Capecitabine vs continuous infusion 5-FU in neoadjuvant treatment of rectal cancer. A retrospective review

Saif, Muhammad Wasif; Hashmi, Shahrukh; Zelterman, Daniel; Almhanna, Khaldoun; Kim, Richard

doi:10.1007/s00384-007-0382-z

Cited by 44 publications

(25 citation statements)

References 28 publications

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“…Our results concerning tumor regression with a rate of 14% of complete regression (TRG4) correspond with the literature [16,25]. Additionally, we found a statistically significant correlation between high-grade acute organ toxicity during RCT and complete histopathologic tumor regression.…”

Section: Discussionsupporting

confidence: 79%

High-Grade Acute Organ Toxicity During Preoperative Radiochemotherapy as Positive Predictor for Complete Histopathologic Tumor Regression in Multimodal Treatment of Locally Advanced Rectal Cancer*

et al. 2009

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Section: Discussionsupporting

confidence: 79%

High-Grade Acute Organ Toxicity During Preoperative Radiochemotherapy as Positive Predictor for Complete Histopathologic Tumor Regression in Multimodal Treatment of Locally Advanced Rectal Cancer*

et al. 2009

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“…In this analysis, we demonstrated that various cell types reach nadir at different time points and are influenced by different clinical and dosimetric predictors. To identify the myelosuppressive effect caused predominantly by RT, we investigated patients undergoing neoadjuvant CRT for rectal cancer, as 5-FU-based chemotherapy has been associated with lesser myelosuppressive properties [12–14]. Acute hematologic toxicity associated with pelvic RT with continuous infusion 5-FU for rectal cancer has been reported up to 8% [5,19–22], and pelvic RT with capecitabine was found to cause less HT in a randomized phase III trial comparing oral capecitabine and intravenous 5-FU chemotherapy (2% vs. 8% with Grade 3 neutropenia) [13].…”

Section: Discussionmentioning

confidence: 99%

“…In this study, we assessed HT in locally advanced rectal cancer patients receiving pelvic RT with concurrent FU-based chemotherapy. Given that infusional 5-FU or capecitabine chemotherapy functioned mainly as a radiosensitizer in patients undergoing neoadjuvant CRT for rectal cancer and had been reported to be associated with a low rate of myelosuppression [12,13–16], we felt that analyzing HT in this population would help us determine the myelosuppressive effect predominantly caused by pelvic RT. Our study aimed to establish the impact of standard long-course pelvic RT on BM suppression and to identify clinical and dosimetric predictors of HT.…”

mentioning

confidence: 99%

Clinical and dosimetric predictors of acute hematologic toxicity in rectal cancer patients undergoing chemoradiotherapy

Yang

Apte

et al. 2014

Radiotherapy and Oncology

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Background and purpose To identify clinical and dosimetric factors associated with hematologic toxicity (HT) during chemoradiotherapy for rectal cancer. Materials and methods We analyzed 120 rectal cancer patients treated with neoadjuvant pelvic radiotherapy (PRT) with concurrent 5-fluorouracil-based chemotherapy. The coxal (ilium, ischium, and pubis) bone marrow (BM), sacral BM, and femoral BM were contoured and dose-volume parameters were extracted. Associations between cell count trend and clinical predictors were tested using repeated-measures analysis of variance (ANOVA) test. Associations between clinical variables, Vx (percentage volume receiving x Gy), and cell count ratio at nadir were tested using linear regression models. Results Nadirs for white blood cell count (WBC), absolute neutrophil count (ANC), and platelets (PLT) occurred in the second week of PRT and the fifth week for hemoglobin and absolute lymphocyte count (ALC). Using cell count ratio, patients treated with 3DCRT had a lower WBC ratio trend during PRT compared to patients treated with IMRT (p = 0.04), and patients ≥59 years of age had a lower hemoglobin ratio trend during PRT (p = 0.02). Using absolute cell count, patients treated with 3DCRT had lower ANC cell count trend (p = 0.03), and women had lower hemoglobin cell count trend compared to men (p = 0.03). On univariate analysis, use of 3DCRT was associated with a lower WBC ratio at nadir (p = 0.02). On multiple regression analysis using dosimetric variables, coxal BM V45 (p = 0.03) and sacral BM V45 (p = 0.03) were associated with a lower WBC and ANC ratio at nadir, respectively. Conclusions HT trends during PRT revealed distinct patterns: WBC, ANC, and PLT cell counts reach nadirs early and recover, while hemoglobin and ALC decline steadily. Patients who were treated with 3DCRT and older patients experienced lower cell count ratio trend during PRT. Dosimetric constraints using coxal BM V45 and sacral BM V45 can be considered.

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“…The most common acute responses were diarrhea, perineum skin radioactive reactions and the hematological toxicity. Capecitabine combined radiotherapy has the same security and toxicity response compared with 5-FU, with a relatively higher incidence of the hand-foot-syndrome [27,28] . Our study showed that preoperative chemoradiotherapy did not significantly increase the grade 3-4 toxicity, and most patients could tolerate the treatment, with a similar surgery mortality as most studies reported.…”

Section: Discussionmentioning

confidence: 93%

Neoadjuvant therapy for advanced rectal carcinoma in China: Whether radiochemotherapy is superior to radiotherapy?

Cai

Zhu

et al. 2009

Chin. J. Cancer Res.

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Objective: To verify whether the 30 Gy preoperative radiotherapy regimen is effective to advanced rectal cancer, and whether the preoperative chemoradiation offers an advantage in sphincter preservation and tumor control compared with irradiation alone.Methods: A total of 141 patients administered neoadjuvant treatment with resectable lower rectal carcinoma from 2002 to 2006 were collected retrospectively. The patients were divided into two groups: preoperative radiotherapy alone (30Gy by 10 fractions) (PRT group) and preoperative chemoradiotherapy (PCRT group). All patients underwent radical surgery after neoadjuvant treatment.Results: The overall sphincter-preservation rate was 68.8% (97/141), with no significant difference between the two groups. The overall downstaging rate was 48.2% (68/141), including 4 patients completely response (2.8%). The T and N downstaging rate were 30.5% (43/141) and 53.8% (57/106) respectively, showing no statistically difference between the two groups. The 2-year overall survival rate was 93.6%; no survival benefit were observed in PCRT group. The 2-year cumulative local recurrence rates were similar as well (4.2% vs 6.7%, P=0.63). Two patients with severe marrow suppression higher than grade 3 and 1 patient with severe perineum ulcer was observed in PCRT group, which did not occur in PRT group.Conclusion: The preoperative adjuvant treatment of 30Gy radiotherapy alone may be an optional treatment for Chinese lower rectal carcinoma. Preoperative chemoradiotherapy does not show actual superiority compared with radiotherapy alone.

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Capecitabine vs continuous infusion 5-FU in neoadjuvant treatment of rectal cancer. A retrospective review

Abstract: CAP when compared to CIV seems to have superior efficacy with reasonable toxicities. It is reasonable to treat LARC with CAP + XRT.

Cited by 44 publications

References 28 publications

High-Grade Acute Organ Toxicity During Preoperative Radiochemotherapy as Positive Predictor for Complete Histopathologic Tumor Regression in Multimodal Treatment of Locally Advanced Rectal Cancer*

High-Grade Acute Organ Toxicity During Preoperative Radiochemotherapy as Positive Predictor for Complete Histopathologic Tumor Regression in Multimodal Treatment of Locally Advanced Rectal Cancer*

Clinical and dosimetric predictors of acute hematologic toxicity in rectal cancer patients undergoing chemoradiotherapy

Neoadjuvant therapy for advanced rectal carcinoma in China: Whether radiochemotherapy is superior to radiotherapy?

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