Oral fluorpyrimidines in preoperative chemoradiotherapy for operable rectal cancer

Abstract

Background. The aim of this study was to compare short and long-term outcomes after neoadjuvant short-course chemoradiotherapy with capecitabine ot tegafur for operable rectal cancer.Materials and methods. Patients with histologycally verified Т3N0M0, Т2–3N1–2M0 rectal cancer, who underwent 5 × 5 Gy neoadjuvant radiotherapy with local 41–45 °C hyperthermia on days 3–5 and metronidazole 10 g/m2 per rectum days 3, 5 were randomized to receive capecitabine 1000 mg/m2 bid per os days 1–14 or tegafur 400 mg/m2 bid per os days 1–21. Toxicity, tumor regression, sphincter preservation rate and long-term outcomes were analyzed.Results. During 2011–2013 26 patients were included in the tegafur group and 30 – in capecitabine group. Overall toxicity was 50 % in the tegafur arm and 36.7 % in the capecitabine arm (p = 0.42), grade III–IV toxicity (diarrhoea was the most common grade 3+ event) was observed in 23.1 % and 6.7 % (p = 0.13) patients accordingly. Grade III–IV tumor regression was observed in 34.6 % patients, who received tegafur and 53.3 % (p = 0.12) patients who received capecitabine. Sphincter-sparing surgery was performed in 84.6 % and 100 % (p = 0.04) patients who received tegafur and capecitabine accordingly. Median follow-up was 31.6 and 32.2 months accordingly. 3-year overall survival in capecitabine and tegafur arms was 95.4 and 82.1 % (р = 0.13), 3-year disease-free survival – 91 and 74 % (р = 0.029).Conclusions. Both fluorpyrimidines demonstrated comparable short-term outcomes with a tendency to better results in the capecitabine arm.

Keywords

• rectal cancer
• chemoradiotherapy
• fluorpyrimidines
• capecitabine
• tegafur
• sphincter-sparing surgery