Bolus Versus Continuous Infusion of Fluorouracil Plus Radiotherapy for Preoperative Treatment of Rectal Cancer

JS Gilroy, RA Zlotecki, WM Mendenhall, CG Morris, SR Schell, WR Rout,RJ Desnoyers, EM Copeland III, SN Hochwald

Hong Kong J Radiol 2003;6:132-6

Objective: To evaluate preoperative bolus versus continuous infusion chemoradiation.

Patients and Methods: Sixty eight patients received either bolus fluorouracil or continuous infusion fluorouracil combined with radiotherapy.

Results: The pathologic stages for bolus fluorouracil, continuous infusion fluorouracil, and overall were pT0, 18%, 31%, and 25% of patients, respectively; pT1-2, 39%, 28%, and 33%, respectively; and pT3-4, 43%, 41%, and 42%, respectively. Nodal downstaging for the 3 groups was N0, 96%, 85%, and 90%, respectively. Sphincter preservation was possible for 51% of patients. Sphincter preservation surgery was performed for 38% of patients receiving bolus fluorouracil compared with 62% of those receiving continuous infusion fluorouracil (p = 0.053). Five-year local control, absolute, and cause-specific survival rates were 88%, 73%, and 76%, respectively. The 5-year outcomes for continuous infusion fluorouracil versus bolus fluorouracil were: local control, 97% versus 76% (p = 0.1944); absolute survival, 80% versus 65% (p = 0.2867); and cause-specific survival, 83% versus 68% (p = 0.425). Nineteen percent of patients did not finish chemotherapy because of European Cooperative Oncology Group grade 3 or greater toxicity.

Conclusion: Both chemotherapy regimens produced high rates of pathologic downstaging and were well tolerated. There was a trend toward higher rates of downstaging, local control, survival, and sphincter preservation with continuous infusion fluorouracil compared with bolus fluorouracil, but at the expense of greater acute toxicity.