cT2-cT3 rectal cancer: is RT boost better than oxaliplatin?

  • Radiother Oncol

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • In patients with locally advanced rectal cancer undergoing capecitabine-based radiochemotherapy (cbRCT) with intensification, a radiotherapy (RT) boost had fewer adverse effects and a similar rate of pathological complete response compared with oxaliplatin.

Why this matters

  • Radiotherapy dose intensification strategies could be adopted as reference treatments for this population.

Study design

  • INTERACT trial of 534 patients presenting with low-located cT2N0-2M0, cT3N0–2M0 (up to 12 cm from anal verge), randomly assigned to receive:
    • Either Xelac, a radiotherapy boost to the bulky site: 45 Gy/1.8 Gy/die, 5 sessions/week to the pelvis, +10 Gy at 1 Gy twice/week to the bulky site+concurrent capecitabine (1650 mg/mq/die).
    • Or Xelox: 45 Gy to the pelvis+5.4 Gy/1.8 Gy/die, 5 sessions/week to the bulky site+concurrent capecitabine (1300 mg/mq/die) and oxaliplatin (130 mg/mq on days 1, 19, 38).
  • Funding: Catholic University of the Sacred Heart.

Key results

  • Toxicity was greater in the Xelox group, including grade ≥3 hematologic (P=.01) and neurologic toxicology (P<.001>
  • Cumulative major response (tumor regression grade 1-2) was more common in the Xelac group (61.7% vs 52.3%; P=.039).
  • Pathologic response rates and 5-year DFS rates were similar between the 2 groups.

Limitations

  • No nonintensified control.

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