Long-course neoadjuvant chemoradiotherapy with versus without a concomitant boost in locally advanced rectal cancer: a randomized, multicenter, phase II trial (FDRT-002)

Jingwen Wang, Yun Guan, Weilie Gu, Senxiang Yan, Juying Zhou, Dan Huang, Tong Tong, Chao Li, Sanjun Cai, Zhen Zhang, Ji Zhu, Jingwen Wang, Yun Guan, Weilie Gu, Senxiang Yan, Juying Zhou, Dan Huang, Tong Tong, Chao Li, Sanjun Cai, Zhen Zhang, Ji Zhu

Abstract

Background: This study was designed to explore whether an intensified chemoradiotherapy (CRT) led to a better clinical outcome in locally advanced rectal cancer.

Methods: Patients with stage II/III rectal cancer were randomly allocated to receive either pelvic intensity-modulated radiation therapy (IMRT) of 50 Gy/25Fx concurrently with capecitabine and oxaliplatin (Arm A), or pelvic radiation of 50 Gy/25Fx with a concomitant boost of 5 Gy to the primary lesion, followed by a cycle of XELOX 2 weeks after the end of CRT (Arm B). All patients were planned to receive a definitive operation 8 weeks after the completion of CRT and a total of six perioperative chemotherapy cycles of capecitabine and oxaliplatin regardless of pathological result. Pathological complete response (ypCR) was the primary endpoint.

Results: From February 2010 to December 2011, 120 patients from three centers were enrolled in this study. Ninety-five percent patients completed a full-dose chemoradiotherapy as planning. Then 53 and 57 patients received a radical surgery, and 8 and 14 cases were confirmed as ypCR in two groups (P = 0.157). The other 10 patients failed to receive a definitive resection because of unresectable disease. Similar toxicities were observed between two groups and more incision healing delay were found in Arm B (3 vs.13, P = 0.011). No statistical differences were observed in local-regional control (P = 0.856), disease-free survival (P = 0.349) and overall survival (P = 0.553). Mesorectal fascia (MRF) involvement was an independent prognostic factor for survival in multivariate analysis.

Conclusions: A concomitant boost to oxalipatin-combined preoperative chemoradiotherapy demonstrated a slightly higher pCR rate but delayed incision healing after surgery. The impact of MRF involvement on survival merits further investigations.

Trial registration: NCT01064999 (ClinicalTrials.gov).

Keywords: Intensity-modulated radiation therapy; Neoadjuvant chemoradiotherapy; Rectal cancer.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Treatment schedules
Fig. 2
Fig. 2
CONSORT for FDRT-002 trial. Arm A, 5 weeks of treatment with radiotherapy 50 Gy/25 fractions with concurrent capecitabine 625 mg/m2 twice daily 5 days per week and oxaliplatin 50 mg/m2 once weekly; Arm B, 5 weeks of treatment with radiotherapy 55 Gy/25 fractions with concurrent capecitabine 625 mg/m2 twice daily 5 days per week and oxaliplatin 50 mg/m2 once weekly, followed by a cycle of XELOX. ITT, intention to treat; TME, total mesorectal excision
Fig. 3
Fig. 3
Long-term survival. a Cumulative incidence of local recurrences; b Disease-free survival and c Overall survival in the intention-to-treat population

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