Preoperative radiation with concurrent 5-fluorouracil continuous infusion for locally advanced unresectable rectal cancer |
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| Institution: | 1. London Regional Cancer Centre, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada;2. Department of Surgery, St. Joseph’s Health Centre London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada;3. Department of Surgical Oncology, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada;1. Ghent University Hospital, Department of Radiation Oncology and Experimental Cancer Research, Belgium;2. Ghent University, Biostatistics Unit, Department of Public Health, Faculty of Medicine and Health Sciences, Belgium;3. Ghent University Hospital, Department of Radiology, Belgium;4. Ghent University Hospital, Department of Urology, Belgium;1. Division of Gynecologic Oncology, University of Toronto, Toronto, Canada;2. Division of Gynecologic Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada;3. Division of Gynecologic Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada;1. The University of Texas MD Anderson Cancer Center, Houston, TX, USA;2. Vanderbilt-Ingram Cancer Center, Nashville, TN 37232, USA;1. Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy;2. Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France;3. Department of Thoracic Surgery, Nancy University Hospital, Nancy, France;4. Department of Biostatistics, Strasbourg University Hospital, Strasbourg, France;5. Unit of Pulmunology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy |
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| Abstract: | Background and Purpose: To determine the percentage of complete responders and the resectability rate for patients with locally advanced carcinoma of the rectum treated by 5-fluorouracil (5-FU) infusional chemotherapy and pelvic radiation.Materials and Methods: Between October 1992 and June 1996, 29 patients with a diagnosis of locally advanced unresectable rectal cancer received preoperative 5 FU by continuous intravenous infusion at a dose of 225 mg/m2/day concurrent with pelvic radiation (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 group was 28 months (range 5–57 months). Six patients were felt to be persistently unresectable or developed distant metastases and did not undergo surgical resection. Of the 29 patients, 23 proceeded to surgery, 18 were resectable for cure, 13 by abdominoperineal resection, 3 by anterior resection and 2 by local excision. Of the 29 patients, 4 (13%) had a complete response, and 90% were clinically downstaged. Of the 18 resected patients, 1 has died of his disease, 17 are alive, and 15 disease-free. The regimen was well tolerated; there was only one treatment-related complication, a wound dehiscence.Conclusion: The combination of 5 FU infusion and pelvic radiation in the management of locally advanced rectal cancer is well tolerated and provides a baseline for comparison purposes with future combinations of newer systemic agents and radiation. |
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