Side Effects and Disease-Free Survival with Capecitabine Compared to 5FU for Concurrent Radiochemotherapy of Rectal Cancer: A 5-year Review

Abstract

Background: 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.