Machiels J-P, Duck L, Honhon B, Coster B, Coche J-C, Scalliet P, Humblet Y, Aydin S, Kerger J, Remouchamps V, Canon J-L, Van Maele P, Gilbeau L, Laurent S, Kirkove C, Octave-Prignot M, Baurain J-F, Kartheuser A, Sempoux C
Clinique des Pathologies Tumorales du Colon et du Rectum, Centre du Cancer, Université Catholique de Louvain, Brussels, Belgium.
Ann Oncol. 2005 Dec;16(12):1898-905. doi: 10.1093/annonc/mdi406. Epub 2005 Oct 11.
Preoperative radiotherapy has been shown to decrease the local recurrence rate of patients with locally advanced rectal cancer. Capecitabine and oxaliplatin are both active anticancer agents in the treatment of patients with advanced colorectal cancer and have radiosensitizing properties. Therefore, these drugs would be expected to improve effectiveness of preoperative radiotherapy in terms of local control and prevention of distant metastases.
Forty patients with rectal cancer (T3-T4 and/or N+) received radiotherapy (1.8 Gy, 5 days a week over 5 weeks, total dose 45 Gy, 3D conformational technique) in combination with intravenous oxaliplatin 50 mg/m2 once weekly for 5 weeks and oral capecitabine 825 mg/m2 twice daily on each day of radiation. Surgery was performed 6-8 weeks after completion of radiotherapy. The main end points were safety and efficacy as assessed by the pathological complete response (pCR).
The most frequent grade 3/4 adverse event was diarrhea, occurring in 30% of patients. pCR was found in five (14%) patients. According to Dworak's classification, good regression was found in six (18%) additional patients.
Combination of preoperative radiotherapy with capecitabine and oxaliplatin is feasible for downstaging rectal cancer.
术前放疗已被证明可降低局部晚期直肠癌患者的局部复发率。卡培他滨和奥沙利铂在晚期结直肠癌患者的治疗中均为有效的抗癌药物，且具有放射增敏特性。因此，预期这些药物在局部控制和预防远处转移方面可提高术前放疗的疗效。
40例直肠癌患者（T3 - T4和/或N +）接受放疗（1.8 Gy，每周5天，共5周，总剂量45 Gy，三维适形技术），同时静脉注射奥沙利铂50 mg/m²，每周1次，共5周，放疗期间口服卡培他滨825 mg/m²，每日2次。放疗结束后6 - 8周进行手术。主要终点为通过病理完全缓解（pCR）评估的安全性和疗效。
最常见的3/4级不良事件为腹泻，30%的患者出现该症状。5例（14%）患者达到pCR。根据德沃拉克分类法，另外6例（18%）患者出现良好消退。
术前放疗联合卡培他滨和奥沙利铂对直肠癌降期是可行的。
