Comparison of continuous infusional 5-fluorouracil and capecitabine in preoperative chemo radiotherapy for locally advanced rectal cancer: experience from a tertiary cancer centre from Southern India

Authors

  • Manjunath I. Nandennavar Department of Medical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
  • Shashidhar V. Karpurmath Department of Medical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
  • Geeta S. Narayanan Department of Radiation Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
  • Rajshri Ashwath Department of Radiation Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
  • Ganesh Mandakulutur Department of Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20174640

Keywords:

5-fluorouracil, Capecitabine, Neoadjuvant chemoradiation, Rectal carcinoma, Southern India

Abstract

Background: Neoadjuvant concurrent chemoradiation (CTRT) is the recommended treatment for locally advanced rectal cancer. 5 Fluorouracil (5-FU) has been the standard chemotherapy drug, but recent studies have proved Capecitabine (CA) is as effective as 5-FU in terms of local response, distant recurrences and overall survival except toxicities. We conducted this study to evaluate acute toxicities and local response rates between 5-FU and CA as neoadjuvant treatment modality combined with radiation.

Methods: All patients with newly biopsy proven adenocarcinoma of rectum of TNM stage T3N0/ any T with N1,N2 and in whom curative treatment was planned with concurrent chemoradiation dose of 5040cGy in 28 fractions were included in the study. From January 2013 to June 2014, a total of thirty patients were enrolled in this study, fifteen patients received 5-FU (arm A) and fifteen patients received CA (arm B) during concurrent chemoradiation. All patients were evaluated for acute toxicities during treatment using RTOG criteria. Local response was assessed radiographically after four weeks of completion of CTRT utilising RECIST (Response Evaluation Criteria in Solid Tumors) criteria and also assessed for surgery simultaneously. Postoperatively adjuvant chemotherapy was considered in all patients.

Results: Grade III toxicities were more in 5-FU arm compared to CA arm. The local response rates were almost same in both the arms, partial response in 5-FU and CA arm were 53.3% and 60% respectively.

Conclusions: This is the first Indian study comparing Capecitabine and continuous Infusional 5FU in neoadjuvant CTRT of standard advanced rectal cancer patients. Oral Capecitabine had same efficacy when compared to 5-FU in terms of local response rates as neoadjuvant treatment modality in locally advanced rectal cancer, but CA was better tolerated with better patient compliance and was less toxic.

References

Torre LA, Bray F, Siegel RL, Ferlay J, Lortet- Tiulent J, Jemal A. Global cancer statistics, 2012. Ca Cancer J Clin. 2015;65:85-108.

Mohandas KK. Colorectal cancer in India: controversies, enigma and primary prevention. Indian J Gastroenterol. 2011;11;3-6.

Pilipshen, Heilweil M, Quan SH, Sternberg SS, Enker WE. Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer. 1984;53:1354-62.

Rich T, Gunderson L, Lew R, Galdibini JJ, Cohen AM, Donaldson G. Patterns of Recurrence of Rectal Cancer after Potentially Curative Surg. Cancer 1983;52:1317-29.

Thomas PR, Lindblad AS. Adjuvant Postoperative Radiotherapy and Chemotherapy in Rectal Carcinoma: A Review of the Gastrointestinal Tumor Study Group Experience. Radiother Oncol. 1988;13:245-52.

Gerard JP, Conroy T, Bonnetain F, Bouché O, Chapet O, Closon-Dejardin MT et al. Preoperative Radiotherapy with or without Concurrent Fluorouracil and Leucovorin in T3-4 Rectal Cancers: Results of FFCD 9203. J Clin Oncol. 2006;24:4620-5.

De Paoli A, Chiara S, Luppi G, Friso ML, Beretta GD, Prete D, et al. Capecitabine in combination with preoperative radiation therapy in locally advanced, resectable, rectal cancer: a multicentric phase II study. Ann Oncol. 2006;17:246-51.

Gerard JP, Azria D, Gourgou- Bourgade S, Laffay I, Hennequin C, Etienne PL, et al. Comparison of Two Neoadjuvant Chemoradiotherapy Regimens for Locally Advanced Rectal Cancer: Results of the Phase III Trial ACCORD 12/0405-Prodige 2. J Clin Oncol. 2010;28:1638-44.

Connell M, Colangelo LH, Beart RW, Petrelli NJ, Allegra CJ, Sharif S, et al. Capecitabine and Oxaliplatin in the Preoperative Multimodality Treatment of Rectal Cancer: Surgical End Points From National Surgical Adjuvant Breast and Bowel Project Trial R-04. J Clin Oncol. 2014;32:1927-34.

Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, et al. German Rectal Cancer Study Group. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731‑40.

Chan AK, Wong AO, Jenken DA. Preoperative capecitabine and pelvic radiation in locally advanced rectal cancer‑is it equivalent to 5‑FU infusion plus leucovorin and radiotherapy? Int J Radiat Oncol Biol Phys. 2010;76:1413‑9.

Hofheinz ED, Wenz F, Post S, Laechelt S, Hartmann JT, Müller Letal. Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised, multicentre, non-inferiority, phase 3 trial. Lancet Oncol. 2012;13:579-88.

Ramani VS, Sun Myint A, Montazeri A, Wong H. Preoperative Chemo Radiotherapy for Rectal Cancer:A Comparison between Intravenous 5-Fluorouracil and Oral Capecitabine. Colorectal Dis. 2010;12:37-46.

Das P, Lin EH, Bhatia S, Skibber JM, Rodriguez-Bigas MA, Feig BW et al. Preoperative chemoradiotherapy with capecitabine versus protracted infusion 5-fluorouracil for rectal cancer: A matched-pair analysisl. Int J Radiat Oncol Biol Phys. 2006;66:1378-83.

Gerard JP, Azria D, Gourgou- Bourgade S, Laffay I, Hennequin C, Etienne PL, et al. Comparison of Two Neoadjuvant Chemoradiotherapy Regimens for Locally Advanced Rectal Cancer: Results of the Phase III Trial ACCORD 12/0405-Prodige 2. J Clin Oncol. 2010;28:1638-44.

Engineer R, Basu T, Chopra S, Arya S, Patil P, Mehta S, et al. Factors influencing response to neoadjuvant chemoradiation and outcomes in rectal cancer patients: tertiary Indian cancer hospital experience. J Gastrointest Oncol. 2015;6:155-64.

Bansal V, Bhutani R, Doval D, Kumar K, Kumar G, Pande P. Neo adjuvant chemo-radiotherapy and rectal cancer: Can India follow the West? J Cancer Res Ther. 2012;8:209-14.

Saha A, Ghosh SK, Roy C, Saha ML, Choudhury KB, Chatterjee K. A randomized controlled pilot study to compare Capecitabine-oxaliplatin with 5- FU- Leucovorin with neoadjuvant concurrent chemoradiation in locally advanced carcinoma of rectum. J Cancer Res Ther. 2015;11:88-93.

Yerushalmi R, Idelevich E, Dror Y, Stemmer SM, Figer A, Sulkes A, et al. Preoperative chemoradioradiation in rectal cancer: Retrospective comparison between capecitabine and contiuous infusion of 5-fluorouracil. J Surg Oncol. 2006;93:529-33.

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Published

2017-11-22

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