Aboelnaga Engy M, Daoud Mohamed A, Eladl Entesar I, Zaid Amir M
Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University Hospital, Mansoura, Egypt,
Med Oncol. 2015 Apr;32(4):108. doi: 10.1007/s12032-015-0556-4. Epub 2015 Mar 7.
Induction chemotherapy has many benefits of in locally advanced rectal cancer (LARC); one of these is the better control of distant failure. Hyperfractionated radiotherapy (HFRT) is new approach still on evaluation in preoperative setting of rectal cancer. We aimed to evaluate the efficacy of induction FOLFOX followed by HFRT in LARC. From September 2011 to December 2013, 27 patients with LARC were enrolled in this prospective, phase I-II study. Induction FOLFOX bolus was given for two cycles followed by HFRT (1.5 Gy twice day for 30 fractions over 3 weeks for a total of 45 Gy). 5-fluorouracil (5-FU) bolus was administrated during first and last 3 days of radiotherapy. Surgical resection was performed in 4-5 weeks further and followed by adjuvant FOLFOX bolus regimen. Twenty-one (77.8 %) patients were males and 22. 2 % of patients were females, and the median age at diagnosis was 46 years. Low sited tumor was the most presenting site (55.6 %). Clinically positive lymph nodes were presented in 70.4 % of patients. Twenty patients (74.1 %) underwent sphincter sparing procedure. Pathological complete response (pCR) was achieved in seven patients (25.9 %). Tumor and nodal downstaging were recorded in (70.3 %) and (42.1 %) of patients, respectively. Acute and late toxicities were in acceptable range. Two-year disease-free survival was 70.2 %, and overall survival was 87.5 %. Induction FOLFOX followed by HFRT and concurrent 5-FU improves pCR in LARC, and this combination was feasible with acceptable toxicity. Further evaluations are mandatory for this new approach.
诱导化疗对局部晚期直肠癌（LARC）有诸多益处；其中之一是能更好地控制远处转移。超分割放疗（HFRT）是一种仍在直肠癌术前环境中进行评估的新方法。我们旨在评估诱导FOLFOX方案序贯HFRT在LARC中的疗效。2011年9月至2013年12月，27例LARC患者纳入了这项前瞻性I-II期研究。给予诱导FOLFOX推注方案两个周期，随后进行HFRT（每天两次，每次1.5 Gy，共30次分割，持续3周，总计45 Gy）。在放疗的第1天和最后3天给予5-氟尿嘧啶（5-FU）推注。4至5周后进行手术切除，随后给予辅助FOLFOX推注方案。21例（77.8%）患者为男性，22.2%为女性，诊断时的中位年龄为46岁。低位肿瘤是最常见的部位（55.6%）。70.4%的患者临床淋巴结阳性。20例（74.1%）患者接受了保留括约肌手术。7例患者（25.9%）达到病理完全缓解（pCR）。分别有70.3%和42.1%的患者出现肿瘤降期和淋巴结降期。急性和晚期毒性在可接受范围内。两年无病生存率为70.2%，总生存率为87.5%。诱导FOLFOX序贯HFRT并同步使用5-FU可提高LARC患者的pCR，且这种联合方案毒性可接受，切实可行。对这种新方法进行进一步评估是必要的。
