Comparison between the toxicity profile of fluorouracil versus capecitabine concomitant with radiotherapy in patients with non-metastatic rectal cancer

Abstract

Introduction: The incidence of colorectal cancer varies considerably around the world. About 944,717 cases were identified worldwide in the year 2000. High incidences of colon and rectal cancer cases are identified in the developed countries. Concurrent preoperative radiotherapy with chemotherapy (5-Flurouracil based) followed by total mesorectal excision (TME) surgery and further systemic therapy is the recommended standard first-line treatment. Fluorouracil (5-FU) remains the most widely used agent for colorectal cancer. Capecitabine is a rationally designed 5-FU pro-drug developed to mimic the continuous infusion of 5-FU while avoiding complications and inconvenience of intravenous administration. Methods: This is a retrospective study aiming at evaluating the toxicity profile (Hematological and non-hematological) in rectal cancer patients who received fluorouracil with radiotherapy versus those who received capecitabine with radiotherapy as neoadjuvant treatment in period from 1-1-2012 till 1-1-2015 in Ain shams university Department of Clinical Oncology and Nasser institute in Cairo-Egypt. Data collected from files of patients included 196 patients (male 101 patients and female 95 patients), the patients were arranged into two groups: group I included 96 patients received 5-FU concomitant with radiotherapy and group II included 103 patients received capecitabine concomitant with radiotherapy. The evaluated side effects were: anemia, neutropenia, thrombocytopenia, hepatotoxicity, renal impairment, cardiotoxicity, neurotoxicity, diarrhea, emesis, mucositis, alterations in taste, xerostomia, gingival bleeding, hypersensitivity reactions, pigmentary changes, alopecia, nail disorders, acral erythema. The collected data was revised, coded, tabulated and introduced to PC using statistical package for social science (SPSS 20.0 for windows; SPSS Inc, Chicago, IL, 2001). Suitable analysis was done according to the type of data obtained for each parameter. Results: The evaluated toxicities showed that there was a statistical significant difference with increase in number of patients who suffered from hypersensitivity reactions (p<0.009) and alopecia (p<0.005) in the group who received 5-Fu compared to Capecitabine group, while acral erythema was higher in the Capecitabine group (p<0.001). The remaining toxicities were not statistical significantly higher in either groups. Conclusion: Capecitabine and 5-flurouracil have comparable toxicity profile but capecitabine offers the feasibility of being oral drug.