scholarly journals Short-course radiotherapy and chemotherapy for conversion surgery in patients with unresectable metastatic rectal cancer: a preliminary case series study

2021 ◽  
Vol 17 (2) ◽  
pp. 111-116
Author(s):  
Youngbae Jeon ◽  
Kyoung-Won Han ◽  
Seok Ho Lee ◽  
Sun Jin Sym ◽  
Seung Joon Choi ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Survival Time ◽  
Systemic Chemotherapy ◽  
Radical Surgery ◽  
Palliative Surgery ◽  
Survival Outcomes ◽  
Term Survival ◽  
Short Course ◽  
Short Course Radiotherapy

Purpose: Curative treatment is challenging in patients with locally advanced rectal cancer and unresectable metastases. The aim of this study was to evaluate the clinical outcomes of short-course radiotherapy (RT) followed by systemic chemotherapy for patients with rectal cancer with mesorectal fascia (MRF) involvement and unresectable distant metastases.Methods: The study included consecutive patients diagnosed as having metastatic mid-to-low rectal cancer treated with short-course RT followed by systemic chemotherapy for conversion radical or palliative surgery between 2014 and 2019 at Gil Medical Center. The patients had primary rectal tumors involving the MRF and unresectable distant metastases. The treatment strategies were determined in a multidisciplinary team discussion.Results: Seven patients (five men and two women) underwent short-course RT (5 × 5 Gy) and preoperative systemic chemotherapy. The median age was 68 years (range, 46–84 years), and the median distance from the anal verge to the primary tumor was 6.0 cm (range, 2.0–9.0 cm). During the median follow-up period of 29.4 months, three patients underwent conversion radical surgery with R0 resection, two underwent palliative surgery, and two could not undergo surgery. No postoperative major morbidity or mortality occurred. The patients who underwent conversion complete radical surgery showed good long-term survival outcomes, with an overall survival time of 29.4–48.8 months and progression-free survival time of 14.7–41.1 months.Conclusion: Short-course RT followed by systemic chemotherapy could provide patients with unresectable stage IV rectal cancer a chance to undergo to conversion radical surgery with good long-term survival outcomes.

A novel preoperative protocol for locally advanced rectal cancer: Hyperfractionated short-course radiotherapy combined with chemotherapy.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 577-577
Author(s):  
Hiroshi Doi ◽  
Naohito Beppu ◽  
Yasuhiro Takada ◽  
Yasue Niwa ◽  
Masayuki Fujiwara ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Radical Surgery ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Disease Free Survival ◽  
Advanced Rectal Cancer ◽  
Short Term ◽  
Term Outcome ◽  
Short Course ◽  
Short Course Radiotherapy

577 Background: Neoadjuvant chemoradiotherapy (NACRT) has become a widely accepted strategy for rectal cancer (RC). The purpose of this study is to examine the safety and efficacy of a novel protocol of neoadjuvant hyperfractionated short-course radiotherapy (NAHSRT) combined with chemotherapy for locally advanced RC. Methods: 82 patients (pts) with RC were treated with NACRT followed by radical surgery between March 2008 and May 2012. 50 pts with RC of cT3N1M0 were analyzed in the present study. NAHSRT was performed with a dose of 2.5 Gy twice daily, with an interval of at least 6 hours between fractions, up to a total dose of 25 Gy (25 Gy in 10 fractions for 5 days) with chemotherapy. Radical surgery was performed within 3 week following the end of the NAHSRT. Results: 50 pts included 37 men and 13 women. The median age was 65.0 (range: 39-85) years. The median follow-up term was 12.0 (2-36) months. S-1, oxaliplatin with capecitabine, and fluorouracil, leucovorin plus irinotecan (FOLFIRI) was administered with NAHSRT in 48 pts, 1 pt, and 1 pt, respectively. 48 pts (96%) had no apparent adverse events before surgery. 49 pts (98%) completed NACRT except for 1 pt stopped chemotherapy (S-1) because of grade 3 gastrointestinal toxicity (CTCAE v.3). In addition, no pts showed grade 4 toxicities. Postoperative complications were found in 30 pts (60.0%). 33 pts (66.0%) received adjuvant chemotherapy. S-1, capecitabine, oxaliplatin with capecitabine, uracil/tegafur (UFT) and oral leucovorin, and oxaliplatin combined with S-1 (SOX) was delivered after surgery in 20 pts, 4 pts, 4 pts, 4 pts, and 1 pt, respectively. No pts. developed local failure, although distant failures were found in 3 pts. The median disease free survival and overall survival was 11.6 (2-36) months and 12.0 (2-36) months, respectively. In addition, disease-specific survival rate was 100.0%. Conclusions: We presented a novel protocol of NAHSRT for locally advanced RC and the short-term outcome. NAHSRT was well tolerated and produced excellent short-term outcomes in pts with locally advanced RC.

Short-course radiotherapy and subsequent CAPOX plus camrelizumab followed by delayed surgery for locally advanced rectal cancer:Short-term results of a phase II trial.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 63-63
Author(s):  
Zhenyu Lin ◽  
Ming Cai ◽  
Peng Zhang ◽  
Xin Li ◽  
Kailin Cai ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Mismatch Repair ◽  
Radical Surgery ◽  
Performance Status ◽  
Locally Advanced ◽  
Ecog Performance Status ◽  
Delayed Surgery ◽  
Short Course ◽  
Number Of Patients ◽  
Short Course Radiotherapy

63 Background: Chemoradiotherapy followed by radical surgery is standard treatment for patients with locally advanced rectal cancer (LARC). Short-course radiotherapy (SCRT), either with immediate or delayed surgery, provides similar oncological results compared with long-course radiotherapy with delayed surgery. Delayed surgery with the addition of neoadjuvant immunotherapy may bring better downstaging effect and minimize the risk of distant relapse. We conducted this single-arm phase 2 trial to investigate the efficacy and safety of SCRT combined with subsequent capecitabine and oxaliplatin (CAPOX) plus Camrelizumab (anti-PD-1 antibody) followed by delayed surgery in patients with LARC. Methods: Patients with histologically confirmed T3–4N0M0 or T1-4N+M0 rectal cancer, previously untreated disease, and ECOG performance status of 0-1, received SCRT (5×5 Gy) with subsequent two 21-day cycles of CAPOX (oxaliplatin 130 mg/m2 ivgtt, d1; capecitabine 1000 mg/m2 po bid, d1-14) plus Camrelizumab (200 mg iv drip, d1) after 1 week, followed by radical surgery after 1 week. Adjuvant therapy was decided by the investigator. The primary endpoint was pathological complete response (pCR) rate, defined as the absence of viable tumor cells in the primary tumor and lymph nodes. The study is ongoing to follow up the survival outcomes and obtain the results of next generation sequencing and PD-L1 expression. The data cutoff date was September 8, 2020. Results: From November 2019 to September 2020, a targeted number of patients (n = 29) were enrolled and are expected to complete the surgery by November 2020. The median age was 57 (range 31-73) years, 55% (16/29) of patients had ECOG performance status of 1, and the median distance from tumor to the anal verge was 5 (range, 1.9-9) cm. At data cutoff, 10 patients had undergone the surgery, with R0 resection rate of 100%. The pCR rate was 60% (6/10), including 56% (5/9) for those with mismatch repair-proficient, and 100% (1/1) for those with mismatch repair-deficient. Of 4 patients without pCR, 2 only received one cycle of CAPOX plus Camrelizumab due to the outbreak of COVID-19 in Wuhan, and 1 had signet-ring cell rectal carcinoma. At data cutoff, 20 patients had received at least one dose of Camrelizumab. Immune-related adverse events (irAEs) were all grade 1-2, and the most common irAE was reactive cutaneous capillary endothelial proliferation in 10 (50%) of 20 patients. Postoperative bleeding and infection occurred in 1 (10%) and 2 (20%) of 10 patients, respectively. No treatment-related death was observed. Conclusions: SCRT combined with subsequent CAPOX plus Camrelizumab followed by delayed surgery showed promising pCR rate with good tolerance in patients with LARC, regardless of the mismatch repair status, suggesting a candidate strategy for the neoadjuvant therapy. Clinical trial information: NCT04231552.

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