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Preoperative chemoradiotherapy for rectal cancer: a comparison between intravenous 5‐fluorouracil and oral capecitabine
Author(s) -
Ramani V. S.,
Sun Myint A.,
Montazeri A.,
Wong H.
Publication year - 2010
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2010.02323.x
Subject(s) - capecitabine , medicine , colorectal cancer , chemoradiotherapy , brachytherapy , fluorouracil , stage (stratigraphy) , surgery , radiation therapy , cancer , gastroenterology , paleontology , biology
Capecitabine provides an attractive alternative to intravenous (IV) 5‐flourouracil (5‐FU) in chemoradiation regimes for rectal cancer by avoiding the need for intravenous access and inpatient stay. We aimed to compare retrospectively the efficacy of concurrent capecitabine with IV 5‐FU in preoperative pelvic chemoradiation schedules for rectal cancer in our centre. Method Patients treated from January 2005 to June 2007 were included. Information was collected on patient characteristics; treatment details; pathological response to treatment; recurrence and survival. All statistical analyses were performed using SPSS V17. Results All patients had pelvic radiation . Ninety‐nine patients were treated with capecitabine and 97 with 5‐FU. The two groups were well matched for age, sex and TNM stage. There were significantly more PS (performance status) 0 patients in the capecitabine group (51% vs 30%) ( P = 0.001). Of the 99 patients in the capecitabine group, 91 (92%) were able to undergo surgery with 84 (93%) achieving R0 resection. In the 5‐FU group, these proportions were 87 (90%) and 70 (80%). The difference in the rate of R0 resection was statistically significant ( P = 0.024). The APR rate was 35% in the capecitabine group compared with 47% in the 5‐FU group ( P = 0.06). There was no significant difference in pathological complete response (pCR) rates between capecitabine (14%) and 5‐FU(12%). A higher pCR rate (30%) was observed in patients who underwent a brachytherapy boost ( P = 0.051). There were three local recurrences in the whole patient group, (capecitabine 1; 5‐FU 2). Thirty‐five patients had distant metastases, 14 in the capecitabine and 21 in the 5‐FU group. There was no significant difference in the risk of recurrence between the two groups. Six patients in each group had grade 3 toxicity with diarrhoea being more common with capecitabine. Conclusions Preoperative chemoradiotherapy with capecitabine for rectal cancer is efficacious and comparable to 5‐FU (IV). It is more convenient, is well tolerated and avoids the need for inpatient admission.