Preoperative chemoradiation in rectal cancer: Retrospective comparison between capecitabine and continuous infusion of 5-fluorouracil

Background We compared the efficacy and toxicity of oral capecitabine and continuous infusion of 5‐fluorouracil (5‐FU) in the preoperative chemoradiation treatment of patients with rectal cancer. Patients and Methods The files of 89 patients with rectal cancer, 43 treated preoperatively with oral capecitabine and 46 with intravenous 5‐FU, were reviewed, and the outcome of the groups was compared. Results There was no statistically significant difference in the complete pathological response rate between the capecitabine and the 5‐FU groups (30% vs. 17%, P = 0.15). The downstaging rate was higher in the capecitabine group (77% vs. 50%, P = 0.009). Toxicity was mild in both groups. The rate of Grade 3 gastrointestinal toxicity was similar in the two groups (diarrhea 2% vs. 4%, proctitis 5% vs. 7%), except for one patient in the 5‐FU group (2%) who developed a rectovaginal fistula. In the capecitabine group, one patient (2%) had Grade 3 hand‐foot syndrome, and another had an acute myocardial infarction. In the 5‐FU group, two patients (4%) had Grade 3 hematological toxicity, and three (6%) had complications from Port‐a‐Cath insertion. Conclusion Preoperative chemoradiation with oral capecitabine appears to be safe and well tolerated, and at least as good as continuous 5‐FU. J. Surg. Oncol. 2006;93:529–533. © 2006 Wiley‐Liss, Inc.