Evaluation of short-course radiotherapy followed by neoadjuvant bevacizumab, capecitabine, and oxaliplatin and subsequent radical surgical treatment in primary stage IV rectal cancer.

T.H. van Dijk, K. Tamas, J.C. Beukema, G.L. Beets, A.J. Gelderblom, K.P. de Jong, I.D. Nagtegaal, H.J. Rutten, C.J. van de Velde, T. Wiggers, G A. Hospers, K. Havenga

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Abstract

Background: To evaluate the efficacy and tolerability of preoperative short-course radiotherapy followed by capecitabine and oxaliplatin treatment in combination with bevacizumab and subsequent radical surgical treatment of all tumor sites in patients with stage IV rectal cancer.

Patients and methods: Adults with primary metastasized rectal cancer were enrolled. They received radiotherapy (5 x 5 Gy) followed by bevacizumab (7.5 mg/kg, day 1) and oxaliplatin (130 mg/m(2), day 1) intravenously and capecitabine (1000 mg/m(2) twice daily orally, days 1-14) for up to six cycles. Surgery was carried out 6-8 weeks after the last bevacizumab dose. The percentage of radical surgical treatment, 2-year survival and recurrence rates, and treatment-related toxicity was evaluated.

Results: Of 50 included patients, 42 (84%) had liver metastases, 5 (10%) lung metastases, and 3 (6%) both liver and lung metastases. Radical surgical treatment was possible in 36 (72%) patients. The 2-year overall survival rate was 80% [95% confidence interval (Cl) 66.3%-90.0%]. The 2-year recurrence rate was 64% (95% Cl 49.8%-84.5%). Toxic effects were tolerable. No treatment-related deaths occurred.

Conclusions: Radical surgical treatment of all tumor sites carried out after short-course radiotherapy, and bevacizumab-capecitabine-oxaliplatin combination therapy is a feasible and potentially curative approach in primary metastasized rectal cancer.

Original languageEnglish
Pages (from-to)1762-1769
Number of pages8
JournalAnnals of Oncology
Volume24
Issue number7
DOIs
Publication statusPublished - Jul 2013

Keywords

  • bevacizumab
  • neoadjuvant chemotherapy
  • preoperative radiotherapy
  • rectal cancer
  • stage IV
  • COLORECTAL LIVER METASTASES
  • RANDOMIZED PHASE-III
  • PREOPERATIVE RADIOTHERAPY
  • RADIOFREQUENCY ABLATION
  • RADIATION-THERAPY
  • HEPATIC RESECTION
  • DELAYED SURGERY
  • TRIAL
  • CHEMOTHERAPY
  • RECURRENCE

Cite this

van Dijk, T. H., Tamas, K., Beukema, J. C., Beets, G. L., Gelderblom, A. J., de Jong, K. P., Nagtegaal, I. D., Rutten, H. J., van de Velde, C. J., Wiggers, T., Hospers, G. A., & Havenga, K. (2013). Evaluation of short-course radiotherapy followed by neoadjuvant bevacizumab, capecitabine, and oxaliplatin and subsequent radical surgical treatment in primary stage IV rectal cancer. Annals of Oncology, 24(7), 1762-1769. https://doi.org/10.1093/annonc/mdt124