Preoperative chemoradiation in locally advanced rectal cancer: A comparison of bolus 5-fluorouracil/leucovorin and capecitabine

Yöney, Adnan; Isikli, L

doi:10.4103/1319-3767.129474

Cited by 8 publications

(13 citation statements)

References 23 publications

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“…There was no significant heterogeneity between the studies ( P = .54), and the fixed-effects model was used. The data in all the 10 studies [15,21–29] were available for the analysis of pCR. There were 1408 patients in the capecitabine group and 1382 patients in the 5-FU group in this meta-analysis, and the pCR rates were 19.53% and 15.48%, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…The improvements in magnetic resonance and ultrasound endoscopy allows more accurate preoperative staging can be achieved, [20] and accordingly develop clinical studies with different regimens of neoadjuvant chemoradiotherapy. [15,21–29] Ten studies of 5-FU and capecitabine efficacies of neoadjuvant CRT in LARC were compared in this meta-analysis. All 10 studies have shown that preoperative CRT using capecitabine and 5-fluouracil is feasible and improves the pCR rate.…”

Section: Introductionmentioning

confidence: 99%

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Capecitabine versus 5-fluorouracil in neoadjuvant chemoradiotherapy of locally advanced rectal cancer

et al. 2019

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Background:The differences in efficacy between capecitabine and 5-fuorouracil (5-FU) in neoadjuvant chemoradiotherapy (CRT) of locally advanced rectal cancer (LARC) are not well recognized. We performed this meta-analysis to analyze the effect of capecitabine and 5-FU on neoadjuvant CRT to more accurately understand the differences between the 2 drugs.Methods:MEDLINE, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Database were performed to identify all published studies investigating the efficacy of capecitabine in neoadjuvant CRT of LARC versus 5-FU before August, 2017. Primary endpoint was the odds ratio (OR) for improving pathological complete response (pCR) rate of patients with LARC. Secondary endpoints were the ORs of efficiency for downstaging tumor and increasing R0 resection in patients with LARC. Safety analyses were also performed. The OR was the principal measurement of effect, which was calculated as capecitabine group versus 5-FU group, and was presented as a point estimate with 95% confidence intervals (CIs). All calculations and statistical tests were performed using RevMan 5.3 software.Results:In all, 2916 patients with LARC enrolled in the 10 studies were divided into capecitabine group (n = 1451) and 5-FU group (n = 1465). The meta-analysis showed that capecitabine improved pCR (OR 1.34, 95% CI 1.10–1.63), and R0 resection rate (OR 1.92, 95% CI 1.10–3.36). There were no statistically significant differences either in overall downstaging rate (OR 1.31, 95% CI 0.79–2.16) or in the tumor downstaging rate (OR 1.24, 95% CI 0.79–1.92), but there was a significant difference of the nodal downstaging rate between the 2 groups (OR 1.68, 95% CI 1.11–2.54). There was no statistically significant difference in sphincter preservation rate between the 2 groups (OR 1.36, 95% CI 0.96–1.92). No obvious safety concerns about mortality and complications were raised in these studies. There were no statistically significant differences in 3-year disease-free-survival (OR 1.29, 95% CI 0.75–2.20), and in grade 3 to 4 acute toxicity during CRT (OR 0.63, 95% CI 0.31–1.30).Conclusions:Compared with 5-FU-based neoadjuvant CRT, capecitabine-based neoadjuvant CRT can safely improve pCR, nodal down-staging, ad R0 resection of patients with LARC.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Capecitabine versus 5-fluorouracil in neoadjuvant chemoradiotherapy of locally advanced rectal cancer

et al. 2019

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“…The result could be misinterpreted to mean that capecitabine has weaker systemic effects than 5-FU, which differs from the results of previous studies. In general, capecitabine not only shows better oncologic outcomes than 5-FU at a systemically effective dose as an adjuvant treatment (1,250 mg/m 2 twice daily), but its oncologic superiority continues at a lower dose (825 mg/m 2 twice daily) as a radiosensitizer for CRT [9, 10]. Because the results in our study may have statistical bias due to the small number of patients in the EF group, further study including a larger number of patients is needed.…”

Section: Discussionmentioning

confidence: 99%

Early Systemic Failure After Preoperative Chemoradiotherapy for the Treatment of Patients With Rectal Cancer

et al. 2019

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Purpose Distant metastasis can occur early after neoadjuvant chemoradiotherapy (CRT) in patients with rectal cancer. This study was conducted to evaluate the clinical characteristics of patients who developed early systemic failure. Methods The patients who underwent neoadjuvant CRT for a rectal adenocarcinoma between June 2007 and July 2015 were included in this study. Patients who developed distant metastasis within 6 months after CRT were identified. We compared short- and long-term clinicopathologic outcomes of patients in the early failure (EF) group with those of patients in the control group. Results Of 107 patients who underwent neoadjuvant CRT for rectal cancer, 7 developed early systemic failure. The lung was the most common metastatic site. In the EF group, preoperative carcinoembryonic antigen was higher (5 mg/mL vs. 2 mg/mL, P = 0.010), and capecitabine as a sensitizer of CRT was used more frequently (28.6% vs. 3%, P = 0.002). Of the 7 patients in the EF group, only 4 underwent a primary tumor resection (57.1%), in contrast to the 100% resection rate in the control group (P < 0.001). In terms of pathologic outcomes, ypN and TNM stages were more advanced in the EF group (P < 0.001 and P = 0.047, respectively), and numbers of positive and retrieved lymph nodes were much higher (P < 0.001 and P = 0.027, respectively). Conclusion Although early distant metastasis after CRT for rectal cancer is very rare, patients who developed early metastasis showed a poor nodal response with a low primary tumor resection rate and poor oncologic outcomes.

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“…Treatment choice for CRC varies according to tumor location and stage at diagnosis. [ 20 21 ] Surgery is the most common treatment for early-stage (stage I and II) CRC. For patients with stage III CRC, surgery is frequently followed by short chemotherapy (approximately 6 months) to decrease the risk of recurrence.…”

Section: Discussionmentioning

confidence: 99%

Significance of BMI1 and FSCN1 expression in colorectal cancer

Alajez

2016

Saudi J Gastroenterol

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Background/Aims:Colorectal cancer (CRC) is the third most common type of cancer in terms of incidence and the fourth in cause of death world-wide, underscoring the need to identify novel biomarkers for early diagnosis, as well as improved disease stratification and treatment choices.Patients and Methods:The Gene Expression Omnibus (GSE21510) and the Cancer Genome Atlas (TCGA) CRC datasets were utilized in the current study. GeneSpring 13.0 was used for normalization and analysis. The log-rank test was used to compare the outcome between expression groups.Result:Significant upregulation of BMI1 (2.3 FC, P = 3.7 × 10-18) and FSCN1 (1.3 FC,P = 4.7 × 10-3) was observed in CRC. High BMI1 expression was associated with reduced overall survival (OS) [Hazard ratio (HR), 1.87; 95% CI. 1.17–3.03; P = 0.009] and reduced disease-free survival (DFS) [HR, 162; 95% CI 1.01–2.63;P = 0.045]. Similarly, high expression of FSCN1 was associated with reduced OS (HR, 2.0; 95% CI, 1.24–3.2; P = 0.0044) and reduced DFS (HR, 1.60; 95% CI, 0.99–2.57;P = 0.055). Importantly, BMI1high/FSCN1high patients experienced the worst OS (HR, 3.17; 95% CI, 1.77–6.15; P = 0.0002) and DFS (HR, 2.34; 95% CI, 1.27–4.67,P = 0.0078). Using pathway analyses, tumors overexpressing BMI1 were enriched in zinc finger proteins and genes involved in DNA binding and regulation of transcription, whereas tumors expressing FSCN1 were enriched in genes involved in cell migration.Conclusion:Our data revealed poor OS and DFS in CRC patients overexpressing BMI1 or FSCN1 and suggest that these two markers in combination may represent superior prognostic marker to either one. Targeting BMI1 and FSCN1 may also provide potential therapeutic opportunity in CRC.

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Preoperative chemoradiation in locally advanced rectal cancer: A comparison of bolus 5-fluorouracil/leucovorin and capecitabine

Cited by 8 publications

References 23 publications

Capecitabine versus 5-fluorouracil in neoadjuvant chemoradiotherapy of locally advanced rectal cancer

Capecitabine versus 5-fluorouracil in neoadjuvant chemoradiotherapy of locally advanced rectal cancer

Early Systemic Failure After Preoperative Chemoradiotherapy for the Treatment of Patients With Rectal Cancer

Significance of BMI1 and FSCN1 expression in colorectal cancer

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