Comparative study between neo-adjuvant FOLFOX4 followed by combined chemoradiotherapy and standard concomitant chemoradio-therapy in the treatment of patients with locally advanced rectal mucinous adenocarcinoma

الملخص EN

Background : Rectal mutinous adenocarcinoma (RMAD) often present at an advanced stage and have the poorest overall prognosis.

Aim : To compare the response, disease free survival, overall survival and toxicity profile of neo-adjuvant FOFOX4 followed by combined chemo radio- therapy and standard concomitant chemo radiation in the treatment of patients with locally advanced mutinous adenocarcinoma of rectum.

Material and Methods : Between December 2006 to December 2008, 90 patients aged 18 to 65 years with locally advanced RMAD (T3 or T4) were assessed prospectively, staging workup was by CT scan.

Patients were divided into 2 groups.

Group A: 45 patients who received FOLFOX4 every 2 weeks for eight consecutive weeks, on week nine, a combined schedule of chemo radiotherapy was given using 5-fluorouracil and Ca leucovorine concomitantly with radiation therapy at a dose of 45 Gy in 25 fractions to the whole pelvis followed by boost of 9 Gy to the tumour bed.

Group B: 45 patients received concomitant chemo radiotherapy using 5 Fu and Ca leucovorine as per Mayo clinic regimen with the same dose as in group A.

For both groups total mesorectal excision was arranged 4-6 weeks after completing the above described treatment to be followed by further 8 doses of FOLFOX4 in group A or 4 cycles of Mayo regimens post operatively at the same described dosing schedule.

Result : All patients undergoing neoadjuvant chemo radiotherapy completed therapy as planned, with no treatment-related interruptions.

Overall objective response rates by RECIST criteria were 89% in both groups.

Additionally all patients experience improvement in rectal bleeding, pelvic pain as shown in verbal questionnaire.

All patients underwent Ro resection.

Pathological complete response was found in 42.2% in group A and 22.2% in group B.

There was statistically significant difference between the studied groups regarding overall survival and disease free survival at 2 year.

Conclusion : Neoadjuvant FOLFOX4 followed by combined chemo radio-therapy in RMAD results in marked tumor regression, rapid symptomatic improvement, the attainment of Ro resection and improvement of pathological complete response, disease free and overall survival.