convert: neoadjuvant chemotherapy alone versus preoperative chemoradiation for locally advanced rectal cancer patients

Conditions: Rectal Neoplasms

Summary: although neoadjuvant radiotherapy greatly decreases local recurrence in locally advanced rectal cancer patients undergoing surgery, it inevitably results in short-term and long-term toxicities. more importantly, it has not been confirmed that neoadjuvant radiotherapy could improve overall survival. the purpose of this study is to compare the effects of chemotherapy alone using a combination regimen known as xelox (capecitabine and oxaliplatin ) and selective use of the standard treatment to the standard treatment of chemotherapy and radiation.

this randomised, open-label, multicentre,phase 3 trial began in august, 2014, as an adjuvant trial comparing capecitabine-based neoadjuvant chemoradiotherapy with chemotherapy alone,in patients aged 18 years to 75 with clinical stage ii-iii locally advanced rectal cancer from six chinese institutions. patients with local advanced rectal cancer (t2n+ or t3-4anany,m0, crm≥2mm, 12cm from the anus verge) were scheduled to group a: receive neoadjuvant chemotherapy alone (4 cycles of xelox: oxaliplatin 130mg/m2 day 1，capecitabine 2000mg/m2 days 1-14, repeated every 21 days) followed by radical surgery and 4 cycles of xelox ( oxaliplatin 130mg/m2 day 1，capecitabine 2000mg/m2 days 1-14, repeated every 21 days) and group b :chemoradiotherapy (50.4 gy plus capecitabine 1650 mg/m² administered orally and concurrently with radiation therapy for 5 days per week.) followed by radical surgery and 6 cycles of xelox ( oxaliplatin 130mg/m2 day 1，capecitabine 2000mg/m2 days 1-14, repeated every 21 days) the primary endpoint was 3-year local recurrence free survival; analyses were done based on all patients with post-randomization data.

Eligibility criteria:
inclusion criteria: disease characteristics: * diagnosis of rectal adenocarcinoma * radiologically measurable or clinically evaluable disease * tumor location within 12cm from anal verge * clinical stage t2n+ or t3-4anany,m0 clinical staging should be estimated based on the combination of the following assessments: physical examination by the primary surgeon, ct scan of the chest/abdomen/pelvis, and a pelvic mri with or without an endorectal ultrasound (erus) * no evidence that tumor is adjacent to (defined as within 2 mm of) the mesorectal fascia on pre-operative mri * no tumor causing symptomatic bowel obstruction * no distant metastasis patient characteristics: * ecog performance status 0, 1 * white blood cell (wbc) ≥ 4,000/mm³ * platelets ≥ 100,000/mm³ * hemoglobin \> 10.0 g/dl * total bilirubin ≤ 1.5 times upper limit of normal (uln) * ast and alt ≤ 1.5 times uln * creatinine ≤ 1.5 times uln * no co-morbid illnesses or other concurrent disease that, in the judgment of the clinician obtaining informed consent, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens exclusion criteria: * pregnant or nursing * patient of child-bearing potential is not willing to employ adequate contraception * not willing to return to enrolling medical site for all study assessments * with other invasive malignancy ≤ 5 years prior to registration; exceptions are colonic polyps, non-melanoma skin cancer, or carcinoma-in-situ of the cervix * chemotherapy within 5 years prior to registration (hormonal therapy is allowable if the disease-free interval is ≥ 5 years) * prior pelvic radiation

Keywords: neoadjuvant chemotherapy preoperative radiotherapy chemoradiotherapy capecitabine oxaliplatin