• Leire Arbea, Rafael Martínez-Monge, Juan A Díaz-González, Marta Moreno, Javier Rodríguez, Jose Luis Hernández, Jesús Javier Sola, Luis Isaac Ramos, Jose Carlos Subtil, Jorge Nuñez, Ana Chopitea, Mauricio Cambeiro, Miren Gaztañaga, Jesús García-Foncillas, and Javier Aristu.
• Department of Oncology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain. larbea@unav.es
• Int. J. Radiat. Oncol. Biol. Phys. 2012 Jun 1; 83 (2): 587-93.

PurposeTo validate tolerance and pathological complete response rate (pCR) of a 4-week preoperative course of intensity-modulated radiation therapy (IMRT) with concurrent capecitabine and oxaliplatin (CAPOX) in patients with locally advanced rectal cancer.Methods And MaterialsPatients with T3 to T4 and/or N+ rectal cancer received preoperative IMRT (47.5 Gy in 19 fractions) with concurrent capecitabine (825 mg/m(2) b.i.d., Monday to Friday) and oxaliplatin (60 mg/m(2) on Days 1, 8, and 15). Surgery was scheduled 4 to 6 weeks after the completion of chemoradiation. Primary end points were toxicity and pathological response rate. Local control (LC), disease-free survival (DFS), and overall survival (OS) were also analyzed.ResultsA total of 100 patients were evaluated. Grade 1 to 2 proctitis was observed in 73 patients (73%). Grade 3 diarrhea occurred in 9% of the patients. Grade 3 proctitis in 18% of the first 50 patients led to reduction of the dose per fraction to 47.5 Gy in 20 treatments. The rate of Grade 3 proctitis decreased to 4% thereafter (odds ratio, 0.27). A total of 99 patients underwent surgery. A pCR was observed in 13% of the patients, major response (96-100% of histological response) in 48%, and pN downstaging in 78%. An R0 resection was performed in 97% of the patients. After a median follow-up of 55 months, the LC, DFS, and OS rates were 100%, 84%, and 87%, respectively.ConclusionsPreoperative CAPOX-IMRT therapy (47.5 Gy in 20 fractions) is feasible and safe, and produces major pathological responses in approximately 50% of patients.Copyright © 2012 Elsevier Inc. All rights reserved.

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