Preoperative concomitant radiotherapy with oral capecitabine in advanced rectal cancer within 6 cm from anal verge.

AIM

This study aimed to evaluate the role preoperative chemo-radiotherapy with oral capacitabine for advanced low rectal cancer within 6 cm of anal verge.

PATIENTS AND METHODS

Twenty-six patients with rectal adenocarcinoma were treated with preoperative radiotherapy, and oral capecitabine administrated at 5 days/week. Conventional abdominoperineal resection (APR) was done in 12 patients, and sphincter-saving resection (SSR) in 14 patients, the mean follow-up was 26.92+/-6.69 months.

RESULTS

Oral capecitabine was well tolerated in all patients; grade 3 toxicity was seen in only one patient (3.85%) in the form of febrile neutropenia, and diarrhea. Clinical response observed in 17 patients (65.38%). There were no intra or postoperative deaths. Pathological down-staging was seen in 16 patients (61.53%) and pathological complete response in three patients (11.54%). There were two disease-linked deaths, one controlled regional recurrence, two evolutive patients (pulmonary metastases), and 22 disease-free patients.

CONCLUSION

Preoperative chemo-radiotherapy with oral capecitabine induced significant down-staging. Combining such a regimen with intersphincteric resection led to the achievement of distal and radial negative margins, allowing a low local recurrence rate.