P-316 - Neo-adjuvant chemo-radiotherapy in advanced rectal adenocarcinoma: analysis of three different chemo-radiation regimens

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Anti-Cancer Agents & Biologic Therapy
Rectal Cancer
Surgery and/or Radiotherapy of Cancer
Presenter A. Ghosh Dastidar
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors A. Ghosh Dastidar
  • Institute of Post Graduate Medical Education and Research, Kolkata/IN

Abstract

Introduction

Neo-adjuvant chemo-radiotherapy (CRT) in advanced rectal adeno-carcinoma (RAC) aims to render unresectable tumour resectable. The efficacy of different CRT schedules for sphincter control and better survival were analysed in this prospective, randomized, open labeled study.

Methods

72 patients of RAC with “unresectable tumour” underwent different regimens of neo-adjuvant CRT from January 2012 to December 2013, at our Institute.

Group A: External beam radiotherapy (EBRT) in conventional fractionation with 4500 cGy / 25 fractions to whole pelvis along with concomitant weekly 5-FU – 425mg/M2 I.V. for 5 weeks.

Group B: 5-FU, leucovorin (20mg/ M2 I.V.); oxaliplatin (135mg/ M2 I.V.) on day-1 of EBRT, repeated on day 22. Third dose was given, 2 weeks after completion of EBRT (same as Group A).

Group C: Hyper-fractionated radiotherapy (HFRT) with 120 cGy twice daily fractionation, 6 hours apart for 14 days along with chemotherapy of 5-FU – 425mg/M2 I.V on day-1, 8 and 15 of radiotherapy course.

On completion of CRT, evaluation done after 5 - 11 weeks for feasibility of surgery.

Results

Group A 14 patients (70%) were selected for surgery. 11 patients (55%) underwent APR (abdomino perineal resection) and permanent colostomy. In 3 patients (15%) SSS (sphincter sparing surgery) were possible. None had positive surgical margin. None had developed grade 3 &/ or 4 acute toxicity after CRT. At 12 months loco-regional relapse occurred in 8 patients (40%) and one had (5%) had multiple sites metastasis.

Group B All patients underwent surgery. 19 patients underwent APR (67.8%) and permanent colostomy; 3 patients underwent SSS (10.7%). 6 patients (21.4%) on laparotomy found unresectable due to pelvic adhesions. Bladder and rectal toxicity (92.8%) delayed surgery for 9 - 13 weeks (median 11 weeks). 2 in the APR group and 1 in SSS group showed pelvic recurrence at the end of 12 months and prolonged salvage chemotherapy was given. 2 patients (7.14%) developed distant metastasis. No evidence of disease till date (follow up for 14 months) was seen in 17 patients.

Group C Surgery was possible in 20 patients (83.3%). 4 patients discontinued treatment after CRT. All underwent APR. One patient (4.1%) had pelvic recurrence at 12 months and 1 at 16 months. Dist. metastasis noted in 2 patients (8.2%). 5 patients had lower limb edema and swelling with no pelvic relapse. After CRT acute rectal toxicity, grade 3 or 4 were (70.8%); grade 3/4 skin toxicity in 14 patients (58.3%); grade 3 diarrhoea in (37.5%).

Conclusion

Hyperfractionated chemoradiotherapy may be a better option for local control of advanced rectal adenocarcinoma although distal metastasis is same as conventional chemoradiotherapy.