Application Of FOLFOX And FOLFIRI In Neoadjuvant Chemotherapy Of Advanced Rectal Cancer

ObjectiveEvaluate the effect of FOLFOX and FOLFIRI regimen on the neoadjuvantchemotherapy, and provide the basis for individualized treatment oneffectiveness and adverse reactions for advanced rectal cancer.Methods63advanced rectal cancer patients which received NACT with FOLFOXor FOLFIRI regimen were reviewed retrospectively in our hospital fromJune2007to June2011.Results:1. The diameter of tumor were4.07cm±1.1with FOLFOX vs.4.11cm±0.93with FOLFIRI before treatment, after treatment3.73cm±1.0vs.3.72cm±0.84;the thickness of tumor were1.74cm±0.41with FOLFOX vs.1.85cm±0.59with FOLFIRI before treatment, after treatment1.17cm±0.28vs.1.23cm±0.45.There was no significant difference between the two regimens.2. The level of carcinoembryonic antigen （CEA） in the treatments: beforeNACT,12.85ng/ml with FOLFOX vs.13.05ng/ml with FOLFIRI; twoweeks after the1st NACT,9.85ng/ml vs.9.17ng/ml; two weeks after the2ndNACT,8.58ng/ml vs.6.52ng/ml;2weeks after operation,4.01ng/ml vs.2.68ng/ml;3months after operation,2.88ng/ml vs.2.43ng/ml;6months after operation,3.24ng/ml vs.2.96ng/ml.3. The leukocyte in the treatment: before NACT,7.49×10⁹/L with FOLFOXvs.7.61×10⁹/L with FOLFIRI;7days after the1st NACT,5.24×10⁹/L vs.5.51×10⁹/L;14days after the1st NACT,6.17×10⁹/L vs.5.24×10⁹/L;7daysafter the2nd NACT,4.68×10⁹/L vs.5.10×10⁹/L; before operation,5.78×10⁹/Lvs.5.35×10⁹/L. The erythrocyte in the treatments: before NACT,4.06×10¹²/L with FOLFOX vs.4.21×10¹²/L with FOLFIRI;7days after the1st NACT,3.99×10¹²/L vs.4.17×10¹²/L;14days after after the1st NACT,4.07×10¹²/L vs.3.96×10¹²/L;7days after the2nd NACT,4.19×10¹²/L vs.3.99×10¹²/L; before operation,4.18×10¹²/L vs.3.97×10¹²/L.4. There were13patients, appeared neurotoxicity, after the1st NACT withFOLFOX and12patients, appeared neurotoxicity, after the2nd NACT. Therewere3patients with diarrhea with FOLFOX and2patients with FOLFIRIafter the1st NACT，3patients with diarrhea with FOLFOX and9patientswith FOLFIRI after the2nd NACT. There were26patients who nauseated andvomited with FOLFOX and12patients with FOLFIRI after the1st NACT;there were18patients who nauseated and vomited with FOLFOX and9patients with FOLFIRI after the2nd NACT.Conclusion1. Of the two regimens, the effects on shrinking volume and down staging arethe same. Also they have therapeutic benefits on rectal tenesmus and stool. 2. The CEA with FOLFIRI is hold in a lower level than FOLFOX, but therewas no significant difference between them. The value of CA199isnot affected significantly by neither of the two regiments.3. Myelosuppression usually appears after NACT. The effect of inhibitingleukocyte with FOLFOX is shorter than FOLFIRI. The leukocyte reboundssignificantly in the intermittent period. After the second course of NACT, theleukocyte drops to a lower level. The leukocyte with FOLFIRI is maintainedat a low level in a long time and the erythrocyte is injured mildly by FOLFIRI.Although the platelet is injured by the two regimens, it’s maintained at normallevel.4. Alanine aminotransferase（ALT） increased slightly after NACT withFOLFOX, which recovers in a short time without treatment. There is no toxicside effect on the function of liver and kidney function with the two regimens.5. The peripheral neurotoxicity caused by FOLFOX can be reduced byprophylaxis. The incidence of diarrhea after FOLFIRI treatment is lower andusually the diarrhea is easier to be controlled than the foreign literatures.