Clinical Study Of Concurrent Preoperative Hyperfractionated Radiotherapy With FOLFIRI In The Treatment Of Mid-low Rectal Carcinoma

Objective:We evaluated concurrent preoperative hyperfractionated radiotherapy (HRT) with FOLFIRI and concurrent preoperative conventional fractionated radiotherapy (CRT) with FOLFIRI in treatment of Mid-low Rectal Carcinoma, to evaluate the efficacy and feasibility of hyperfractionated radiotherapy with FOLFIRI in the treatment of mid-low rectal carcinoma.Methods:A total of68patients with mid-low rectal carcinoma were enrolled in Department of Radiation Treatment of Shanxi Province Tumor Hospital during2005to2010, of which34patients in group A received concurrent preoperative hyperfractionated radiotherapy (HRT) with FOLFIRI and other34cases in group B were treated with concurrent preoperative conventional fractionated radiotherapy (CRT) with FOLFIRI.68patients of mid-low rectal carcinoma were treated with6MV-X ray for whole-pelvic radiotherapy. In group A,30Gy was the total dose of radiotherapy, and3Gy twice daily (interval6h between fraction). The radiotherapy lasted5days. Two cycles chemotherapy were given concurrently on days1and8with FOLFIRI. Surgery was performed in1-2weeks with total mesorectal excision (TME). Patients of mid-low rectal carcinoma were given with40Gy with one time every day,2Gy fractions every time in group B, and chemotherapy is the same as group A. Then patients received operation after4weeks with total mesorectal excision (TME). The patients of retention anal sphincter used the double stapling.Results:1. All patients completed the preoperative chemoradiotherapy and surgery with TME.2. There was no significant difference in the acute toxic side effect (Bone marrow inhibition p=0.323, rectum reaction p=0.514), and it was mainly distributed in during levels of1II.3.Two groups of A and B were mainly distributed in UICC stage T2and T3disease before chemoradiation, and rates of T2in UICC stage were20.59%and29.41%,(p=0.404). While after chemoradiation, volume of tumor reduced and T0-T3were all in distribution, which number of A and B group respectively were5,8,16,5and6,9,15,4,and the difference of two groups has no statistical difference and T and N downstaging(p=0.535).4. All patients were suffered resection. The sphincter preservation rate of group A and group B were79.4%and85.5%, and there was no significant difference (p=0.525).Conclusion:1. It is feasible for concurrent preoperative hyperfractionated radiotherapy with FOLFIRI in the treatment of mid-low rectal carcinoma with bone marrow inhibition and rectum reaction.2. There is no significant difference in efficacy between concurrent preoperative hyperfractionated radiotherapy group and conventional fractionated radiotherapy group, while time of the treatment is obvious short, and it is effective option for mid-low rectal carcinoma.