Clinical efficacy of preoperative SIB-IMRT for 26 cases of locally-advanced low rectal cancer
Liu Qiteng, Feng Linchun, Jia Baoqing, Du Xiaohui, Liu Hongyi, Dai Guanghai, Chen Jing, Yang Yongqiang, Wen Ke, Wang Yunlai, Yang Tao, Gao Yuyan
Department of Radiation Oncology (Liu QT (Current Affiliation:Department of Radiation Oncology,Beijing Luhe Hospital affiliated to Capital Medical University,Beijing 101149,China),Feng LC,Chen J,Wang YL,Yang T)),Department of General Surgery Ⅱ(Jia BQ,Liu HY),Department of General Surgery I (Du XH),Department of Medical Oncology (Dai Gh),Chinese PLA General Hospital,Beijing 100853,China;Department of Radiation Oncology,The Second Affiliated Hospital of Soochow University,Suzhou 215004,China (Yang YQ);Department of Radiation Oncology,Chinese PLA 302 Hospital,Beijing 100039,China (Wen K);Department of Radiation Oncology,Beijing Luhe Hospital affiliated to Capital Medical University,Beijing 101149,China (Gao YY)
Objective To evaluate the feasibility and clinical efficacy of preoperative simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) combined with neoadjuvant chemotherapy of capecitabine in patients with locally-advanced low rectal cancer. Methods Between 2015 and 2016,26 patients admitted to 301 Hospital who were diagnosed with locally-advanced low rectal cancer,which was located within 5 cm from the anal verge,were enrolled in this investigation. Dose fractionation pattern was delivered:58.75 Gy in 25 fractions (2.35 Gy/fraction) for rectal cancer and lymph node metastasis and 50 Gy in 25 fractions for the pelvic lymphatic drainage area and simultaneously combined with capecitabine chemotherapy (825 mg/m2,bid d1-5 weekly).One cycle of capecitabine (1250 mg/m2,twice daily,d1-14) was given at one week after the completion of chemoradiotherapy (CRT).Total mesorectal excision (TME) was performed at 6 to 8 weeks after the completion of CRT.The primary endpoints included pathological complete response rate (ypCR) and sphincter-preserving rate. The secondary endpoints included acute toxicity,tumor downstaging rate and postoperative complications. Results Twenty-six patients successfully completed neoadjuvant CRT,25 of them underwent surgical resection and one patient failed to receive surgery due to perianal edema. Postoperative ypCR rate was 32%(8/25),the sphincter-preserving rate was 60%(15/25),the tumor downstaging rate was 92%(23/25) and the R0 resection rate was 100%.During the period of CRT,grade 1 and 2 adverse events occurred in 24 patients,grade 3 radiation dermatitis was noted in 2 cases. No ≥ grade 4 acute adverse event was observed. Postoperative complications included ureteral injury in one case and intestinal obstruction in one patient. Conclusions Preoperative SIB-IMRT combined with neoadjuvant chemotherapy of capecitabine is a feasible and safe treatment for patients with locally-advanced low rectal cancer,which yields expected ypCR rate,R0 resection rate and sphincter-preserving rate. Nevertheless,the long-term clinical benefits remain to be elucidated.Clinical Trial Registry Chinese Clinical Trial Registry,registration number:ChiCTR-ONC-12002387.
Liu Qiteng,Feng Linchun,Jia Baoqing et al. Clinical efficacy of preoperative SIB-IMRT for 26 cases of locally-advanced low rectal cancer[J]. Chinese Journal of Radiation Oncology, 2018, 27(10): 906-910.
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2018, Vol. 27 
