Oxaliplatin-based Neo-adjuvant Concurrent Chemo-radiotherapy in Treating Locally Advanced Lower Rectal Cancer

Abstract

Purpose. Lower advanced rectal cancer, for surgeons, is problematic. Neo-adjuvant concurrent chemo-radiotherapy, described in last decade, leads local control at high percentage of R0 resection and pathologic response rate with compactable results in our published journal.1 Addition of oxaliplatin to 5-FU/leucovorin has been proposed because of evidence of improved disease-free and overall survival in patients with stage III colon cancer. 2, 3 We hypothesized whether by adding Oxaliplatin to CCRT regimen, better results could be achieved. Methods. From January 2008 to November 2008, 22 patients with locally advanced lower rectal cancer receiving Oxaliplatin-based Neo-adjuvant CCRT were enrolled for study group. From January 2005 to June 2007, 43 patients with locally advanced rectal cancer receiving non-Oxaliplatinbased Neo-adjuvant CCRT were enrolled for control group. Factors including circumferential margin and pathologic response rate were evaluated. Results. Three patients, not receiving post-CCRT curative resection were excluded. Pathologic response rate was 100%; complete response rate: 31.6% & partial response rate: 68.4% respectively. Oxaliplatin based group had a better pathologic response rate versus non-Oxaliplatin based group (100% vs. 79.1%, p=0.047) and excellent results in complete pathologic response (31.6% vs. 11.6%, p=0.031) and an improved circumferential margin rate (94.7% vs. 90.7%, p=1.00). Oxaliplatin based group had shorter stays (9.00±3.96 vs. 11.47±4.75, p=0.003) and less anastomosis leakage (5.3% vs. 27.8%, p=0.075). Conclusion. Oxaliplatin-based Neo-adjuvant CCRT gives locally advanced lower rectal cancer patients more favorable results without increasing complications.