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. 2021 Mar 10;62(2):300-308.
doi: 10.1093/jrr/rraa117.

Efficacy and tolerability of preoperative chemoradiotherapy with S-1 alone for locally advanced rectal cancer

Nobuki Imano  1 , Yuji Murakami  1 , Katsumaro Kubo  1 , Daisuke Kawahara  1 , Yuki Takeuchi  1 , Ikuno Nishibuchi  1 , Tomoki Kimura  1 , Masatoshi Kochi  2 , Yuji Takakura  2 , Wataru Shimizu  2 , Hiroyuki Egi  2 , Shinnosuke Uegami  3 , Hiroki Ohge  3 , Shinya Takahashi  3 , Hideki Ohdan  2 , Yasushi Nagata  1
Affiliations

Efficacy and tolerability of preoperative chemoradiotherapy with S-1 alone for locally advanced rectal cancer

Nobuki Imano et al. J Radiat Res. .

Abstract

Preoperative chemoradiotherapy with capecitabine or 5-fluorouracil is a standard treatment for locally advanced rectal cancer (LARC). S-1, a prodrug of 5-fluorouracil, is a candidate for this chemoradiotherapy regimen in Japan; however, treatment outcomes after S-1 treatment alone are not clear. This study aimed to assess the efficacy and tolerability of preoperative chemoradiotherapy with S-1 alone for LARC. We retrospectively evaluated 54 LARC patients who underwent preoperative chemoradiotherapy with S-1 alone in our institution between 2005 and 2017. The clinical tumor stage was cT2-3 in 31 patients and cT4 in 23 patients, and lymph node metastases were clinically evident in 31 patients. S-1, at a dose of 80 mg/m2/day, was orally administered during radiotherapy. A total dose of 45-50.4 Gy was delivered in 25-28 fractions (median: 50.4 Gy). Surgical resections were scheduled 6-10 weeks after chemoradiotherapy completion. The 3- and 5-year overall survival rates were 92.4 and 72.8%, respectively, with a median follow-up time of 51 months. The 3- and 5-year local control rates were 96.2 and 85.9%, respectively. A pathological complete response was observed in 7 patients (13.0%) at the time of surgery. Ten patients (18.5%) had grade 3 acute toxicities and 5 patients (9.3%) had grade 3 late toxicities. No grade 4 or 5 toxicities were observed. Preoperative chemoradiotherapy with S-1 alone followed by total mesorectal excision resulted in a low incidence of toxicities and comparable clinical results. Therefore, S-1 alone can be a treatment option for preoperative chemoradiotherapy in LARC patients.

Keywords: S-1 alone; locally advanced rectal cancer; preoperative chemoradiotherapy.

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Figures

Fig. 1.
Fig. 1.
(a) Typical irradiation field, (b) typical dose map.
Fig. 2.
Fig. 2.
Overall survival and progression-free survival for all patients. The median follow-up period was 51 months (range, 12–155 months) for all patients and 56 months (range, 28–155 months) for survivors. The 3- and 5-year OS rates were 92.4 and 72.8%, respectively. The 3- and 5-year PFS rates were 70.4 and 58.1%, respectively.
Fig. 3.
Fig. 3.
Local control rates for all patients. The 3- and 5-year LCRs were 96.2 and 85.9%, respectively.
See this image and copyright information in PMC

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