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Phase II trial of first-line chemoradiotherapy with intensity-modulated radiation therapy followed by chemotherapy for synchronous unresectable distant metastases rectal adenocarcinoma

Ji Zhu13, Peng Lian23, Fangqi Liu23, Ye Xu23, Junyan Xu34, Zuqing Guan23, Liping Liang13, Minghe Wang23, Sanjun Cai23 and Zhen Zhang13*

Author Affiliations

1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China

2 Department of Colorectal Cancer, Fudan University Shanghai Cancer Center, Shanghai, 200032, China

3 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China

4 Department of nuclear medicine, Fudan University Shanghai Cancer Center, Shanghai, 200032, China

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Radiation Oncology 2013, 8:10  doi:10.1186/1748-717X-8-10

Published: 7 January 2013



Based on the hypothesis that first-line chemoradiation followed by chemotherapy was superior for primary tumor and non-inferior for distant lesions compared to chemotherapy alone in synchronous unresectable distant metastases rectal adenocarcinoma, this study was designed to assess the efficacy and safety of this strategy.

Materials and methods

Thirty two eligible patients received intensity modulated radiation therapy (45 Gy to the pelvis and a concomitant 10 Gy boost to the gross tumor), along with concurrent weekly capecitabine and oxaliplatin. Patients underwent radical surgery if all lesions were visually evaluated as resectable and received chemotherapy for a total of 6 months, whether pre- or post-operatively (definitive therapy group). The remaining patients received 6 months of consolidation chemotherapy followed by maintenance chemotherapy (non-definitive therapy group).


The toxicities were acceptable, with radiation-induced dermatitis around the anal verge being the most common (18.8%). Fourteen patients underwent surgical resection of the rectal tumor, with 5 (35.7%) experiencing a pathological complete response. Nine out of 14 received definitive treatment, defined as R0 resections of all visible tumors. At a median follow-up of 12 months (range, 4–23 months), 2 cases were evaluated as local failure, and the median overall survival (OS) and progression free survival (PFS) for all 32 patients were 17.5 and 12 months, respectively. OS differed significantly in the definitive and non-definitive therapy groups (p=0.045), and PFS tended to differ (p=0.274).


It was demonstrated that the strategy of first-line chemoradiation followed by chemotherapy was effective and tolerable, especially for local control. OS and PFS were superior in patients who did than did not undergo curative therapy.

Rectal cancer; Synchronous unresectable distant metastases; Chemoradiotherapy; Imtensity modulated radiation therapy