Fa. Calvo et al., Pathologic downstaging of T3-4NX rectal cancer after chemoradiation: 5-fluorouracil vs. Tegafur, INT J RAD O, 51(5), 2001, pp. 1264-1270
Citations number
39
Categorie Soggetti
Radiology ,Nuclear Medicine & Imaging","Onconogenesis & Cancer Research
Journal title
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
Purpose: To describe downstaging effects in locally advanced rectal cancer
induced by 2 fluopirimidine radiosensitizing agents given through different
routes in conjunction with preoperative radiotherapy.
Methods and Materials: From March 1995 to December 1999, two consecutive gr
oups of patients with cT(3-4)N(x) rectal cancer (94% CT scan, 71% endorecta
l ultrasound) were treated with either (1) 45-50 Gy (1.8 Gy/day, 25 fractio
ns) and 5-fluorouracil (5-FU) (500-1,000 mg/m(2) by 24-h continuous i.v. in
fusion on Days 1-4 and 21-25) or (2) oral Tegafur (1,200 mg/day on Days 1-3
5, including weekends). Surgery was performed 4 to 6 weeks after the comple
tion of chemoradiation.
Results: The total T downstaging rate was 46% in the 5-FU group and 53% in
the Tegafur group. Subcategories were downstaged by the sensitizing agents
(5-FU vs. Tegafur) as follows: pT(0-1), 14% vs. 23%; pT(2), 32% vs. 32%; pT
(3), 49% vs. 37%; pT(4), 5% vs. 7%; and N-0, 74% vs. 86%. Analysis of resid
ual malignant disease in the specimen discriminated mic/mac subgroups (mic:
<20% of microscopic cancer residue), with evident superior downstaging eff
ects in the Tegafur-treated group: pTmic 23% vs. 58% (p = 0.002).
Conclusions: When administered concurrent with pelvic irradiation, oral Teg
afur induced downstaging rates in both T and N categories superior to those
induced by intermediate doses of 5-FU by continuous i.v. infusion. In this
pilot experience, oral Tegafur reproduced the characteristics of downstagi
ng described previously when full doses of 5-FU have been combined with rad
iotherapy. (C) 2001 Elsevier Science Inc.