Combined modality therapy of rectal cancer: decreased acute toxicity with the preoperative approach.
Publication: Journal of Clinical Oncology
Abstract
Purpose
We compared the combined radiation therapy (RT) plus chemotherapy segments of two separate parallel phase I trials to determine if combined pelvic RT, fluorouracil (5-FU), and high-dose leucovorin (LV) had less acute toxicity when delivered preoperatively versus postoperatively in patients with rectal cancer.
Patients and Methods
Patients with unresectable disease received preoperative RT plus LV and 5-FU followed by surgery and postoperative LV and 5-FU. Patients with resectable disease received identical doses, techniques, and schedules of RT and LV and 5-FU except all therapy was delivered postoperatively. On day 1, patients received LV and 5-FU times one cycle. RT began on day 8. A second cycle of LV and 5-FU was given concurrently with the fourth week of RT.
Results
Although more patients (75% v 32%; P = .02) received the higher dose level of 5-FU (250 mg/m2), significantly fewer experienced acute grade 3 to 4 toxicity with preoperative versus postoperative therapy (13% v 48%; P = .045). There was no grade 3 to 4 myelosuppression in either group. The two grade 3 toxicities in the preoperative group were gastrointestinal. The grade 3 toxicities in the postoperative group included seven gastrointestinal and two genitourinary; four patients had a grade 4 toxicity.
Conclusion
Given the high incidence of grade 3 to 4 toxicity also reported in the postoperative combined modality adjuvant randomized trials, future adjuvant trials should explore the preoperative approach.
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Copyright
© 1992 by American Society of Clinical Oncology.
History
Published in print: August 01, 1992
Published online: September 21, 2016
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Article Citation
Combined modality therapy of rectal cancer: decreased acute toxicity with the preoperative approach.. JCO 10, 1218-24(1992).
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Combined modality therapy of rectal cancer: decreased acute toxicity with the preoperative approach.
Journal of Clinical Oncology 1992 10:8, 1218-1224 View Options
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