Is intensity-modulated radiotherapy plus capecitabine safe and effective for treating locally advanced rectal cancer?

This study assessed the safety and efficacy of intensity-modulated radiotherapy plus capecitabine (Xeloda) before rectal surgery.

Locally advanced rectal cancer indicates that the cancer has spread beyond the lining of the rectum or has spread to the nearby lymph nodes. Patients with locally advanced rectal cancer are usually treated with chemotherapy, radiation and surgery.

One of the most commonly used chemotherapy drugs is 5-fluorouracil (Efudex). It is normally administered by continuous injection over a number of days using a pump. Capecitabine is a newer drug which is converted to 5-fluorouracil in the body. It can be taken as a tablet making it more practical for patients. Intensity-modulated radiotherapy uses advanced technology to target the radiation beams directly at the tumor. This minimizes the exposure of the surrounding tissues to radiation and should reduce the risk of damage. The safety and efficacy of combining these two treatments requires further research.

This study examined the records of 260 patients to determine the efficacy and safety of combining capecitabine and intensity-modulated radiotherapy. Patients had locally advanced rectal cancer and received the radiotherapy and capecitabine over a period of 30 days. After an average of 8 weeks patients underwent surgery. Cancer relapse and cancer-specific survival (time until death from rectal cancer) were assessed for each patient. The rate of surgical complications were also recorded.

After 3 years cancer had returned in 18.6% of patients. The cancer had returned at or near the original site in 5.8% of patients. 7.8% of patients had died as a direct result of rectal cancer.

Complications occurred in 23.1% of patients after the surgery. However, severe complications only occurred in 2.7% of patients. The most common severe complication was anastomotic leakage (leaking of fluids from the point where the intestines are re-connected following removal of the tumor; 4 cases). The most common mild complication was with the surgical wounds (35 cases).

The study concluded that intensity-modulated radiotherapy plus capecitabine was safe and effective for treating patients with locally-advanced rectal cancer.