Side Effects and Disease-Free Survival with Capecitabine Compared to 5FU for Concurrent Radiochemotherapy of Rectal Cancer: A 5-year Review
AbstractBackground: Considering the ease of administration of capecitabne instead of infusional 5FU for concurrent radiochemotherapy (RcT) of rectal cancer, the use of capecitabine has increased significantly in our radiation oncology department in the past years. Thus we decided to compare the safety and survival with these 2 drugs by a retrospective review.Methods: Files of all patients receiving RcT either pre- or post-operatively for rectal cancer in our department in the 5 years of 2004-2008 were reviewed. Side effects were compared for all patients treated by capecitabine versus 5FU; while for homogeneity of data, disease-free survival was only compared in the patients treated pre-operatively.Results: During the review period, 322 rectal cancer patients had received concurrent RcT in our department. Radiation dose-fractionation regimens were mostly 45 or 50 Gy in 25 fractions or 5040 in 28 fractions. The use of pre-operative treatments increased from 33% in 2004 to 67% in 2008. The use of capecitabine versus 5FU also went up from 2% in 2004 to 65% in 2008. The grades of leucopenia, thrombocytopenia and radiation dermatitis were significantly higher in the 5FU group (p<0.05). There was only one case of hand-foot syndrome, observed in the capecitabine group. In the 102 patients (66.7% male with a mean age of 53.7 years) who had received pre-operative RcT, median disease-free survival was 53% for all patients, with no statistically significant difference between the patients treated by capecitabine and 5FU.Conclusions: The use of capecitabine for concurrent RcT of rectal cancer in our patients was easy and safe, with a favorable acute side-effect profile compared to 5FU, and comparable survival.
Berg DT. Capecitabine: a new adjuvant option for colorectal cancer. Clin J Oncol Nurs. 2006 Aug;10(4):479-86.
Qiu MZ, Teng KY, Ruan DY, et al.Impact of adjuvantchemotherapy- duration on 3-yeardisease-freesurvival of colorectalcarcinomapatient- safterradicalresection.Ai Zheng. 2009 Jul;28(7):743-8. [In Chinese]
Sauer R, Becker H, Hohenberger W, et al. Preoperativeversuspost- operative chemoradiotherapy for rectal cancer. N Engl J Med.2004 Oct 21;351(17):1731-40.
Sun W, Haller DG.Chemotherapy for colorectal cancer. Hematol On- col Clin North Am. 2002 Aug;16(4):969-94.
André T, Louvet C, de Gramont A.Colon cancer: what is new in 2004?.Bull Cancer. 2004 Jan;91(1):75-80. [In French]
Saif MW, Hashmi S, Zelterman D, et al.Capecitabinevscontinuous infusion5-FU in neoadjuvanttreatment of rectalcancer. A retrospecti- vereview. Int J Colorectal Dis. 2008 Feb;23(2):139-45.
Faithfull S, Deery P.Implementation of capecitabine (Xeloda) into a cancercentre: UKexperience.Eur J Oncol Nurs. 2004;8 Suppl 1:S54-62.
Saif MW, Katirtzoglou NA, Syrigos KN.Capecitabine: an over- view of the side effects and their management.Anticancer Drugs. 2008 Jun;19(5):447-64.
Roche. Xeloda (capecitabine). [product information]. Nutley: Ro- chePharmaceuticals; 2003
Cancer Therapy Evaluation Program,2006. Common terminology criteria for adverse events v3.0 (CTCAE). (http://ctep.cancer.gov).
Wiltshire KL, Ward IG, Swallow C,et al .Preoperative radiation with concurrentchemotherapy for resectablerectal cancer: effect of dose es- calation on pathologiccompleteresponse, local recurrence-free survival, disease-free survival, and overall survival. Int J Radiat Oncol Biol Phys. 2006 Mar 1;64(3):709-16.
Dunst J, Reese T, Sutter T,et al. Phase I trial evaluating the con- current combination of radiotherapy and capecitabine in rectal cancer.J Clin Oncol. 2002 Oct 1;20(19):3983-91.
Kim JC, Kim TW, Kim JH,et al. Preoperativeconcurrentradiothera- py with capecitabine before totalmesorectalexcision in locallyadvance- drectal cancer.Int J Radiat Oncol Biol Phys. 2005 Oct 1;63(2):346-53.
Chan AK, Wong AO, Jenken DA. Preoperativecapecitabine and pel- vicradiation in locally advancedrectal cancer—is it equivalent to 5-FU infusion plus leucovorin and radiotherapy?.Int J Radiat Oncol Biol Phys. 2010 Apr;76(5):1413-9.
Hofheinz RD, Wenz F, Post S ,et al. Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a andomized, multicentre, non-inferiority, phase 3 trial. Lancet Oncol. 2012 Jun;13(6):579-88.
Desai SP, El-Rayes BF, Ben-Josef E,et al .A phase II study of preop- erativecapecitabine and radiation therapy in patients with rectal cancer.Am J Clin Oncol. 2007 Aug;30(4):340-5.
Veerasarn V, Boonnuch W, Chinswangwatanakul V,et al .Preopera- tivechemoradiation for locallyadvancedrectalcancer with capecitabine 2,000 mg/m2/day.J Med Assoc Thai. 2008 Oct;91(10):1583-8.
Kim JS, Kim JS, Cho MJ,et al. Comparison of the efficacy of oral capecitabine versus bolus 5-FU in preoperative radiotherapy of locally advanced rectal cancer. J Korean Med Sci. 2006 Feb;21(1):52-7.
Ramani VS, Sun Myint A, Montazeri A, et al. Preoperative chemo- radiotherapy for rectal cancer: a comparison between intravenous 5-fluorouracil and oral capecitabine.Colorectal Dis. 2010 Aug;12 Suppl 2:37-46.
|Issue||Vol 6 No 1 (2014)|
|Rectal carcinoma Radiochemotherapy 5FU Capecitabine|
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