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Title: Neoadjuvant Sandwich Treatment With Oxaliplatin and Capecitabine Administered Prior to, Concurrently With, and Following Radiation Therapy in Locally Advanced Rectal Cancer: A Prospective Phase 2 Trial

Abstract

Purpose: Systemic failure remains the major challenge in management of locally advanced rectal cancer (LARC). To optimize the timing of neoadjuvant treatment and enhance systemic control, we initiated a phase 2 trial to evaluate a new strategy of neoadjuvant sandwich treatment, integrating induction chemotherapy, concurrent chemoradiation therapy, and consolidation chemotherapy. Here, we present preliminary results of this trial, reporting the tumor response, toxicities, and surgical complications. Methods and Materials: Fifty-one patients with LARC were enrolled, among which were two patients who were ineligible because of distant metastases before treatment. Patients were treated first with one cycle of induction chemotherapy consisting of oxaliplatin, 130 mg/m² on day 1, with capecitabine, 1000 mg/m² twice daily for 14 days every 3 weeks (the XELOX regimen), followed by chemoradiation therapy, 50 Gy over 5 weeks, with the modified XELOX regimen (oxaliplatin 100 mg/m²), and then with another cycle of consolidation chemotherapy with the XELOX regimen. Surgery was performed 6 to 8 weeks after completion of radiation therapy. Tumor responses, toxicities, and surgical complications were recorded. Results: All but one patent completed the planned schedule of neoadjuvant sandwich treatment. Neither life-threatening blood count decrease nor febrile neutropenia were observed. Forty-five patents underwent optimal surgery with total mesorectal excision (TME). Four patients refused surgerymore » because of clinically complete response. There was no perioperative mortality in this cohort. Five patients (11.1%) developed postoperative complications. Among the 45 patients who underwent TME, pathologic complete response (pCR), pCR or major regression, and at least moderate regression were achieved in 19 (42.2%), 37 (82.2%), and 44 patients (97.8%), respectively. Conclusions: Preliminary results suggest that the strategy of neoadjuvant sandwich treatment using XELOX regimen as induction, concomitant, and consolidation chemotherapy to the conventional radiation is well tolerated. The strategy is highly effective in terms of pCR and major regression, which warrants further investigation.« less

Authors:
 [1];  [1];  [1];  [1];  [1];  [1]; ; ; ; ;  [1];  [1]
  1. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou (China)
Publication Date:
OSTI Identifier:
22420508
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 90; Journal Issue: 5; Other Information: Copyright (c) 2014 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BLOOD COUNT; CHEMOTHERAPY; CLINICAL TRIALS; METASTASES; MORTALITY; NEOPLASMS; PATENTS; PATIENTS; RADIOTHERAPY; RECTUM; SURGERY; TOXICITY

Citation Formats

Gao, Yuan-Hong, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Lin, Jun-Zhong, Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, An, Xin, Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Luo, Jie-Lin, Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Cai, Mu-Yan, Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, Cai, Pei-Qiang, Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, Kong, Ling-Heng, Liu, Guo-Chen, Tang, Jing-Hua, Chen, Gong, Pan, Zhi-Zhong, Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Ding, Pei-Rong, and Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou. Neoadjuvant Sandwich Treatment With Oxaliplatin and Capecitabine Administered Prior to, Concurrently With, and Following Radiation Therapy in Locally Advanced Rectal Cancer: A Prospective Phase 2 Trial. United States: N. p., 2014. Web. doi:10.1016/J.IJROBP.2014.07.021.
Gao, Yuan-Hong, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Lin, Jun-Zhong, Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, An, Xin, Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Luo, Jie-Lin, Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Cai, Mu-Yan, Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, Cai, Pei-Qiang, Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, Kong, Ling-Heng, Liu, Guo-Chen, Tang, Jing-Hua, Chen, Gong, Pan, Zhi-Zhong, Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Ding, Pei-Rong, & Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou. Neoadjuvant Sandwich Treatment With Oxaliplatin and Capecitabine Administered Prior to, Concurrently With, and Following Radiation Therapy in Locally Advanced Rectal Cancer: A Prospective Phase 2 Trial. United States. https://doi.org/10.1016/J.IJROBP.2014.07.021
Gao, Yuan-Hong, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Lin, Jun-Zhong, Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, An, Xin, Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Luo, Jie-Lin, Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Cai, Mu-Yan, Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, Cai, Pei-Qiang, Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, Kong, Ling-Heng, Liu, Guo-Chen, Tang, Jing-Hua, Chen, Gong, Pan, Zhi-Zhong, Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Ding, Pei-Rong, and Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou. 2014. "Neoadjuvant Sandwich Treatment With Oxaliplatin and Capecitabine Administered Prior to, Concurrently With, and Following Radiation Therapy in Locally Advanced Rectal Cancer: A Prospective Phase 2 Trial". United States. https://doi.org/10.1016/J.IJROBP.2014.07.021.
@article{osti_22420508,
title = {Neoadjuvant Sandwich Treatment With Oxaliplatin and Capecitabine Administered Prior to, Concurrently With, and Following Radiation Therapy in Locally Advanced Rectal Cancer: A Prospective Phase 2 Trial},
author = {Gao, Yuan-Hong and Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou and Lin, Jun-Zhong and Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou and An, Xin and Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou and Luo, Jie-Lin and Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou and Cai, Mu-Yan and Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou and Cai, Pei-Qiang and Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou and Kong, Ling-Heng and Liu, Guo-Chen and Tang, Jing-Hua and Chen, Gong and Pan, Zhi-Zhong and Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou and Ding, Pei-Rong and Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou},
abstractNote = {Purpose: Systemic failure remains the major challenge in management of locally advanced rectal cancer (LARC). To optimize the timing of neoadjuvant treatment and enhance systemic control, we initiated a phase 2 trial to evaluate a new strategy of neoadjuvant sandwich treatment, integrating induction chemotherapy, concurrent chemoradiation therapy, and consolidation chemotherapy. Here, we present preliminary results of this trial, reporting the tumor response, toxicities, and surgical complications. Methods and Materials: Fifty-one patients with LARC were enrolled, among which were two patients who were ineligible because of distant metastases before treatment. Patients were treated first with one cycle of induction chemotherapy consisting of oxaliplatin, 130 mg/m² on day 1, with capecitabine, 1000 mg/m² twice daily for 14 days every 3 weeks (the XELOX regimen), followed by chemoradiation therapy, 50 Gy over 5 weeks, with the modified XELOX regimen (oxaliplatin 100 mg/m²), and then with another cycle of consolidation chemotherapy with the XELOX regimen. Surgery was performed 6 to 8 weeks after completion of radiation therapy. Tumor responses, toxicities, and surgical complications were recorded. Results: All but one patent completed the planned schedule of neoadjuvant sandwich treatment. Neither life-threatening blood count decrease nor febrile neutropenia were observed. Forty-five patents underwent optimal surgery with total mesorectal excision (TME). Four patients refused surgery because of clinically complete response. There was no perioperative mortality in this cohort. Five patients (11.1%) developed postoperative complications. Among the 45 patients who underwent TME, pathologic complete response (pCR), pCR or major regression, and at least moderate regression were achieved in 19 (42.2%), 37 (82.2%), and 44 patients (97.8%), respectively. Conclusions: Preliminary results suggest that the strategy of neoadjuvant sandwich treatment using XELOX regimen as induction, concomitant, and consolidation chemotherapy to the conventional radiation is well tolerated. The strategy is highly effective in terms of pCR and major regression, which warrants further investigation.},
doi = {10.1016/J.IJROBP.2014.07.021},
url = {https://www.osti.gov/biblio/22420508}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 5,
volume = 90,
place = {United States},
year = {Mon Dec 01 00:00:00 EST 2014},
month = {Mon Dec 01 00:00:00 EST 2014}
}