Departments of Oncology.
Departments of Oncology.
Ann Oncol. 2012 Oct;23(10):2627-2633. doi: 10.1093/annonc/mds056. Epub 2012 Apr 2.
Preoperative chemoradiation in patients with locally advanced rectal cancer has no impact on overall survival (OS) and distant recurrences. The aim of the study was to evaluate local downstaging, toxicity and long-term outcome in patients with locally advanced rectal cancer after induction therapy with capecitabine and oxaliplatin (CAPEOX) followed by radiotherapy concomitant with capecitabine [chemoradiotherapy (CRT)] before total mesorectal excision (TME).
Patients with T4 tumors, all T3N+ tumors or T3 tumors involving or with a distance ≤1 mm to the mesorectal fascia were included. Patients were planned for two cycles of CAPEOX followed by radiotherapy concomitant with capecitabine. TME was carried out 6 weeks after the completion of CRT.
Of 84 consecutively admitted patients starting induction CAPEOX, 77 patients underwent surgery. R0 resection was seen in 94% and T downstaging in 69%. In the intention-to-treat group, pathological complete response was seen in 23%. Five-year disease-free survival (DFS) and OS were 63% [95% confidence interval (CI), 52.2% to 73.7%] and 67% (95% CI, 56.1% to 77.3%), respectively. Grade 3/4 toxicity was seen in 18%, and four deaths occurred within 2 months of therapy.
Induction chemotherapy before CRT and surgery showed a high local control rate and promising long-term outcome as OS and DFS.
局部晚期直肠癌患者的术前放化疗对总生存期（OS）和远处复发没有影响。本研究旨在评估卡培他滨和奥沙利铂（CAPEOX）诱导化疗后行放疗联合卡培他滨（放化疗），然后行全直肠系膜切除术（TME）治疗局部晚期直肠癌患者的局部降期、毒性和长期结果。
纳入 T4 肿瘤、所有 T3N+肿瘤或 T3 肿瘤累及或距离直肠系膜筋膜≤1mm 的患者。患者计划接受 2 周期 CAPEOX 诱导化疗，然后行放疗联合卡培他滨。放化疗结束后 6 周行 TME。
84 例连续入组接受诱导 CAPEOX 的患者中，77 例行手术治疗。R0 切除率为 94%，T 降期率为 69%。在意向治疗组中，病理完全缓解率为 23%。5 年无病生存率（DFS）和总生存率（OS）分别为 63%（95%CI，52.2%至 73.7%）和 67%（95%CI，56.1%至 77.3%）。3/4 级毒性发生率为 18%，4 例患者在治疗后 2 个月内死亡。
放化疗前的诱导化疗和手术显示出较高的局部控制率和有希望的长期结果，包括 OS 和 DFS。
