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ORIGINAL ARTICLE
Year : 2018  |  Volume : 35  |  Issue : 2  |  Page : 218-224

Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy in locally advanced rectal carcinoma


Clinical Oncology and Nuclear Medicine Department, Mansoura University, Mansoura, Egypt

Correspondence Address:
Dr. Ola M El-Nady
Mansoura City, Dakahlia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bmfj.bmfj_170_17

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Background Evaluation of the safety and efficacy of neoadjuvant chemoradiation containing oxaliplatin in locally advanced cancer rectum. Patients and methods A prospective, single-arm, phase-II study, carried out on 40 patients with locally advanced (T3, T4, N+) rectum cancer from June 2013 to June 2015. Patients received 2 months induction FOLFOX4 chemotherapy, followed by concomitant chemoradiotherapy (CRT) consisted of oxaliplatin 100 mg/m2 D1, 29 of radiotherapy (RT), folinic acid 20 mg/m2 D1: 29, and 5-FU 300 mg/m2 D1: 5, 29: 33 continuous infusion (during the first and fifth week of RT), with three-dimensional conformal pelvic RT 45 Gy by conventional fractionation. Surgery was done 4–6 weeks after end of the CRT course. Adjuvant treatment consisted of 2 months FOLFOX4 chemotherapy. A booster dose of RT 9 Gy/5 fractions was added in cases with positive margin or persistent T4 tumors after surgery. Results In all, 95% of the patients ended neoadjuvant CRT course with 75% receiving full treatment doses. Overall response occurred in 86% of patients; 16% of them showed pathological complete response; initial failure occurred in only 5% of patients; sphincter sparing surgery was done in 43% of patients. CRT course passed with tolerable and reversible toxicity; grade III toxicity occurred in only 10% of patients, and no grade IV toxicity was reported. Conclusion Adding oxaliplatin to neoadjuvant CRT in locally advanced cancer rectum cases was feasible, tolerable, with satisfactory response rates, thus encouraging more studies with larger number of patients and longer follow-up periods.


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