Lawson Joshua D, Kauh John, Koshy Mary, Staley Charles, Landry Jerome
Department of Radiation Oncology, Emory University, Atlanta, GA 30322, USA.
Clin Colorectal Cancer. 2008 Sep;7(5):325-30. doi: 10.3816/CCC.2008.n.043.
Preoperative chemoradiation with 5-fluorouracil (5-FU) has improved local control and resectability in patients with locally advanced rectal adenocarcinoma. The possible benefit of adding oxaliplatin is being investigated. We present background on the use of oxaliplatin as well as institutional experience assessing treatment tolerability and early outcome data.
From August 2001 to August 2006, 15 patients were treated with concurrent 5-FU, oxaliplatin, and radiation. Each had locally advanced rectal carcinoma with staging as follows: T3 (10 patients), T4 (5 patients), N1 (3 patients), and M1 (1 patient). Three patients were treated for local recurrence; 2 had received previous radiation therapy. All patients received continuous-infusion 5-FU at 225 mg/m2 per day. The oxaliplatin dose was 70 mg/m2 in 1 patient and 85 mg/m2 in the others, administered every other week x 3 weeks starting on day 1 of radiation. Resection followed completion of radiation by 6 weeks.
The treatment was tolerable, with the most frequent hematologic toxicity being grade 1/2 anemia. Twelve patients were evaluable, with 11 treated preoperatively. All were able to undergo resection with negative margins, with T stage at resection as follows: T4 (2 patients, 1 with 5% viable tumor), T3 (4 patients), T2 (1 patient), T1 (2 patients); there were pathologic complete responses in 4 patients. At resection, 2 patients had N2 disease; 1 of these was also found to have a peritoneal metastasis. Two patients with clinical N1 disease initially were N0 at resection. With median follow-up of 13 months (range, 4-36 months), 9 patients have clinically no evidence of disease. There have been no local recurrences and 1 death from disease.
We present tolerability and early clinical efficacy data for patients treated with concurrent 5-FU and oxaliplatin chemoradiation. The oxaliplatin-based regimen was tolerable. All patients were able to undergo resection with negative margins, with encouraging downstaging, local control, and survival.
术前使用5-氟尿嘧啶（5-FU）进行放化疗可提高局部晚期直肠腺癌患者的局部控制率和可切除性。目前正在研究添加奥沙利铂的潜在益处。我们介绍了奥沙利铂的使用背景以及评估治疗耐受性和早期结果数据的机构经验。
2001年8月至2006年8月，15例患者接受了5-FU、奥沙利铂同步放化疗。所有患者均为局部晚期直肠癌，分期如下：T3期（10例）、T4期（5例）、N1期（3例）、M1期（1例）。3例患者接受局部复发治疗；2例曾接受过放疗。所有患者均接受持续静脉输注5-FU，剂量为225mg/m²/天。1例患者奥沙利铂剂量为70mg/m²，其他患者为85mg/m²，从放疗第1天开始，每2周1次，共3周。放疗结束6周后进行手术切除。
治疗耐受性良好，最常见的血液学毒性为1/2级贫血。12例患者可评估，11例接受术前治疗。所有患者均能进行切缘阴性的切除手术，切除时的T分期如下：T4期（2例，1例有5%存活肿瘤）、T3期（4例）、T2期（1例）、T1期（2例）；4例患者达到病理完全缓解。切除时，2例患者为N2期疾病；其中1例还发现有腹膜转移。2例临床N1期疾病患者切除时为N0期。中位随访13个月（范围4-36个月），9例患者临床上无疾病证据。无局部复发，1例死于疾病。
我们提供了接受5-FU和奥沙利铂同步放化疗患者的耐受性和早期临床疗效数据。基于奥沙利铂的方案耐受性良好。所有患者均能进行切缘阴性的切除手术，分期降低、局部控制和生存情况令人鼓舞。
