Authors:
Aktham Sharif, M.D.,(1)
Munther Ajlouni, M.D.,(1)
Ira Wollner, M.D.,(2)
John C. Eggenberger, M.D.,(3)
Jae Ho Kim, M.D.,(1)
Alicia C. Shillington, Ph.D, MPH(4)

Abstract:

PURPOSE:
We report our experience with 27 rectal cancer patients receiving concurrent neoadjuvant irradiation and capecitabine.

METHODS:
27 patients out of 148 with rectal cancer were identified through the Henry Ford Hospital tumor registry who received concurrent chemotherapy and radiation between May, 1999 and December, 2002. Medical records of these patients were reviewed and data extracted.

RESULTS:
The population consisted of 18 males and 9 females with a median age of 64 years (range 35-84), each with histologically confirmed adenocarcinoma. Twenty-one were moderately differentiated, 5 well differentiated, and 1 poorly differentiated. The median dose of capecitabine was 1330mg/m2/day (range 825-1650mg/m2/day) administered orally for five days per week for the duration of radiation therapy. Patients also received a radiation dose of 50.4 Gy at 1.8 Gy per fraction for 51⁄2- 6 weeks. One patient underwent a trans-anal polypectomy, and because she expressed her desire not to have surgery following her neoadjuvant therapy - Gy at 1.8 Gy per fraction followed by 16 Gy boost at 2.0 Gy per fraction (total 61 Gy). Out of the 27 patients, 23 underwent surgery approximately 4-6 weeks post combined therapy. Of the remaining four, three refused surgery and one developed metastatic disease prior to her surgery and was treated with further chemotherapy. Eight patients had a low anterior resection, and fifteen had an abdomino-perineal resection. Five patients (22%) had a complete response, eleven (48%) had partial response, four (17%) had stable disease, and three (13%) patients suffered disease progression. One patient was referred to hospice care shortly after his surgery because of progression and subsequently died. No Grade 3 or 4 toxicities were observed. One patient reported mild Hand –Foot Syndrome (Palmar-Plantar erythrodysesthesia). No treatment related mortality was observed.

CONCLUSION:
Concurrent neoadjuvant capecitabine and radiation was tolerated very well. It has efficacy, which appears to be at least equivalent to 5FU infusion, has demonstrated less utilization of hospitalizations, antibiotics, antiemetics, and warrants further investigation in prospective trials.