Publication:

Comparison of continuous infusional 5-fluorouracil and capecitabine in preoperative chemo radiotherapy for locally advanced rectal cancer: experience from a tertiary cancer centre from Southern India

Background Neoadjuvant concurrent chemoradiation (CTRT) is the recommended treatment for locally advanced rectal cancer. 5 Fluorouracil (5-FU) has been the standard chemotherapy drug, but recent studies have proved Capecitabine (CA) is as effective as 5-FU in terms of local response, distant recurrences and overall survival except toxicities. We conducted this study to evaluate acute toxicities and local response rates between 5-FU and CA as neoadjuvant treatment modality combined with radiation.

Methods All patients with newly biopsy proven adenocarcinoma of rectum of TNM stage T3N0/ any T with N1,N2 and in whom curative treatment was planned with concurrent chemoradiation dose of 5040cGy in 28 fractions were included in the study. From January 2013 to June 2014, a total of thirty patients were enrolled in this study, fifteen patients received 5-FU (arm A) and fifteen patients received CA (arm B) during concurrent chemoradiation. All patients were evaluated for acute toxicities during treatment using RTOG criteria. Local response was assessed radiographically after four weeks of completion of CTRT utilising RECIST (Response Evaluation Criteria in Solid Tumors) criteria and also assessed for surgery simultaneously. Postoperatively adjuvant chemotherapy was considered in all patients.

Results Grade III toxicities were more in 5-FU arm compared to CA arm. The local response rates were almost same in both the arms, partial response in 5-FU and CA arm were 53.3% and 60% respectively.

Conclusions This is the first Indian study comparing Capecitabine and continuous Infusional 5FU in neoadjuvant CTRT of standard advanced rectal cancer patients. Oral Capecitabine had same efficacy when compared to 5-FU in terms of local response rates as neoadjuvant treatment modality in locally advanced rectal cancer, but CA was better tolerated with better patient compliance and was less toxic.