Evaluation of Response and Toxicity in Patients with Locally Advanced Rectal Cancer Treated with Neoadjuvant Chemoradiation

Abstract

Aims and Objective: To study response after giving neoadjuvant chemoradiation in patients with locally advanced rectal cancer with Cap capecitabine 825 mg/m2 daily PO Bid with radiation in dose of 45Gy/20#/4 weeks and to study to the clinical profile of different patients with locally advanced rectal cancer and to assess the toxicity of patients treated with neoadjuvant chemoradiation
 Materials and Methods: A prospective observational study was conducted in 60 patients from October 2018 to April 2020 with locally advanced Rectal carcinoma which were proven histopathologically. Neoadjuvant chemoradiation was planned with Capecitabine 825mg/m2 PO Bid with radiation to a dose of 45 Gy/20#/4 weeks. Radiological response assessed after 6 weeks of completion of treatment and then surgery was planned according to response.
 Results: Thirty-seven patients received definitive surgery. Pathological complete response was observed in 1 patient, near complete response in 7, partial response in 27 and poor or no response was seen in 2 patients. Among 37 patients who have undergone surgery ,30% of patients received sphincter preserving surgery. Radiation induced acute skin and acute lower gastrointestinal were seen. Capecitabine induced diarrhea, hematological toxicities and few patients of hand foot syndrome were seen.
 Conclusion: In locally advanced rectal cancer, preoperative radio chemotherapy with Capecitabine improves local control and reduces the risks of acute and late toxicity as compared to postoperative radio chemotherapy . Thus, preoperative radio chemotherapy with Capecitabine is safe and well-tolerated in locally advanced rectal cancer, especially in tumors of the lower and middle rectum.
 Keywords: Rectal Cancer, Capecitabine, Neoadjuvant Chemoradiation