Neoadjuvant chemotherapy of FOLFIRI with or without radiotherapy in the treatment of marginally resectable recurrent rectal cancer exposed to oxaliplatin: A cohort study

Background FOLFIRI is the standard secondline chemotherapy for recurrent rectal cancer previously exposed to oxaliplatin. For resectable recurrent rectal cancer, the optimal sequence of chemotherapy and resection is still unknown. We carried out a cohort study to evaluate the efficacy and feasibility of neoadjuvant chemotherapy of FOLFIRI in this setting. Patients and Methods Patients aged from 18 to 80 yearold with histologically confirmed and resectable recurrent rectal adenocarcinoma previously exposed to oxaliplatin were recruited. Resectability was decided by three colorectal surgeons. Eligible patients received six preoperative and six more postoperative FOFIRI regimens (irinotecan 180mg/m2, folinic acid 400mg/m2 and fluorouracil 2800mg/m2, repeated every 14 days). Tumor response was assessed after 3 and 6 cycles. The primary end point was R0 resection rate and the second end points were grade 3 or 4 toxicity and tumor regression grade (Ryan). All the patients signed written informed consent. Result 65 eligible patients were enrolled in this trial. According to RECIST criteria, 22 ( 33.8%) cases had partial remission, 18 ( 27.7%) cases had stable disease, 24 ( 36.9%) cases had progression disease and 1 patient refused to evaluate and quit study. 21 ( 32.8%) patients achieved R0 resection with 5 cases of TRG 1, 11 cases of TRG 2 and 5 cases of TRG 3. 25 patients received concurrent radiotherapy. Grade 3 or 4 toxicity was seen in 4 (6%) patients. One patient had intestinal perforation and one had bowel obstruction during chemotherapy. No one died during treatment. Conclusion Neoadjuvant chemotherapy of FOLFIRI in resectable recurrent rectal cancer can be well tolerated. But more active regimen is still needed for this setting to accomplish better outcome.