Clinical Response and Toxicities of Neo-Adjuvant Concurrent Chemoradiation with Tablet Capecitabine or Mayo-Clinic Regimen in locally advanced Rectal Cancer: A Comparative Study

Abstract

Background: Neo-adjuvant Concurrent Chemoradiation (nCRT) with intravenous administration of 5-Fluorouracil/Leucovorin (Mayo-clinic regimen) or Tab. Capecitabine has been considered as standard protocol for locally advanced rectal cancer.

Objectives: To compare tumor response and toxicities of tablet Capecitabine or Mayo-clinic regimen along with External Beam Radiation Therapy (EBRT) in the treatment of locally advanced rectal cancer (stage IIC–IIIC). Methods: This quasi-experimental study was conducted at Department of Radiotherapy, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh from July 2019 to June 2020. A total of sixty (60) patients with locally advanced adenocarcinoma of the rectum (stage IIC–IIIC) were randomized into nCRT with tablet Capecitabine in Group A (Arm A) or Mayo-clinic regimen in Group B (Arm B) with thirty patients falling in each group. They were followed up for 3 months at a regular interval. Treatment response and toxicities were assessed and compared between the groups.

Results: The mean age of the patients in Arm A was 46.20 (SD±13.35) years and that was 41.80 (SD±12.55) years in Arm B (p= 0.193). Of them in Arm A; 19(63.33%) patients were male and 11(36.67%) were female and in Arm B; 17(56.67%) were male and 13(43.33%) were female. It was observed that, haematological toxicities, mucositis and proctitis were more common in the Mayo-clinic group. Gastrointestinal toxicities and the hand-foot syndrome were more common in the Caepacitabine group. There was a complete response rate of 33.33% in the Capecitabine group and 26.67% in the Mayoclinic group (p= 0.868).

Conclusion: There is no significant difference in tumor response and toxicities between Neo-adjuvant Concurrent Chemoradiation (nCRT) with ta