Medical Oncology Department, University Hospital La Fe, C/ Bulevar Sur, s/n, ES-46026 Valencia, Spain.
Clin Transl Oncol. 2012 Jun;14(6):471-80. doi: 10.1007/s12094-012-0826-y.
Neoadjuvant 5-FU-based chemoradiotherapy in resectable rectal cancer (RC) is a standard of treatment. The use of oral fluoropyrimidines and new agents such as oxaliplatin may improve efficacy and tolerance.
Between 1999 and 2009, 126 RC patients with T3-T4 and/or N+ disease were given three successive protocols: UFT (32), UFT-oxaliplatin (75) and capecitabine-oxaliplatin (19), alongside 45 Gy of radiotherapy; with surgery 4-6 weeks after. Adjuvant treatment was given in all patients. The primary objective was pathologic complete response (pCR).
Preoperative therapy was well tolerated, with no toxic deaths and a 15% grade 3-4 toxicity rate. Eighty-five percent of patients received the full chemotherapy dose, 56% had an abdominoperineal resection, 6% reinterventions and 57% received the full adjuvant chemotherapy planned. The pCR rate was 13%. The downstaging rate was 80%; 8% had progression of disease. The relapse rate was 20%, with local relapse in 6%. By 5 years of followup, 92% of relapses had occurred. Median follow-up was 73 months, 5- and 10-year disease-free survival rates were 75% and 50%, and 5- and 10-year overall survival rates were 79% and 66% respectively. There was no benefit from the use of oxaliplatin regarding survival or pCR rates. Older patients had worse long-term outcomes.
Neoadjuvant chemoradiotherapy with oral fluoropyrimidines and oxaliplatin is feasible and well tolerated. The risk of early progression is low. However, there was no added benefit with the use of oxaliplatin. There were no relapses in patients with pCR. The role of adjuvant chemotherapy is unclear.
新辅助 5-FU 为基础的放化疗在可切除的直肠癌（RC）中是一种标准治疗。口服氟嘧啶类药物和奥沙利铂等新药物的使用可能会提高疗效和耐受性。
1999 年至 2009 年间，126 例 T3-T4 和/或 N+疾病的 RC 患者接受了三个连续的方案：UFT（32 例）、UFT-奥沙利铂（75 例）和卡培他滨-奥沙利铂（19 例），同时接受 45 Gy 的放疗；术后 4-6 周进行手术。所有患者均接受辅助治疗。主要目标是病理完全缓解（pCR）。
术前治疗耐受性良好，无毒性死亡，3-4 级毒性发生率为 15%。85%的患者接受了全剂量化疗，56%接受了腹会阴切除术，6%需要再次干预，57%接受了计划的全辅助化疗。pCR 率为 13%。降期率为 80%；8%有疾病进展。复发率为 20%，局部复发率为 6%。5 年随访时，92%的复发发生。中位随访时间为 73 个月，5 年和 10 年无病生存率分别为 75%和 50%，5 年和 10 年总生存率分别为 79%和 66%。奥沙利铂的使用对生存或 pCR 率没有获益。老年患者的长期预后更差。
口服氟嘧啶类药物和奥沙利铂的新辅助放化疗是可行的，且耐受性良好。早期进展的风险较低。然而，奥沙利铂的使用没有带来额外的益处。pCR 患者无复发。辅助化疗的作用尚不清楚。
