Effect of neoadjuvant concurrent three-dimensional conformal chemoradiotherapy with conventional two-dimensional chemoradiotherapy in locally advanced rectal cancer
DOI:
https://doi.org/10.18203/2349-3933.ijam20241010Keywords:
Chemoradiotherapy, Neoadjuvant, Radiation, Rectal cancer, ToxicityAbstract
Background: Rectal carcinoma is a prevalent clinical condition, and treatment hinges on factors like tumor specifics, staging, grading, and histopathological characteristics. While surgery remains the primary treatment, neoadjuvant chemoradiotherapy, particularly using 3D-CRT, has proven effective in reducing local recurrence rates for locally advanced cases. Alternatively, 2D-RT is considered for neoadjuvant treatment. This study aimed to compare the impact of neoadjuvant concurrent three-dimensional conformal chemoradiotherapy with conventional two-dimensional chemoradiotherapy in the context of locally advanced rectal cancer.
Methods: In this multicentre quasi-experimental study, 60 patients with biopsy-proven adenocarcinoma and clinically confirmed locally advanced rectal cancer, were divided into Group A (receiving oral capecitabine with three-dimensional conformal radiotherapy) and Group B (receiving the same capecitabine dose with 50 Gy two-dimensional radiotherapy). After surgery within 6-12 weeks, outcomes were analysed.
Results: After neoadjuvant chemoradiotherapy, clinical complete response rates were 16.7% in Group A and 10.0% in Group B, with a higher pathological complete response in Group A (10.0% vs. 3.3%). Tumor downsizing occurred in 83.3% of Group A and 73.3% of Group B, and sphincter-sparing surgery was achieved in 73.3% of Group A and 56.7% of Group B. Grade 2 toxicities included anemia (10.0% vs. 13.3%), leucopenia (13.3% vs. 20.0%), diarrhoea (10.0% vs. 16.7%), proctitis (13.3% vs. 40.0%), and urinary toxicity (10.0% vs. 20.0%). Grade-1 toxicities were nausea (20.0% vs. 40.0%), vomiting (20.0% vs. 36.7%), mucositis (56.7% vs. 60.0%), hand-foot syndrome (33.3% vs. 40.0%), and urinary toxicity (43.3% vs. 56.67%), with significant proctitis in Group A (p=0.012). Other toxicities showed non-significant p-values (>0.05).
Conclusions: Tumour response was not statistically significant between the patients of concurrent 3D-CRT and 2D-RT Arms. But the patients of 3D-CRT arm showed better response arithmetically. Also, there was an observable significant reduction of toxicities (lower gastrointestinal) in the 3D-CRT arm.
References
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clinic. 2018;68(6):394-424.
Directorate General of Health Services, Ministry of Health and Family Welfare. National cancer control strategy and plan of action, 2009-2015. Dhaka: Non-Communicable Diseases and Other Public Health Interventions, 2008. Available at: https://www.iccp-portal.org/system/files/plans/Publication_Cancer_Strategy.pdf.pdf. Accessed on 12th January 2024.
Jemal A, Center MM, DeSantis C, Ward EM. Global patterns of cancer incidence and mortality rates and trends. Can Epidemiol Biomark Prevent. 2010;19(8):1893-907.
Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, et al. Guidelines 2000 for colon and rectal cancer surgery. J Nat Cancer Insti. 2001;93(8):583-96.
Steven K. Libutti, Leonard B. Saltz, Christopher G. Willett, and Rebecca A. Levine. Cancer of the Colon. In: V. DeVita Jr., T. Lawrence and S. Rosenberg, ed., DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology. 11th ed. Philadelphia: Wolters Kluwer Health and Lippincott Williams & Wilkins; 2019:970-992.
Bamia C, Lagiou P, Buckland G, Grioni S, Agnoli C, Taylor AJ, et al. Mediterranean diet and colorectal cancer risk: results from a European cohort. Europ J Epidemiol. 2013;28(4):317-28.
Barrett A, Dobbs J, Morris S, Roques T. Practical radiotherapy planning. 4th ed. London: Hodder Arnold; 2009:165.
Beck DE, Roberts PL, Saclarides TJ, Senagore AJ, Stamos MJ, Nasseri Y. eds. The ASCRS textbook of colon and rectal surgery. Springer Science & Business Media; 2011.
Gérard JP, Conroy T, Bonnetain F, Bouché O, Chapet O, Closon-Dejardin MT, et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clini Oncol. 2006;24(28):4620-5.
Cancer Registry Report. System wise distribution of the cancers. Hospital Based Cancer Registry Report. National Institute of Cancer Research and Hospital, 2014.
Hofheinz RD, Wenz F, Post S, Matzdorff A, Laechelt S, Hartmann JT, et al. Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised, multicentre, non-inferiority, phase 3 trial. Lancet Oncol. 2012;13(6):579-88.
Gunnlaugsson A, Kjellen E, Nilsson P, Bendahl PO, Willner J, Johnsson A. Dose-volume relationship between enteritis and irradiated bowel volumes during 5-fluouracil and oxaliplatin based chemoradiotherapy in locally advanced rectal cancer. Acta Oncol. 2007;46:937-44.
Corner C, Khimji F, Tsang Y, Harrison M, Glynne-Jones R, Hughes R. Comparison of conventional and three-dimensional conformal CT planning techniques for preoperative chemoradiotherapy for locally advanced rectal cancer. Brit J Radiol. 2011;84(998):173-8.
Mahmoud M, El-Hossiny HA, Diab NA, El Razek MA. A comparative dosimetric study of neoadjuvant 3D conformal radiotherapy for operable rectal cancer patients versus conventional 2D radiotherapy in NCI-Cairo. Chin-Germ J Clin Oncol. 2012;11:224-8.
Wagman R, Minsky BD, Cohen AM, Guillem JG, Paty PP. Sphincter preservation in rectal cancer with preoperative radiation therapy and coloanal anastomosis: long term follow-up. Int J Radiat Oncol Biolo Phys. 1998;42(1):51-7.
