Sequential short-course radiation therapy and chemotherapy in the neoadjuvant treatment of rectal adenocarcinoma
Abstract Background There is continued debate regarding the optimal combinations of radiation therapy and chemotherapy in the preoperative treatment of locally advanced rectal adenocarcinomas. We report our single-institution experience of feasibility and early oncologic outcomes of short-course pre...
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doaj-6b3dd154f5e34c41a74fac0b7d0df4a52020-11-25T03:54:23ZengBMCRadiation Oncology1748-717X2019-08-011411610.1186/s13014-019-1358-1Sequential short-course radiation therapy and chemotherapy in the neoadjuvant treatment of rectal adenocarcinomaAngela Y. Jia0Amol Narang1Bashar Safar2Atif Zaheer3Adrian Murphy4Nilofer S. Azad5Susan Gearhart6Sandy Fang7Jonathan Efron8Tam Warczynski9Amy Hacker-Prietz10Jeffrey Meyer11Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of MedicineDepartment of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of MedicineDepartment of Surgery, Johns Hopkins University School of MedicineDepartment of Radiology and Radiological Science, Johns Hopkins University School of MedicineDepartment of Oncology, Johns Hopkins University School of MedicineDepartment of Oncology, Johns Hopkins University School of MedicineDepartment of Surgery, Johns Hopkins University School of MedicineDepartment of Surgery, Johns Hopkins University School of MedicineDepartment of Surgery, Johns Hopkins University School of MedicineDepartment of Surgery, Johns Hopkins University School of MedicineDepartment of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of MedicineDepartment of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of MedicineAbstract Background There is continued debate regarding the optimal combinations of radiation therapy and chemotherapy in the preoperative treatment of locally advanced rectal adenocarcinomas. We report our single-institution experience of feasibility and early oncologic outcomes of short-course preoperative radiation therapy (5 Gy X 5 fractions) followed by consolidation neoadjuvant chemotherapy. Methods We reviewed the records of 26 patients with locally advanced rectal adenocarcinoma. All patients underwent short course radiotherapy (5 Gy X 5 fractions) followed by chemotherapy [either modified infusional and bolus 5-fluorouracail and oxalipatin (mFOLFOX6) or capecitabine and oxaliplatin] prior to consideration for surgery. A full course of chemotherapy was defined as at least 8 weeks of chemotherapy. Results There were five clinical (c) T2, 16 cT3, and five cT4 rectal tumors, with 88% cN+. Twenty-five patients received a median of 4 cycles (range 3 to 8) of mFOLFOX6 (with one cycle defined as a two-week period); one patient received 3 cycles of capecitabine and oxaliplatin. All patients completed SCRT; 81% completed the full course of neoadjuvant chemotherapy with 19% requiring dose reductions in chemotherapy, most commonly due to neuropathy. Nineteen patients underwent post-treatment endoscopic evaluation, and nine patients were noted to achieve a complete clinical response (CCR). Six of the nine patients who achieved CCR opted for a non-operative approach of watch-and-wait. Twenty patients underwent surgical resection; pathologic complete response was observed in seven (35%) of these twenty. The main radiation-associated toxicity was proctitis with CTCAE Grade 2 proctitis observed in seven patients (27%). Post-operative Clavien-Dindo Grade 3 complications within 30 days of surgery were identified in six patients (30%), with no Grade 4 or 5 adverse events. Median length of hospital stay was 4.5 days (range 2–16 days); three patients were readmitted within a 30 day period. Conclusions Short course preoperative radiotherapy followed by neoadjuvant chemotherapy was well-tolerated and achieved oncologic outcomes that compare favorably with short-course radiation therapy alone or long-course chemoradiotherapy. This regimen is associated with high rates of clinical and pathologic complete response.http://link.springer.com/article/10.1186/s13014-019-1358-1Rectal cancerShort-course chemoradiotherapyWatch and wait |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Angela Y. Jia Amol Narang Bashar Safar Atif Zaheer Adrian Murphy Nilofer S. Azad Susan Gearhart Sandy Fang Jonathan Efron Tam Warczynski Amy Hacker-Prietz Jeffrey Meyer |
spellingShingle |
Angela Y. Jia Amol Narang Bashar Safar Atif Zaheer Adrian Murphy Nilofer S. Azad Susan Gearhart Sandy Fang Jonathan Efron Tam Warczynski Amy Hacker-Prietz Jeffrey Meyer Sequential short-course radiation therapy and chemotherapy in the neoadjuvant treatment of rectal adenocarcinoma Radiation Oncology Rectal cancer Short-course chemoradiotherapy Watch and wait |
author_facet |
Angela Y. Jia Amol Narang Bashar Safar Atif Zaheer Adrian Murphy Nilofer S. Azad Susan Gearhart Sandy Fang Jonathan Efron Tam Warczynski Amy Hacker-Prietz Jeffrey Meyer |
author_sort |
Angela Y. Jia |
title |
Sequential short-course radiation therapy and chemotherapy in the neoadjuvant treatment of rectal adenocarcinoma |
title_short |
Sequential short-course radiation therapy and chemotherapy in the neoadjuvant treatment of rectal adenocarcinoma |
title_full |
Sequential short-course radiation therapy and chemotherapy in the neoadjuvant treatment of rectal adenocarcinoma |
title_fullStr |
Sequential short-course radiation therapy and chemotherapy in the neoadjuvant treatment of rectal adenocarcinoma |
title_full_unstemmed |
Sequential short-course radiation therapy and chemotherapy in the neoadjuvant treatment of rectal adenocarcinoma |
title_sort |
sequential short-course radiation therapy and chemotherapy in the neoadjuvant treatment of rectal adenocarcinoma |
publisher |
BMC |
series |
Radiation Oncology |
issn |
1748-717X |
publishDate |
2019-08-01 |
description |
Abstract Background There is continued debate regarding the optimal combinations of radiation therapy and chemotherapy in the preoperative treatment of locally advanced rectal adenocarcinomas. We report our single-institution experience of feasibility and early oncologic outcomes of short-course preoperative radiation therapy (5 Gy X 5 fractions) followed by consolidation neoadjuvant chemotherapy. Methods We reviewed the records of 26 patients with locally advanced rectal adenocarcinoma. All patients underwent short course radiotherapy (5 Gy X 5 fractions) followed by chemotherapy [either modified infusional and bolus 5-fluorouracail and oxalipatin (mFOLFOX6) or capecitabine and oxaliplatin] prior to consideration for surgery. A full course of chemotherapy was defined as at least 8 weeks of chemotherapy. Results There were five clinical (c) T2, 16 cT3, and five cT4 rectal tumors, with 88% cN+. Twenty-five patients received a median of 4 cycles (range 3 to 8) of mFOLFOX6 (with one cycle defined as a two-week period); one patient received 3 cycles of capecitabine and oxaliplatin. All patients completed SCRT; 81% completed the full course of neoadjuvant chemotherapy with 19% requiring dose reductions in chemotherapy, most commonly due to neuropathy. Nineteen patients underwent post-treatment endoscopic evaluation, and nine patients were noted to achieve a complete clinical response (CCR). Six of the nine patients who achieved CCR opted for a non-operative approach of watch-and-wait. Twenty patients underwent surgical resection; pathologic complete response was observed in seven (35%) of these twenty. The main radiation-associated toxicity was proctitis with CTCAE Grade 2 proctitis observed in seven patients (27%). Post-operative Clavien-Dindo Grade 3 complications within 30 days of surgery were identified in six patients (30%), with no Grade 4 or 5 adverse events. Median length of hospital stay was 4.5 days (range 2–16 days); three patients were readmitted within a 30 day period. Conclusions Short course preoperative radiotherapy followed by neoadjuvant chemotherapy was well-tolerated and achieved oncologic outcomes that compare favorably with short-course radiation therapy alone or long-course chemoradiotherapy. This regimen is associated with high rates of clinical and pathologic complete response. |
topic |
Rectal cancer Short-course chemoradiotherapy Watch and wait |
url |
http://link.springer.com/article/10.1186/s13014-019-1358-1 |
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