Capecitabine-oxaliplatin (CAPOX) prior to chemoradiotherapy (CRT) and surgery in magnetic resonance imaging (MRI)-defined poor-risk rectal carcinoma (PRRC): A single center experience.

Abstract

e15638 Background: Clinical trials have studied the efficacy and safety of neoadjuvant chemotherapy (CT) and CRT in PRRC. Chau published his data on PRRC studied with MRI: tumors within 1 mm of mesorectal fascia, T3 at or below levators, tumors extending > 5 mm into perirectal fat, T4 and T1-4N2 tumors (JCO 2006; 245: 668-674). Following this strategy, we present the data from our center. Methods: between February 2006- July 2018 we treated 77 PT with MRI-defined PRRC with CAPOX x 4 cycles, Capecitabine-radiotherapy, surgery and capecitabine 4 cycles (Chau strategy). Results: Our sample includes 43 men and 34 women, median age 59 (range 31-77). A patient died after the first CAPOX due to a hemorrhagic stroke. 69 PT had symptomatic improvement with CT, without identifying any progression. Surgery has performed in 75 PT and 65 had R0 resection, R1 in 6 patients, R2 in 2 patients and 2 lost. On an intent-to-treat analysis, pathological complete responses was achieved in 13 (pCR: 16,9%) of patients. The mean number of lymph nodes removed was 11. 51 patients (66,2%) started CT post-surgery. With a median follow up of 113 months [range 24-199],26 patient (33,8%) presented disease progression, 5 local and 21 distant recurrence. There were 14 deaths due to disease progression. 5-years OS was 87% (CI 95%: 79,4-94,6%) and DFS was 80,2 (CI 71-89,4%). Conclusions: Our data support the rutine use of CAPOX and following CRT prior to surgery on PT with PRRC, with promising results consistent with published trial data.