Capecitabine and Oxaliplatin versus 5-Fluorouracil in the Neoadjuvant Chemoradiation for Patients with Locally Advanced Rectal Carcinoma: A Comparative Study
2018
Aim of work: This study aimed to evaluate the resectability rate, rate of conservative
surgery, toxicity, local control, and disease free survival for oxaliplatin and
capecitabine based chemoradiation compared to standard 5-FU based
chemoradiation in locally advanced cancer rectum. Patients and methods: 65 patients were eligible; 33 patients received oxaliplatin and capecitabine
based chemoradiation (arm I) and 32 patients received 5-FU based chemoradiation
(arm II). Results: The overall response rate in arms I and II were 78.7%
and 87.5% respectively. Conservative surgery was done in 81.81% and 53.13% of
patients with arms I and II, pathologic complete response (pCR) rate was
significantly better in arm I than arm II (30.3% vs. 21.9%, P ; the
median disease free survival (DFS) were 30 months and 15 months in arms I and
II respectively. Grade III anemia, grade IV diarrhea and severe proctitis were
developed in a significantly large number of patients with arm I; in
addition deep venous thrombosis (DVT) was developed in 15.15% of patients with
arm I but none in arm II. Conclusion: The addition of oxaliplatin to the
preoperative chemo radiation increased the response rate mainly pCR rate which
was considered a target goal in the neoadjuvant treatment, but it was not
recommended because of higher toxicity and no significant effect on DFS in
different response groups of arm I when compared to arm II, but longer follow
up may be needed to evaluate the overall survival.
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