PREOPERATIVE RADIATION WITH CONCURRENT 5-FLUOROURACIL CONTINUOUS-INFUSION FOR LOCALLY ADVANCED UNRESECTABLE RECTAL-CANCER

Background and Purpose: To determine the percentage of complete respon ders and the resectability rate for patients with locally advanced car cinoma of the rectum treated by 5-fluorouracil (5-FU) infusional chemo therapy and pelvic radiation. Materials and Methods: Between October 1 992 and June 1996, 29 patients with a diagnosis of locally advanced un resectable rectal cancer received preoperative 5 FU by continuous intr avenous infusion at a dose of 225 mg/m(2)/day concurrent with pelvic r adiation (median 54 Gy/28 fractions). All patients were clinical stage T4 on the bases of organ invasion or tumor fixation. Median time for surgical resection was 6 weeks. Results: Median follow-up for the grou p was 28 months (range 5-57 months). Six patients were felt to be pers istently unresectable or developed distant metastases and did not unde rgo surgical resection. Of the 29 patients, 23 proceeded to surgery, 1 8 were resectable for cure, 13 by abdominoperineal resection, 3 by ant erior resection and 2 by local excision. Of the 29 patients, 4 (13%) h ad a complete response, and 90% were clinically downstaged. Of the 18 resected patients, 1 has died of his disease, 17 are alive, and 15 dis ease-free. The regimen was well tolerated; there was only one treatmen t-related complication, a wound dehiscence. Conclusion: The combinatio n of 5 FU infusion and pelvic radiation in the management of locally a dvanced rectal cancer is well tolerated and provides a baseline for co mparison purposes with future combinations of newer systemic agents an d radiation. (C) 1998 Elsevier Science Inc.