Department of Radiation Oncology, Tom Baker Cancer Centre, Alberta, Canada.
Int J Radiat Oncol Biol Phys. 2010 Apr;76(5):1413-9. doi: 10.1016/j.ijrobp.2009.03.048.
The aim of this retrospective case-matching study was to compare the treatment outcomes and acute toxicity of preoperative radiotherapy (RT) with capecitabine vs. preoperative RT with intermittent 5-fluorouracil (5-FU) infusion, leucovorin, and mitomycin C in rectal cancer.
We matched 34 patients who were treated with preoperative concurrent capecitabine and 50 Gy of RT by their clinical T stage (T3 or T4) and the tumor location (<or=7 cm or >7 cm from the anal verge) with another 68 patients who were treated with preoperative intermittent 5-FU infusion, leucovorin, mitomycin C, and 50 Gy of RT for a comparison of the pathologic tumor response, local control, distant failure, and survival rates.
The pathologic complete response rate was 21% with capecitabine and 18% with 5-FU and leucovorin (p = 0.72). The rate of T downstaging after chemoradiation was 59% for both groups. The rate of sphincter-sparing resection was 38% after capecitabine plus RT and 43% after 5-FU plus RT (p = 0.67). At 3 years, there was no significant difference in the local control rate (93% for capecitabine and 92% for 5-FU and leucovorin), relapse-free rate (74% for capecitabine and 73% for 5-FU and leucovorin), or disease-specific survival rate (86% for capecitabine and 77% for 5-FU and leucovorin). The acute toxicity profile was comparable, with little Grade 3 and 4 toxicity.
When administered with concurrent preoperative RT, both capecitabine and intermittent 5-FU infusion with leucovorin modulation provided comparable pathologic tumor response, local control, relapse-free survival, and disease-specific survival rates in rectal cancer.
本回顾性病例对照研究旨在比较术前放化疗联合卡培他滨与术前放化疗联合 5-氟尿嘧啶（5-FU）、亚叶酸钙、丝裂霉素 C 间歇性输注治疗直肠癌的治疗效果和急性毒性。
我们根据临床 T 分期（T3 或 T4）和肿瘤位置（距肛门<7cm 或>7cm），将 34 例接受术前同步卡培他滨和 50Gy 放疗的患者与 68 例接受术前 5-FU 间歇性输注、亚叶酸钙、丝裂霉素 C 和 50Gy 放疗的患者进行匹配，以比较病理肿瘤反应、局部控制率、远处失败率和生存率。
卡培他滨组病理完全缓解率为 21%，5-FU 和亚叶酸钙组为 18%（p=0.72）。两组放化疗后 T 分期降级率为 59%。卡培他滨加放疗组保肛切除率为 38%，5-FU 加放疗组为 43%（p=0.67）。3 年时，局部控制率（卡培他滨组为 93%，5-FU 和亚叶酸钙组为 92%）、无复发生存率（卡培他滨组为 74%，5-FU 和亚叶酸钙组为 73%）和疾病特异性生存率（卡培他滨组为 86%，5-FU 和亚叶酸钙组为 77%）无显著差异。急性毒性谱相似，仅有少量 3 级和 4 级毒性。
在术前同步放化疗中，卡培他滨和 5-FU 联合亚叶酸钙间歇性输注均能提供相似的病理肿瘤反应、局部控制率、无复发生存率和疾病特异性生存率。
