CancerBase No. 10 [Internet]. Lyon, France: International Agency for Research on Cancer; 2010. [acceso 23 Oct 2012]. Disponible en: http://globocan.iarc.fr
Registro Poblacional de Cali. Facultad de Salud. Universidad del Valle. Disponible en: rpcc.univalle.edu.co
"Anuario Estadístico 2010", República de Colombia. Ministerio de la Protección Social. Instituto Nacional de Cancerología.
Hong TS, Kachnic LA. Preoperative Chemoradiotherapy in the Management of localized Rectal Cancer: The new Standard. Gastrointest Cancer Res. 2007;1:49‐56.
Glimelius B, Holm T, Blomqvist L. Chemotherapy in Addition to Preoperative Radiotherapy in Locally Advanced Rectal Cancer - A Systematic Overview. Reviews on Recent Clinical Trials. 2008;3:204-11.
https://doi.org/10.2174/157488708785700294
Mandard AM, Dalibard F, Mandard A, Marnay J, Henry‐Amar M, Petiot JF, et al. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Cancer. 1994;73:2680‐6.
https://doi.org/10.1002/1097-0142(19940601)73:11<2680::AID-CNCR2820731105>3.0.CO;2-C
Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med. 1997;336:980‐7.
https://doi.org/10.1056/NEJM199704033361402
Bosset JF, Collette L, Calais G, Mineur L, Maingon Ph, Radosevic‐Jelic L, et al. Chemotherapy with Preoperative Radiotherapy in Rectal Cancer. N Engl J Med. 2006;355:1114‐23.
https://doi.org/10.1056/NEJMoa060829
Gérard JP, Conroy T, Bonnetain F, Bouché O, Chapet O, Closon‐Dejardin MT, et al. Preoperative Radiotherapy With or Without Concurrent Fluorouracil and Leucovorin in T3‐4 Rectal Cancers: Results of FFCD 9203. J Clin Oncol. 2006;24:4620‐5.
https://doi.org/10.1200/JCO.2006.06.7629
Rouanet P, Rivoire M, Lelong B, Rullier E, Dravet F, Mineur L, et al. Sphincter preserving surgery after preoperative treatment for ultra-low rectal carcinoma. a French multicenter prospective trial: GRECCAR 1.
Bujko K, Nowacki MP, Nasierowska-Guttmejer A, Michalski W, Bebenek M, Kryj M, for the Polish Colorectal Study group. Long-term results of a randomized trial comparing preoperative short‐course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg. 2006;93:1215‐23.
https://doi.org/10.1002/bjs.5506
Ceelen WP, Van Nieuwenhove Y, Fierens K. Preoperative chemoradiation versus radiation alone for stage ii and iii resectable rectal cancer. Cochrane Database of Systematic Reviews 2009, issue 1. art. no.: CD006041.
https://doi.org/10.1002/14651858.CD006041.pub2
Roh M, Colangelo L, O'Connell M, Yothers G, Deutsch M, Allegra C, et al. Preoperative Multimodality Therapy Improves Disease‐Free Survival in Patients With Carcinoma of the Rectum: NSABP R‐03. J Clin Oncol. 2009;27:5124‐30.
https://doi.org/10.1200/JCO.2009.22.0467
Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731‐40.
https://doi.org/10.1056/NEJMoa040694
Glynne‐Jones R, Dunst J, Sebag‐Montefiore D. The integration of oral capecitabine into chemoradiation regimens for locally advanced rectal cancer: how successful have we been? ann Oncol. 2006;17:361‐71.
https://doi.org/10.1093/annonc/mdj052
Hofheinz RD, Wenz F, Post S, Matzdorff A, Laechelt S, Hartmann JT, et al. Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised, multicentre, non‐inferiority, phase 3 trial. Lancet Oncol. 2012;13:579‐88.
https://doi.org/10.1016/S1470-2045(12)70116-X
Roh MS, Yothers GA, O'Connell MJ, Beart RW, Pitot HC, Shields AF, et al. The impact of capecitabine and oxaliplatin in the preoperative multimodality treatment in patients with carcinoma of the rectum: NSABP R‐04. J Clin Oncol. 2011;29 Suppl:abstr 3503.
https://doi.org/10.1200/jco.2011.29.15_suppl.3503
National Comprehensive Cancer network Version 3. 2012. Rectal cancer.
Glimelius B, Pahlman L, Cervantes A on behalf of the ESMO Guidelines Working. Group Rectal cancer: ESMO Clinical Practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21 (Suppl 5):v82-6.
https://doi.org/10.1093/annonc/mdq170
Aschele C, Cionini L, Lonardi S, Pinto C, Cordio S, Rosati g, et al. Primary tumor response to preoperative chemoradiation with or without oxaliplatin in locally advanced rectal cancer: pathologic results of the STAR‐01 randomized phase III trial. J Clin Oncol. 2011;29:2773‐80.
Gérard JP, Azria D, Gourgou‐Bourgade S, Martel‐Laffay I, Hennequin C, Etienne PL. Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer: results of the phase iii trial aCCORD 12/0405-Prodige 2. J Clin Oncol. 2010;28:1638‐44.
https://doi.org/10.1200/JCO.2009.25.8376
Garajová I, Di Girolamo S, de Rosa F, Corbelli J, Agostini V, Biasco g, et al. Neoadjuvant treatment in rectal cancer: actual status Chemother Res Pract. 2011;2011:839742.
https://doi.org/10.1155/2011/839742
Castaño R, Puerta J, Restrepo J, Ruiz M, Salazar R, Suárez D, et al. Estudio multicéntrico de quimiorradioterapia pre y postoperatoria en estados II y III de cáncer de recto. Rev Col gastroenterol. 2005;20:25-34.
Kerr SF, Norton S, Glynne‐Jones R. Delaying surgery after neoadjuvant chemoradiotherapy for rectal cancer may reduce postoperative morbidity without compromising prognosis. Br J Surg. 2008;12:1534-40.
https://doi.org/10.1002/bjs.6377
Tulchinsky H, Shmueli E, Figer A, Klausner JM, Rabau M. An interval >7 weeks between neoadjuvant therapy and surgery improves pathologic complete response and disease-free survival in patients with locally advanced rectal cancer. Ann Surg Oncol. 2008;15:2661‐7.
https://doi.org/10.1245/s10434-008-9892-3
Habr-gama A, Perez RO, Proscurshim I, Nunes Dos Santos RM, Kiss D, Gama‐Rodrigues J, et al. Interval between surgery and neoadjuvant chemoradiation therapy for distal rectal cancer: does delayed surgery have an impact on outcome? Int J Radiat Oncol Biol Phys. 2008;71:1181‐8.
https://doi.org/10.1016/j.ijrobp.2007.11.035
Vecchio FM, Valentini V, Minsky BD, Padula GD, Venkatraman ES, Balducci M, et al. The relationship of pathologic tumor regression grade (TRg) and outcomes after preoperative therapy in rectal cancer. Int J Radiat Oncol Biol Phys. 2005;62: 752‐60.
https://doi.org/10.1016/j.ijrobp.2004.11.017
Rödel C, Martus P, Papadoupolos T, Füzesi L, Klimpfinger M, Fietkau R, et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol. 2005;23:8688-96.
https://doi.org/10.1200/JCO.2005.02.1329
Maas M, Nelemans PJ, Valentini V, Das P, Rödel C, Kuo LJ, et al. long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol. 2010; 11:835-44.
https://doi.org/10.1016/S1470-2045(10)70172-8
Sauer R, Roedel C, Martus P, Fietkau R, Wittekind C for the German Rectal Cancer Study Group. Prognostic factors after neoadjuvant radiochemotherapy for rectal cancer: Update of the CAO/ARO/AIO‐94 Phase III study. J Clin Oncol (Meeting abstracts). 2005;23(16) Suppl 3503.
How to Cite
Downloads
Downloads
Published
Issue
Section
License
Todos los derechos reservados.
