Wolfgang Eisterer1, Gudrun Piringer2, Alexander DE Vries3, Dietmar Öfner4, Richard Greil5, Jörg Tschmelitsch6, Hellmut Samonigg7, Lidija Sölkner8, Michael Gnant9, Josef Thaler10. 1. Department of Internal Medicine, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria. 2. Department of Internal Medicine IV, Wels-Grieskirchen Medical Hospital, Wels, Austria gudrun.piringer@hotmail.com. 3. Department of Radiotherapy and Radio-Oncology, Feldkirch Hospital, Feldkirch, Austria. 4. Department of Visceral-, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Innsbruck, Austria. 5. Department of Internal Medicine III, Paracelsus Medical University, Salzburg, Austria. 6. Department of Surgery, St. Veit Hospital, Sankt Veit an der Glan, Austria. 7. Department of Internal Medicine, Medical University, Graz, Austria. 8. Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria. 9. Department of Surgery and Comprehensive Cancer Center, Medical University, Vienna, Austria. 10. Department of Internal Medicine IV, Wels-Grieskirchen Medical Hospital, Wels, Austria.
Abstract
AIM: To evaluate feasibility and safety of neoadjuvant chemotherapy with capecitabine, oxaliplatin and bevacizumab followed by concomitant standard chemoradiation and surgical resection in patients with high-risk locally advanced rectal cancer. PATIENTS AND METHODS: Magnetic resonance imaging (MRI)-defined high-risk cT3/4 rectal cancer patients were treated with 3 cycles of neoadjuvant chemotherapy with capecitabine (1,000 mg/m2 twice daily days 1-14, 22-35, 43-56), oxaliplatin (130 mg/sqm on days 1, 22, 43) and bevacizumab (7.5 mg/kg on days 1, 22, 43) followed by capecitabine (825 mg/m2 twice daily on radiotherapy days week 1-4) concomitantly with radiotherapy (1.8 Gy daily up to 45 Gy in 5 weeks) and surgical resection by total mesorectal excision. Feasibility, safety, response rate and postoperative morbidity were evaluated. RESULTS: Twenty-five patients were recruited. Median age was 62 years (range=24-78 years) and all patients had Eastern Cooperation Oncology Group (ECOG) performance status 0. From all patients, 79.2% finished neoadjuvant chemotherapy. Twenty patients underwent surgery. Pathologic complete remission rate, R0 resection and T-downstaging were achieved in 25%, 95% and 54.2% of the "intention to treat" (ITT) patients. The most common grade 3 adverse events (AEs) during neoadjuvant chemotherapy were diarrhea (16.6%) and mucositis (12.5%). In one patient, a grade 4 acute renal failure occurred (4.2%). During chemoradiation, skin reactions (5.3%) were the most common grade 3 AEs. Two major perioperative complications required re-intervention. CONCLUSION: Neoadjuvant chemotherapy with bevacizumab, capecitabine and oxaliplatin followed by concomitant standard chemoradiation is feasible in patients with high-risk locally advanced rectal cancer (LARC) and resulted in complete pathologic remission (pCR) rate of 25% and neoadjuvant chemotherapy completion rate of 80%. Copyright
AIM: To evaluate feasibility and safety of neoadjuvant chemotherapy with capecitabine, oxaliplatin and bevacizumab followed by concomitant standard chemoradiation and surgical resection in patients with high-risk locally advanced rectal cancer. PATIENTS AND METHODS: Magnetic resonance imaging (MRI)-defined high-risk cT3/4 rectal cancerpatients were treated with 3 cycles of neoadjuvant chemotherapy with capecitabine (1,000 mg/m2 twice daily days 1-14, 22-35, 43-56), oxaliplatin (130 mg/sqm on days 1, 22, 43) and bevacizumab (7.5 mg/kg on days 1, 22, 43) followed by capecitabine (825 mg/m2 twice daily on radiotherapy days week 1-4) concomitantly with radiotherapy (1.8 Gy daily up to 45 Gy in 5 weeks) and surgical resection by total mesorectal excision. Feasibility, safety, response rate and postoperative morbidity were evaluated. RESULTS: Twenty-five patients were recruited. Median age was 62 years (range=24-78 years) and all patients had Eastern Cooperation Oncology Group (ECOG) performance status 0. From all patients, 79.2% finished neoadjuvant chemotherapy. Twenty patients underwent surgery. Pathologic complete remission rate, R0 resection and T-downstaging were achieved in 25%, 95% and 54.2% of the "intention to treat" (ITT) patients. The most common grade 3 adverse events (AEs) during neoadjuvant chemotherapy were diarrhea (16.6%) and mucositis (12.5%). In one patient, a grade 4 acute renal failure occurred (4.2%). During chemoradiation, skin reactions (5.3%) were the most common grade 3 AEs. Two major perioperative complications required re-intervention. CONCLUSION: Neoadjuvant chemotherapy with bevacizumab, capecitabine and oxaliplatin followed by concomitant standard chemoradiation is feasible in patients with high-risk locally advanced rectal cancer (LARC) and resulted in complete pathologic remission (pCR) rate of 25% and neoadjuvant chemotherapy completion rate of 80%. Copyright
Authors: Hamid Nasrolahi; Sepideh Mirzaei; Mohammad Mohammadianpanah; Ali Mohammad Bananzadeh; Maral Mokhtari; Mohammad Reza Sasani; Ahmad Mosalaei; Shapour Omidvari; Mansour Ansari; Niloofar Ahmadloo; Seyed Hasan Hamedi; Nezhat Khanjani Journal: Ann Coloproctol Date: 2019-10-31